Who pays for better mental health?
Tuesday, September 27th, 2011
We had an interesting round table discussion with two of the leading thinkers and do-ers in the worlds of social enterprise and mental health yesterday – Mark Brown and David Floyd.
Mark is editor of leading mental health magazine One in Four, whilst David runs Social Spider – the social enterprise, which, amongst other things, publishes One in Four. David also writes what in my opinion is the best UK blog on social enterprise, Beanbags and Bullsh!t. Well worth a read if you want an honest, front-line take on the world of social business.
We’d invited Mark and David to Leeds because we’ve been chatting to various people over the last few months about exploring new ways to support people with a mental health need. And, just as importantly, exploring ways that people can help themselves. Mark and David had written a thinkpiece about the potential for a Big Society approach to helping people to improve people’s mental health – so we were keen to hear more. The thinkpiece is excellent (but not available online yet) and yesterday’s discussion was fascinating.
I’m no expert in the field of mental health – I’m just someone who cares about this stuff and is interested in trying to work out how to do things better. But it strikes me that some of the things that can contribute to a person’s improved mental health and sense of wellbeing could include:
- Active involvement in the development and delivery of the support that they receive and the opportunity to influence things (you might call that co-production)
- Support from and contact with peers – people who are – or who have been – in a similar situation – with an emphasis on self-help and peer support
- Appropriate, non-institutionalised, personalised services
- A sense that they matter – they’re not just a statistic in a faceless world of health and social care
So, with that in mind, you can imagine how an approach – which you might call Big Society – could work. People setting things up themselves to support eachother. Local charities and social enterprises setting up services which are funded through contracts and charges to paying customers. All sounds great doesn’t it?
Except the discussion yesterday – whilst highlighting the potential of a Big Society approach – also emphasised the barriers that are in place if more of this stuff is to happen. Fundamentally, it comes down to money. Where is the money in the mental health field? Much of it stays within the NHS and the local authority. Some of it goes out through contracts – to deliver pre-determined outcomes, tightly monitored through Key Performance Indicators. And a bit of it – if you’re lucky – might go on innovative, local, risky, do-it-yourself initiatives.
And please don’t tell me that Personal Budgets could fund this kind of thing. They could – in theory – and should. But our experience – and increasing amounts of evidence such as this report into Personal Budget pilots in Scotland – suggest that few people with a mental health need are getting support which is different in a meaningful way through a Personal Budget.
Locally, we’re hearing that the local authority will approve a Personal Budget to cover someone’s transport costs to get to an activity (which could be a Big Society, DIY, self-help/peer support activity) – but they won’t pay for the activity itself. So how is the service supposed to develop? And, given that many people with a mental health need are on pretty minimal benefits, they will tend to struggle to pay for that activity.
Solutions? I doubt there are any quick fixes. But, as always, the starting point needs to be an honest assessment of where things are. Big Society approaches aren’t going to magically spring up out of thin air. If the State decides that more of this kind of thing should happen, then we need to invest in it. In Leeds we’ve made a start with the Ideas That Change Lives investment fund, which has teamed up with UnLtd to offer support to people with good ideas. It’s a good start, but we need plenty more.







