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Changing practice and service development – implementing the SEU report, implications and expectations for modernised day services. David Morris Programme Director, National Social Inclusion Programme National Institute for Mental Health in England.

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Changing practice and service development – implementing the SEU report, implications and expectations for modernised day services

David Morris

Programme Director,

National Social Inclusion Programme

National Institute for Mental Health in England

social exclusion unit mental health project remit and time scale
Social Exclusion Unit Mental Health Project - remit and time scale
  • How to enable more adults with mental health problems to enter and retain work?
  • How to enable social participation and access to services?
  • Feb 03 to Mar 04: consultation - users, organisations and Ministers
  • Publication: June 04; implementation: from Sept 04
social exclusion defined
Social exclusion defined
  • What can happen when people or areas suffer from a combination of linked problems – unemployment, poor skills, low incomes, poor housing, high crime, bad health and family breakdown.
  • Characterised by the inter relatedness of problems that are mutually reinforcing; combined they create a fast moving, complex and vicious cycle

(Social Exclusion Unit 2004)

inclusion the ministerial vision
Inclusion - the Ministerial vision

“Social Inclusion for people with mental health problems is a ‘moral imperative”

(Rosie Winterton Minister for Health, launching SEU report June 04)

“Our vision is a future where people with mental health problems have the same opportunities to work and participate in their communities as any other citizen”

(SEU Report p94)

less than 40 of employers would recruit people with mental health problems
Less than 40% of employers wouldrecruit people with mental health problems

Two thirds put off applying for jobs for fear of unfair


  • but many ...
  • highly skilled
  • relevant experience
  • able to work with minimal adjustment
less than a quarter of adults with mental health problems are in work
Less than a quarter of adults with mental health problems are in work

Main barriers

  • fear of losing benefits
  • employers’ attitudes
  • fluctuating nature of condition
  • low expectations of health professionals
people are excluded in many different ways
People are excluded in many different ways

serious illness


low levels of participation in

FE/leisure activities

harassment complaint

not taken seriously

not eligible to be

juror or school governor

1/4 tenants with serious

arrears/at risk of eviction

financial services

hard to access

people can become very isolated
People can become very isolated



Sport/ exercise


Family/ neighbourhood


Faith communities

Arts and Culture

Sue attends the day centre and the clinic.

She has 5 friends she sees at outpatients or the day centre

action plan six main themes
Action plan - six main themes

stigma and discrimination

  • sustained programme to challenge discrimination: 5-year plan launched by Rosie Winterton on 23 June
  • practical teaching resources for schools and monitoring of broadcast

media with Ofcom

  • promoting best practice in the public sector

role of health and social care services

  • implementing evidence-based practice on employment, working towards an employment adviser for everyone with severe mental health problems
  • improved access in primary care to advice on employment and community activities
  • changing day services so they help people to do things in their community
  • strengthened training on social inclusion
action plan six main themes 2
Action plan - six main themes (2)


  • improved training on mental health issues for Jobcentre Plus staff
  • £1.5m from the Phoenix Fund to support people interested in self employment / enterprise
  • clarifying benefit rules for people wanting to return to work
  • improved support for employers and job retention

supporting families and community participation

  • targeted family support for parents with mental health problems and their children
  • improved support to access education and training opportunities
  • removal of unnecessary barriers to community roles such as jury service
action plan six main themes 3
Action Plan - six main themes (3)

getting the basics right

- new guidance to housing authorities to prevent unnecessary evictions

- improved access to financial and legal advice and affordable transport

making it happen

  • implementation programme with ministerial oversight:

- cross-govt team

- independent advisory group to advise govt. on progress

- local implementation led by PCTs and Local Authorities

- effective use of voluntary and community sector

why is this report so important
Why is this report so important?
  • establishes action on inclusive practice as a moral imperative, underpinning citizen rights
  • calls for balancedaction on the multiple impact of exclusion – on employment and wider aspects of participation
  • supports action on inequalities by making inequity of accessand participation an equalities issue
  • demands attention as much to the mainstream; the ordinary as the specialist – centralises the role of primary care as setting for vocational advice
  • signals need for cultural shift both in and beyond the service system
  • Recognises that inclusion is effect and cause in stigma and discrimination
national social inclusion programme
National Social Inclusion Programme

Capacity – 3 key sources:

  • Central cross govt. multi-agency team
  • Regional SI resources – SI leads and local projects/people
  • Affiliates network – 40 User/NGO/Professional orgs


  • 8 major projects, each led by DC with central support
  • 5 cross cutting work streams, led by central team


  • Cross govt network – key officials
  • Independent Advisory Group – reports to Ministers
  • SEU – monitoring team

Programme Delivery - leadership integration, accountability for corporate programme goals


Project Support Leading cross-cutting action

Programme Delivery - locality of corporate programme goals

DEVELOPMENT CENTRES - Project Leadership

DC 1 DC2 DC3 DC4 DC5 DC 6 DC7 DC8


Project 1

Stigma & Discrimination (Delivery by S&D prog)

Project 2


Project 3

Income & Benefits

Project 4


Project 5


Project 6

Community Participation

Project 7

Social Networks

Project 8

Direct Payments

cross cutting action themes

Workforce Development Research Evidence Community Engagement Criminal Justice Tackling Inequalities

Affiliated Organisations - NGOs x 20 - 25

Project Teams:

  • Management & Delivery
  • Service User organisation rep
  • Development Centre SI Lead
  • National Implementation team rep
  • Affiliate organisation(s)
  • Support & Stakeholder
  • Good practice networks
  • Affiliate organisation(s)
early progress
Early progress


  • Commissioning guidance in preparation:

- day services modernisation

- employment

  • Direct payments guidance completed
  • DfES advice to Learning and Skills Council on MH issued
  • Project teams and plans x 8 in place;
  • National ‘New Ways of Working’ guidance to support S.I. agreed
inclusion barriers and challenges
Inclusion, barriers and challenges
  • growing the evidence base realistically to support measurement and monitoring of progress
  • making the link between MHP and MH Services stick - moving on from ‘silos’ to cross - boundary, work in the ‘ordinary world’
  • challenging cynicism; inclusion being seen as the ‘softener’ for MH Bill
  • capacity for organisational change at local level
  • sustaining cross - government action nationally
barriers and challenges 2
Barriers and challenges 2
  • embedding creative practice in organisations not just individuals
  • developing primary care and re - equipping social care – making it a commissioning priority
  • exploiting opportunities for community level action and engagement afforded by local regeneration and Local Strategic Partnerships
  • making inclusive practice and culture a mainstream aspect of service organisation; at heart of leadership and workforce development agendas for all professional and non - aligned groups
  • day services transformation - a major challenge
the day services agenda post seu
The day services agenda – post SEU


‘transform day services into community resources that promote social inclusion through improved access to mainstream opportunities’

key objectives for day services
Key objectives for day services

To provide for:

  • access to community opportunities
  • person – centred provision irrespective of severity
  • clear links to community services and partner agencies
  • befriending, advocacy and support to enable local service access
  • service user involvement in service design and delivery
  • achieving social inclusion and employment outcomes
dimensions of a modernised day service
Dimensions of a modernised day service
  • supports recovery
  • portal to mainstream activity
  • not principally a bricks and mortar enterprise
  • specific to needs and aspirations of individual, but:
  • builds the community capacity necessary to their achievement through:
  • alliances and partnerships beyond the MH system

community engagement for community bridge building

new day services opportunities
New day services – opportunities
  • new focus on policy – neglected area
  • resource potential, sometimes from mixed funding sources
  • staff skills base – extensive experience of severe need and rehabilitation objectives
  • familiarity with carer and some social networks
  • may have rich community links and effective inter-agency relationships
new day services risks
New day services - risks
  • loss of staff skills
  • insensitive pace of change
  • poor engagement with developing ‘replacement services’
  • inadequate attention to specific personal need and/or preference
  • neglecting importance of internal social networks
  • loss of public confidence in service