Being a true equal…Citizenship, contribution & mutual support in the modern welfare state

Dr Simon Duffy of the Centre for Welfare ReformVICSERV Mental Health Conference 2016, Melbourne

@simonjduffy @CforWR #TowardsRecovery

The welfare state’s a good thing, but

we’ve designed it wrong. We try to solve

social problems with money and power

and we end up solving the wrong

problems in the wrong way. Over time

we’ve created an empire of services that

protect their own interests and

undermine the possibility of better

solutions. This is causing mental illness,

and many other problems. We need to

rethink the system - and more

importantly we need to reclaim our own

citizenship.

“These findings [better long-term outcomes for schizophrenia in developing countries] still generate some professional contention and disbelief, as they challenge outdated assumptions that generally people do not recover from schizophrenia and that outcomes for western treatments and rehabilitation must be superior. However, these results have proven to be remarkably robust, on the basis of international replications and 15-25 year follow-up studies. Explanations for this phenomenon are still at the hypothesis level, but include: (1) greater inclusion or retained social integration in the community in developing countries, so that the person retains a role or status in the society (2) involvement in traditional healing rituals, reaffirming community inclusion and solidarity (3) availability of a valued work role that can be adapted to a lower level of functioning (4) availability of an extended kinship or communal network, so that family tension and burden are diffused, and there is often less negatively 'expressed emotion' in the family”Dr Alan Rosen from Destigmatising day-to-day practices: What Can Developed Countries learn from Developing Countries? World Psychiatry 2006, 5: 21-24

Recovery rates better without mental health services

How did we get here?

We’ve tried to solve complex social problems with services

We’ve created a rainforest and a desert

Mental health improves in a decent

society

Black men in Britain are 5 times more likely to be in prison and 17 times more likely to be diagnosed with a psychotic illness.

Prejudice and racismcause mental illness

“In total, across England as a whole, the WCA disability reassessment process during this period [2010-13] was associated with an additional 590 suicides (95% CI 220 to 950), 279,000 additional cases of self-reported mental health problems (95% CI 57,000 to 500 000) and the prescribing of an additional 725 000 antidepressant items (95% CI 406,000 to 1,045,000).”Barr B, et al. ‘First, do no harm’: are disability assessments associated with adverse trends in mental health? A longitudinal ecological study J Epidemiol Community Health 2015;0:1–7. doi:10.1136/jech-2015-206209

Government policy causes suicide

Income inequality causes mental illness

Mental health improves in strong

communities

• Postnatal depression reduced by 77%• Unemployment dropped by 71%• Reduced fear of crime• Childhood accident rate dropped by

50%

Community led programme of neighbourhood renewal

Peers with mental health problems leading community change

Mental health improves with good

family life

Lots of services, but not the right support

The women with the most complex needs don’t fit in services

Managing a serious health condition 64%Finding a safer place to live 27%Living with childhood abuse 51%Didn’t finish their education 76%Recent experience of domestic violence 85%Fractured family (for those with young families) 66%Children experienced abuse (for those with children) 55%Living with a severe level of mental illness 55%Living with some mental illness 91%History of drug or alcohol misuse 52%Victim of crime 41%Perpetrator of crimes 39%Worried by debt or lack of money 65%

Service label n Urgent problem n Real need n

Victim of domestic

violence

55 Debt 50 Better self-esteem 64

Mentally ill 39 Housing 48 To overcome past

trauma

54

Criminal 35 Benefits 46 To manage current

trauma

51

Poor mother 33 Health 37 To stop being bullied 50

Misuses alcohol 24 Rent 32 Guidance 50

Uses drugs 22 Criminal justice Advocate 24 Relationship skills 45

Violent 19 Dentistry 8 Mothering skills 26

Chronic health condition 16 Others 3 Others 1

A partnership between women - improving mental health

Mental health improves with greater

citizenship

http://www.centreforwelfarereform.org/library/by-az/recovery-stories.html

“I use direct payments to go to the gym, travelling and volunteering.” [Adam]“The payments enable me to exercise several times a week which has had a really positive effect on my wellbeing as well as keeping me fit.” [Ruth]“I now have a purpose on life and hopefully this will lead me to have an independent life in the future.” [Susan]“Straight away I started singing lessons…” [RG]“I used my direct payments to enable me to meet up and spend time with my brother.” [Bernadette]“…he used the money to pay for bus and taxi fares.” [Christine]

“.…to pay for swimming lessons.” [S.S.S.]“Our hope for the future is that my husband will continue to live at home. Direct Payments plus committed and smart professionals are the key enablers for this.” [Fred]“This allowed me to have a holiday with my daughter… I also go to the theatre, meals out… hobbies such as card making…” [Carol]

“Personal budgets have enabled us to work in partnership with our service users to identify and access services and resources that are meaningful to their Recovery.” [Mandy]

http://www.centreforwelfarereform.org/library/by-date/active-patient.html

Transportation 13% Crafts 2%

Computers and accessories 12% Licenses/ certification 2%

Dental services 11% Entertainment 2%

Medication management services 8% Vision services 2%

Psychotropic medications 8% Furniture 1%

Mental health counselling 8% Non-mental health medical 1%

Housing 7% Camera and supplies 1%

Massage, weight control, smoking cessation 5% Education, training, materials 1%

Utilities 3% Haircut, manicure etc. 1%

Travel 3% Pet ownership 1%

Equipment 3% Supplies and storage <1%

Clothing 2% Other <1%

Food 2% Total 100%

www.centreforwelfarereform.org/library/by-date/active-patient.html

The deinstitutionalisatio

n challenge

The crossroads ahead for community services…

Service into Community or Organisation of Community

Why are we consumers?

Origin of “Consumer” early 15c.“one who squanders or wastes” agent noun from consume. In economic sense, “one who uses up goods or articles” (opposite of producer) from 1745.The idea of consumer negates the idea that

we - people, families and even professionals have something to contribute.It forgets that we make our world together.

Control, not choice, is what we need

Why not citizens?

The home of citizenship

Citizenship is beautiful for it means:We can all be free to express who we really are.We all share responsibility for making the world as good as it can be.We can live together as equals, in all our diversity.

So let’s act as citizens