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SWUF A Mental Health Service User Group. Presented by; Michelle Evans, Theresa Jones, Holly Potter, Selina Rawicz, Josh Sklar, Bethan Smith and Rachael Turner.

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SWUF A Mental Health Service User Group

Presented by; Michelle Evans, Theresa Jones, Holly Potter, Selina Rawicz, Josh Sklar, Bethan Smith and Rachael Turner.


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Mental illness is very common. About one in four people has this diagnosis, but there is a great deal of controversy about what it is, what causes it, and how people can be helped to recover. People with a mental illness can experience problems in the way that they think, feel or behave. This can significantly affect their relationships, their work, and their quality of life. Having a mental illness is difficult, not only for the person concerned, but also for their family and friends. Mental illnesses are some of the least understood conditions in society. Because of this, many people face prejudice and discrimination in their everyday lives. However, unlike the images often found in books, on television and in films, most people can lead productive and fulfilling lives with appropriate treatment and support. For some people, drugs and other medical treatments are helpful, but for others they are not. Medical treatment may only be a part of what helps recovery, and not necessarily the main part. It is important to remember that having a mental illness is not someone's fault, it is not a sign of weakness, and is not something to be ashamed of. Seeing someone’s problem solely as an illness that requires medical treatment is far too narrow a view. It discourages people from thinking about the many different influences on someone's life, on their thoughts, feelings and behaviour, which can cause mental distress. It may also prevent people from exploring the various non-medical treatment options that are available. For these reasons, some people prefer to talk about mental or emotional distress, rather than mental illness – MIND Website


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Overview

  • Introductions

  • The Medical and Social Model

  • Labels/ Stigma

  • Back to the future?

  • ‘Paws’ for thought


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Introductions

  • Why the mental health user group?

    • Personal and professional interests

  • A short exercise

  • Why is SWUF different from the other service user groups?

    • Power and autonomy


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Introduction cont…

  • Introductions to SWUF

    • The importance of a ‘voice’


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  • Who attended?

    • Lots of diversity (?!)

  • Terms used

    • ‘Service User’

    • ‘Mental illness’

  • What was decided in regards to these terms and why?


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Mental Health/illness

  • Not Illness – prefers the terms disorder/ emotional distress/ emotional dysfunction/ mental disability

  • Schizophrenia/ Bi-Polar/ Neurotic/ Psychotic/ OCD

  • Survivors/ “just getting by” as opposed to “living”

  • Repression/ stigma/ social exclusion, i.e employment; jury service/ marginalized/ stressful scenarios/ enclosure


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Mental Health/Illness…Continued

  • Lack of concentration

  • Labelling

  • Media – negative/ violence/ fear/ psychopath/ mad/ wrong impression/ wrong perception

    • Action groups set up to counteract effects of media/ MIND

    • Education required in order to change attitudes


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Social Work

  • Busy bodies/ nosy parkers/ separating families/ needy people (service users)/ friction (-)

  • Reactive (-)/ radical activists (+/-)

  • Practical help/ supportive/ friendly/ regular contact/ compassionate/ caring/ empathetic/ befriender/ human/ mutual respect /role model/ genuine/ advocate (+)

  • Going beyond the call of duty/ parameters set (+)


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How People Treat You

  • Employment – discrimination against/ catch 22 – tell them about your illness = no job or not tell them and risk being found out, then sacked for lying

  • Need to prove yourself even before being given a chance

  • Form filling

  • Shabby/shoddy treatment – oppression


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How People Treat You…Continued

  • Labelling – can be due to type of medication

  • Medical model rather than holistic approach

  • Distorted in the media/ film – people feel like they know you and your problems as a result

  • Made a joke out of/ stigma – ignored by psychiatrists


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How You Would Like to Be Treated

  • With empathy/ respect/ equality/ compassion/ care/ professionalism/ as an individual

  • Being given opportunities, e.g MIND/ empowered/ heard by appropriate people/ accepted socially

  • Have suitable housing/ accessible transport

  • Live in a therapeutic environment


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Medical and Social perspectives in Mental Health

Looking at Service Users experience of medical and social intervention

By talking to Service Users in group and as individuals in one to one meetings

Highlighting group and individual perceptions of their care/treatment programmes

Relating their experience to medical and social models of caring for people with mental health problems


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Medical and Social perspectives in Mental Health (Service users perceptions of medical intervention)

  • Emphasis on medical treatment (medication, ECT)

  • Not happy with Side effect of medication

  • Power of diagnosis (labelling)

  • Understanding of the diagnosis

  • Coming to terms with diagnosis and coping with stigma


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Medical and Social perspectives in Mental Health (Service users perceptions of Social intervention)

  • Social Workers are busy bodies, nosey parkers and they separate families

  • Not much understanding of Social Workers role

  • Not as easy to get help from a Social Worker as it is from Health Professionals

  • Those with Social Workers have a better perception of what they do and are more positive about the help they receive


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Medical and Social perspectives in Mental Health (medical model)

  • Long history, Early days of incarceration and separation from society with little in the way of treatment, latter on ECT and surgery

  • More recently based with biological intervention of treating the symptoms with drugs (and sometimes ECT) with a view to stabilising their condition and moving them back into the community

  • Still involuntary admission and treatment orders under the Mental Health Act (1983)

  • Medical model still dominant


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Medical and Social perspectives in Mental Health (social model)

  • The focus is on understanding mental illness within the social context of individuals

  • Sees interpersonal relationships as explanations of behaviour rather than isolate the individual from family and environment

  • Looks for explanations for psychiatric breakdown

  • Working with the person and educating them and their families to help them live within society

  • Offers an alternative to the purely medical model


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Medical and Social perspectives in Mental Health (Social and medical intervention and support)

  • Health and Social Services work in partnership with each working from their own theoretical base

  • Medical staff from the nurse to the psychiatrist treat mental illness in the same way as physical illness

  • Diagnosis, psychotropic medication, TLC, monitoring recovery

  • Behavioural/cognitive therapy from psychologist and Occupational Therapy to improve deficits in personal, social and economic functioning


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Medical and Social perspectives in Mental Health (Social and medical intervention and support)

  • Social Workers meet with families as well as the person giving a social biography to help in diagnosis

  • Are a link between the hospital and friends/relatives helping them cope

  • Co-ordinate the provision of care including health, housing, income, occupation and social inclusion

  • Educate about diagnosis, prognosis and treatment including coping with side effects of drugs

  • Planning care around changing needs


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Medical and Social perspectives in Mental Health (Social and medical intervention and support)

  • Improved treatment of people suffering from mental illness over the years

  • New partnerships provide continuity of care

  • Gradual education of others in society to alleviate labelling and stigma

  • Society still will not tolerate the behaviour which is sometimes displayed by people suffering from mental illness


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Exercise medical intervention and support)

  • M is a 36 year old woman who has had experienced a long period of domestic violence spanning some 20 years. After fleeing her family home she took refuge in a women’s shelter in another city. Staff at the shelter became increasingly worried about her erratic behaviour and the unruliness of her two children. Social Services were informed and the children were placed into voluntary foster care. M was diagnosed as bi-polar (manic depression). Six months on and M is feeling better, but continues to live in the shelter, and her children are still in foster care.

  • How can we help M to get her life back on track?

    • Consider what obstacles M may encounter in this process.


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Mental Health medical intervention and support)

Media and Stigmatisation


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Negative medical intervention and support)

Giving the wrong impression

Promoting Fear

Psychopaths

Perception of Violence

Mad

What SWUF said…

…about the media:

To what extent is the media responsible for negative perceptions and the stigmatisation of mental illness?


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What the literature says… medical intervention and support)

Those with Mental Illness in the media are:

  • Considered a danger to themselves

  • Considered ‘childlike’ & unable to care for themselves

  • Portrayed as ‘different’ and terms used include ‘psychotic’ and ‘unstable’

  • Depicted as:

    • Dangerous and unpredictable

    • Unsociable

    • Unemployed

    • Transient

  • Sensational, vivid & stereotypical language is used


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What the research says… medical intervention and support)

  • Signorielli (1989): 72% of characters on USA TV with MI were depicted as violent compared to 42% of ‘normal’ characters

  • Rose (1998): two thirds of people with MI were portrayed as violent in British TV news stories

  • Wahl (2000): with reference to 107 magazines depicting Obsessive Compulsive Disorder over 15 years, only one third portrayed the condition accurately

= Negative and unbalanced media coverage


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The consequences… medical intervention and support)

STIGMATISATION!!!

  • Wahl (1999): “Stigmatisation is detrimental to the well-being of persons with mental illness” – discrimination

  • 1300 people questioned reported stigmatisation left them discouraged, hurt, angry and lowered their self-esteem

  • Others treated them as ‘less competent’

  • MIND questioned 515 people suffering from MI:

    • 73% said coverage unfair, unbalanced or very negative

    • 50% said coverage had negative effect on their mental health

    • 25% said neighbours behaved in hostile manner due to media

“Poor, unbalanced press coverage of mental health issues fuels stigma and reduces quality of life for sufferers” (MIND)


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Wot the Sun said… medical intervention and support)

What MH groups said…

  • Belongs to an era when Mental patients were locked up like animals

  • Ignorant reporting

  • Insult to Bruno & thousands of people who endure MI

  • “Reporting reflected prejudice against mental illness throughout society” – Dr Liam Fox

MIND & SANE called for a more mature, sensitive & understanding approach to mental illness


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Power medical intervention and support)WITH responsibility…

  • Service User group identified a need for more positive, informative and educational media coverage

  • Important because, lacking direct experience, media is opinion-former

  • Media DOES have power to inform, educate and raise awareness:

    • Cathy Come Home

    • Amnesty International

  • More SUs working with media than ever before

  • Debate and discussion is helpful


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A positive way forward… medical intervention and support)

The ‘Changing Minds’ campaign was launched to inform the media and public, and tackle stigma (changingminds.co.uk)

A London Underground poster


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FILM GOES HERE medical intervention and support)


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“While the media isn’t wholly to medical intervention and support)blame for negative perceptions, every time a programme, article or film portrays a stereotype or fails to clear up a misunderstanding about a mental disorder, it helps to perpetuate the myths”

– Changing Minds Campaign



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I hope we all agree that …. medical intervention and support)

  • “It is extremely unjust, a waste of human potential, a great cost to society, and unlawful to exclude anyone from employment simply because that person had experienced or experiences mental health problems.”

  • http://www.dh.gov.uk/assetRoot/04/06/03/81/04060381.pdf


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However…… medical intervention and support)

  • discrimination in the workplace is one of the greatest barriers to social inclusion.

  • Unemployment affects those with long- term mental health problems more than any other groups of people with disabilities (ONS 1998).

  • Only 13% are in employment compared to over a third of people with disabilities generally. (Labour Force Survey 1997/98)


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Experience of Service Users as expressed throughout consultation:

  • At least four of the service users felt that their mental health problems affected access to employment.

  • At least two clients felt that they had been actively discriminated against in their workplace.

  • There were occasions when clients were turned down for internal jobs they applied for. It was later discovered that the rejection was due to concerns of previous hospitalisation of the applicant.


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  • One client stated that when they were first ill, they wanted to work but…

  • The psychiatrist told them to take a couple of years off and to treat it like a holiday. The client has done so ever since.

  • The client had got used to psychiatrists making lots of decisions for them and expects psychiatrists to make decisions for them about going back to work.

  • The client would like the government to ‘push’ them back to work so that they at least know if they will be able to deal with it.


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  • At least one client felt that if they were to start working again, they could take or need less medication.

  • However, it was also stated that the medication drains away the incentive to work and they would be more motivated if they were on less medication.

  • One client cited an occasion when their Community Psychiatric Nurse came to their workplace to give them an injection and their employer found out that they suffer from mental health problems and consequently moved then to an easier job.


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  • One participant had raised the issue of the Disability Working Allowance to a prospective employer. He was not successful in getting the job and thought this might be because he was discriminated against.

  • One service user stated that most survivors who are in paid employment work in the mental health field.


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Access to Education: Working Allowance to a prospective employer. He was not successful in getting the job and thought this might be because he was discriminated against.

At least one service user felt they had been discriminated against at a local college when the tutor on a computer course thought they were just lazy and that their mental health illness was an excuse and this has put them off education

Whereas at least one other participant attended a very supportive college and was the source of much of their social life.


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The strategies used to cope with discrimination in access to employment:

  • Not declaring that they had been previously hospitalised due to mental health problems or that they had a mental health problem at all.

  • At least one client described a ‘Catch 22’ equation regarding employment,

    ‘Tell them (potential employer) about your illness means no job or not tell then and risk being found out, than sacked for lying’


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  • One service user did not tell their employer of their medical health problem and tried to keep this concealed. This led to increased paranoia and stress which induced schizophrenic symptoms .

  • Ultimately they had to stop going to work. The service user stated that they would avoid this in the future and would like to find a job with an employer who is sensitive to those suffering from mental health problems.

  • The service user would like to get a job as a support worker with people with mental health problems but is waiting for a time when they feel more prepared and able.


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Disability Discrimination Act 1995 medical health problem and tried to keep this concealed. This led to increased paranoia and stress which induced schizophrenic symptoms .

  • The employment provisions of the Disability Discrimination Act came into force Dec 1996

  • Under the Act , it is unlawful for most employers to treat a disabled person less favourably then someone else because of his or her disability without justification, or fail to comply with a duty upon them to make reasonable adjustments without showing that the failure is justified.


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  • One of the definitions of disability the Act works with is that a disabled person is someone who at the relevant time has a physical or mental impairment.

  • The Act does not include any impairment resulting from or consisting of a mental illness unless it is a clinically well- recognised illness.

  • Examples of conditions include: depression, schizophrenia, dyslexia, bi- polar (manic depression) and learning disabilities.


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Moving forward that a disabled person is someone who at the relevant time has a physical or mental impairment.

  • It is suggested that what is needed is for all employers, not just the public sector, to commit to anti- discriminatory principles.

    http://www.dh.gov.uk/assetRoot/04/06/03/81/04060381.pdf

  • It must include the commitment that this type of discrimination is taken seriously and will be eradicated.

  • Mental health should not be the cause of derision or ridicule and people with mental health problems have the same right to be treated fairly and with respect as everyone else.


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Employer Case Study discriminatory attitudes within the workplace and issues of confidentiality.

  • The NHS are described as taking a lead role in anti- discriminatory access to employment for people with mental health problems incorporated in, ‘Mental Health Issues in Employment’.

  • This guidance aims to address the management of mental health issues in employment, raising awareness among staff and reasons for employing people with mental health problems.


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Reasons for Employing People with Mental Health Problems: discriminatory attitudes within the workplace and issues of confidentiality.

  • reasons cited for employing people with mental health problems was based on the skills and experience gained throughout the course of their ‘illness’ and how these skills could be used to improve the quality of the mental health services offered.

  • These are valid claims and it is often the case that those suffering or who have suffered with mental health problems go onto roles where they can support others with mental health problems.


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However… discriminatory attitudes within the workplace and issues of confidentiality.

  • it can argued, that this is not anti- discriminatory or inclusive. Is it enough to say these people are useful in the mental health arena only?

    Reasons to employ people should not be based on their experiences as a sufferer of mental health problems alone but on individual ability and rights to employment.


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The Role of Social Work in Mental Health discriminatory attitudes within the workplace and issues of confidentiality.

  • Mental Health Act 1983 introduced the Approved Social Worker (ASW) role

  • By the end of the 1980s, Community Mental Health Teams were set up; these brought social workers and mental health professionals under one roof.

  • Proposal to replace the ASW post with an Approved Mental Health Professional (AMHP), this post will straddle both health and social care


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The Way Forward discriminatory attitudes within the workplace and issues of confidentiality.

  • The Department of Health policy guidelines 1999 - those people who use mental health services should be involved in the planning and delivery of care that they receive.

  • Service user involvement can take a number of forms,

    • as a recipient of communication; subject of consultation and agent in control, with levels of interaction between fellow service users, between user and professionals, management of local services and planning of overall services. (Peck et al (2002))

    • Hickey (1998) identified a participation continuum which included: information/explanation, consultation, partnership and user-control.


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The Way Forward continued .. discriminatory attitudes within the workplace and issues of confidentiality.

  • Service user involvement is imperative as

    • Bracken & Thomas (2001); Double (2002), and Smail (1993) all recognised that our current understanding of psychological distress is partial and limited.

  • With the introduction of the Mental Capacity Act 2005, it is felt that the needs of the service user will be better met.

  • Harper (2002) advocated moving away from the ‘tyranny of expert knowledge’.

  • Beresford (2000) felt that the inclusion of service user groups in training was imperative for the future of social work.


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Back to the Future discriminatory attitudes within the workplace and issues of confidentiality.

Mental Health - implications for the 21st century


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The Mental Health Bill discriminatory attitudes within the workplace and issues of confidentiality.

  • Defines “when” and “how” individuals diagnosed with a mental health illness can and should be treated without their consent.

  • Treatment without “consent” should only be administered if absolutely necessary.

  • Treatment should be explained to the patient.


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Mental Health Bill cont… discriminatory attitudes within the workplace and issues of confidentiality.

  • Mental Health Advocacy Service to be set up under the terms of the Bill.

  • Allows for Service Users to choose a “nominated person” to vouch for them.

  • This does not need to be a health professional.

  • Social Worker role is limited and sparsely referred to.


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What the critics say… discriminatory attitudes within the workplace and issues of confidentiality.

  • Emphasis within the Bill is on the “avoidance of risk” rather than “providing benefit through appropriate treatment interventions”. (S. London & Maudsley NHS Trust)

  • “Mental Disorder” and “Medical Treatment” definitions too broad. (S. London & Maudsley NHS Trust)

  • Mental Health User groups agree.

  • “a public order Bill dressed up as mental health legislation”.


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What the critics say cont… discriminatory attitudes within the workplace and issues of confidentiality.

  • Mental Disorder and Dangerousness – reinforcing the stigma.

  • “It risks substantially increasing the stigmatisation of a vulnerable group, contrary to the entire thrust of current mental health and social care policy” (South London & Maudsley NHS Trust)


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Social Workers and the Mental Health Bill discriminatory attitudes within the workplace and issues of confidentiality.

  • No power to singularly veto the use of compulsion.

  • Constrains the independence of the Approved Social Worker role.

  • Approved Mental Health professionals might replace Approved Social Workers.


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Employment and Mental Health discriminatory attitudes within the workplace and issues of confidentiality.

  • Less than 4 out of 10 employers would knowingly employ an individual with a mental health condition. (The Social Exclusion Report 2004)

  • People who experienced mental distress have the highest rate of unemployment amongst people with disabilities.

  • Only 19% are employed.


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Progress…? discriminatory attitudes within the workplace and issues of confidentiality.

  • Very little increase in the past 10 years in adults with neurotic or psychotic disorders in the labour force. (Mental Health and Soc. Exclusion Report)

  • Over half of respondents in a survey commissioned by the Office for National Statistics believed they had definitely or possibly been turned down for a job due to their mental health problems.

  • Most did not feel confident disclosing their experience of mental health problems on job application forms.


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Some good news discriminatory attitudes within the workplace and issues of confidentiality.

  • Mental Health and Social Exclusion Project outlines Govt. commitment to:-

  • “Reduce social exclusion among adults with mental health problems.”

  • Prevent these individuals from “falling out of the labour market”.

  • To ensure they enjoy and have access to the same “opportunities for social participation and access to services as the general population”.

  • Working with Service user groups.


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Thank you for listening!! discriminatory attitudes within the workplace and issues of confidentiality.


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