Delivering change in mental health care for women

1. Delivering change in mental health care for women Karen NewbiggingJoint lead for the national programme for gender equality and women's mental healthCSIP/NIMHE

2. Structure of presentation • Progress in translating policy into action • Introducing gender equality and the public sector duty • Implications for policy, service and practice development

3. Progress in translating policy into action

4. Gender differences……….

5. Mainstreaming gender “Mainstreaming gender and the needs of women service users are as much to do with making adjustment to existing structures and processes that are consistent and sustainable” Implementation guidance, 2003, p9.

6. Progress in implementing ‘Into the Mainstream’Building In or Building On? • Increase in women-only secure provision • Improvements in provision of inpatient care • Positive developments in the voluntary sector but funding a concern • Leads for women's services identified • Examples of strategy development • Training in gender awareness

7. Progress with developing range of women-only secure provision • Women only medium secure services • 21 providers, 26 sites (436 beds) • At least 1 in each region • Evaluation • 4 Women Enhanced Medium Secure Services • London, East Midlands, North West, Yorkshire and North West • High support pilots • Community-based • East Sussex, Yorkshire, North West and East Midlands • Increasing number of women-only accommodation within low secure units and development of women-only PICUs

8. Rank order Development Examples 1 Single sex provision In-patient wards, PICUs, High dependency area, MSU, women only crisis house, dedicated services for women with a diagnosis of BPD 2 Single gender provision within a mixed sex environment Women only group work or sessions, women only services within day services, provision for younger women with dementia 3 Perinatal mental health service development Specialist perinatal mental health services, Strengthening partnership working, Capacity building, Pathway development, other 4 Training and development Women's mental health, child protection & vulnerable adults, women and equality, self harm, eating disorders and childhood sexual abuse 5 Violence and abuse DH sexual assault pilot programme, training and protocol development in relation to domestic violence 6 Strengthening the involvement of service users In strategy and service improvement groups 7 Other Choice of care coordinators Monitoring standards for in-patient care Initiatives taken to implement ‘Into the Mainstream’

9. Different starting points • Little, if any, development (“Why not men?”) • 1 or 2 isolated champions • Initiatives in the voluntary sector • Defensiveness about needing to consider gender and specifically women • Few women in senior positions • Little engagement with women who use services

10. 2. Piecemeal development, mainly separate services (“We are doing women!”) • Some excellent initiatives - women only services – secure provision • Adding on services • Co-existing with mainstream mental health services which may not be sensitive to women’s needs • Initiated by champions – Trust leads, clinicians, voluntary sector and women who use services • Board level support

11. 3. Mainstreaming gender • (We have still a way to go but we understand what we need to do”) • Assessed and understand what needs to be done in partnership with stakeholders across organisational boundaries • Senior leadership and accountability • Diversity in senior team • Workforce development – training, supervision and capacity building • Developing a whole system approach – identified priorities • Redesigning existing provision • Initiatives to support and evaluate implementation

12. National Gender Equality and Women’s Mental Health Programme • Raising profile • Increasing accountability • Moving to an integrated approach to equalities • Adopting the Public Sector Gender Duty methodology • Focus on workforce development

13. National Gender Equality and Women’s Mental Health Programme Priority Areas 2006/08

14. Barriers to successful implementation • Incomplete understanding of desired changes • Not persuaded/committed to another way of doing things/actively resistant • Outcomes vague • Absence of effective project management • Insufficient resources or available resources otherwise committed • Other priorities or practical problems competing for attention • Lack of coordinated planning between organisations

15. Introducing gender equality and the public sector duty

16. What is gender equality? It is the concept that human beings are free to develop their personal ability without the limitation set by strict gender roles; that different behaviours, aspirations and needs are considered and valued equally. (DTI, GIAs)

17. Mainstreaming “… is mobilising policies and measures specifically for the purpose of achieving equality and openly taking into account, at the planning stage, the possible effects on the respective situations of men and women” EOC 2003

18. Principles of mainstreaming • Seeing people as individuals and as a whole person • Men and women have equal status and are differentially affected by the same issues and by different issues • Participation in decision-making and policy-making processes • Fairness, justice and equality • Enabling diversity to change policies and services

19. The Public Sector Gender Duty • A legal framework for mainstreaming gender equality • Came into effect April 6 2007 • All public sector bodies have to demonstrate equity of outcome for women and men in all aspects of policy, service delivery and workforce issues • Prohibits discrimination on the basis of gender in undertaking their functions. • Places a clear responsibility on organisations to take action to promote gender equality rather than relying on individuals to take action

20. Specific duties1 Prepare and publish a Gender Equality Scheme showing how organisation intends to fulfil the general and specific duties and setting out its gender equality objectives In preparing a scheme: • Consult employees, service users and others (including trade unions) • Take into account any information it has gathered or considers relevant as to how its policies and practices affect gender equality in the workplace and in the delivery of its services • In formulating its overall gender equality objectives, consider the need to have objectives to address the causes of any gender pay gap

21. Specific duties2 • Ensure scheme sets out actions authority has taken or intends to take to: • gather information on the effect of policies and practices on men and women • use information to review implementation of scheme objectives • assess impact of current and future policies and practices on gender equality • consult relevant employees, service users and others (including trade unions) • ensure implementation of the scheme objectives

22. Specific duties3 • Implementscheme and actions for gathering and using information - within three years of publication of the scheme (unless unreasonable or impracticable) • Review and revise scheme at least every three years • Annually reporton progress

23. Enforcement of equality legislation • Commission for Equality and Human Rights - independent public body with overall watchdog brief - to be set up 2007 • Incorporating Disability Rights Commission, Equal Opportunities Commission and Commission for Racial Equality • Also to cover religion or belief, age, sexual orientation and human rights

24. Facilitating implementation • Organisational ownership and leadership • Top level sign up & champions • Trust/PCT leads • Multiagency programme board • Participation and co-production • Involvement of women with experience • Capacity building • Gender and race specific information • Disaggregating data • Community engagement

25. Implications for policy, service and practice development

26. Implications for policy development: Key questions • What is the policy/service trying to achieve and who will it benefit? • What are the gender (and other) differences on this issue? • How might the context of women’s lives and men’s lives make their experience of this issue different? • Where does the evidence to support the gender (and other) differences come from? • How do current policies, legislation, prevailing attitudes impact on this?

27. ………….service development • Needs assessment and service and resource mapping • Joint strategic needs assessment • Disaggregation of data • Appropriate investment and support in involving a broad range of service users • Identify priority areas • Develop a whole system vision • Connect agendas across organisations • Reshaping provision and investing differently • Encourage and support evaluation of changes

28. National Gender Equality and Women’s Mental Health Programme Priority Areas 2006/08

29. …………..and practice development • Identify and articulate the need for change • The legislative, ethical and clinical cases for gender equality and service improvements • Profile views of women service users • Leadership – clinical and managerial • Workforce development • Training: gender inequalities, diverse needs, violence and abuse, sexual safety, maternal mental health etc. • Supervision • Team learning and innovation

30. karen.newbigging@btinternet.com Tel: 01623-812941 Mob: 07785-555678 jeniferpaul@btinternet.com Mob: 07780- 605372