This document summarizes a presentation on mental health reform that discusses several key points: 1. Self-directed support for those with mental illness allows individuals greater choice and control over budgets and improves outcomes, but has been slow to be adopted. 2. Relationship-based support for women through organizations like WomenCentre that treat the "whole woman" in a holistic way has also been shown to be effective. 3. Peer support from those with lived experience of mental illness, not just peer support workers, can have a major positive impact. 4. Social factors like income inequality, debt, stigma, and lack of social support are strongly correlated with mental illness prevalence and should be addressed in reforms.

1. Mental Health Reform
Self-Directed Support, WomenCentre & Peer Support
Dr Simon Duffy ￭ The Centre for Welfare Reform ￭ 7th October 2013 ￭ Perth, WA ￭
Western Australia Association for Mental Health (WAAMH)
1

2. The Centre for Welfare Reform
• Welfare state is good - it is just
designed wrong.
• We need to move from meritocratic
paternalism, and instead respect
human diversity & equality
• New thinking must promote justice,
citizenship, family & community.
• Innovate to build practical alternatives
2

3. 1. Self-directed support works really well in mental
health but has been slow to take off.
2. Working with women, as whole women, through
relationships also works.
3. Peer support (not just peer support workers) has
a tremendous impact.
4. Mental health is at least partly caused by social
justice.
5. The future of mental health is to fund life, not
services.
3

4. 4

5. 1. Self-directed
support
5

6. 6

7. 7

8. We spend people’s money for
them on things they wouldn’t
really buy for themselves
8

9. I used to work in the fashion design industry as a product developer
until I became ill. This was a hard time in my life. I was diagnosed
with paranoid schizophrenia...
...as I am now on the road to recovery my budget has reduced. I
have updated my plan myself and this has given me the opportunity
to talk about what I want for the future. The opportunity to be
creative is very important to me and is something that keeps me
well. I now receive a little support and a one off payment which I
use to help me to buy equipment to make jewellery. I hope that I
will eventually be able to teach other people how to make jewellery
to give something back. My goal is to start up my own jewellery
business and be financially self-supporting, and the recovery team
is helping me with this.
Without the support that I have I would still be wondering where my
life is going, but now I have hopes for the future. I would definitely
recommend considering a personal budget. You can really make it
work for you in a way that I didn’t know was possible. I feel lucky
that I have been able to get back some of the life I have lost.
From Health Efficiency by Alakeson & Duffy
9

10. 10

11. 11

12. 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%
12

13. 13

14. 14

15. Support needs to fit the person, not the reverse
15

16. 16

17. IT’S NOT ABOUT SPENDING MONEY - ITS ABOUT LIFE
17

18. 18

19. 2. WomenCentre
19

20. 20

21. Mental illness intersects with many other social problems
21

22. There are lots of services, but...
22

23. 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%
Of 44 women working with WomenCentre:
23

24. The multiple reinforcing erosion of personal resilience
Mental illness is linked to real poverty
24

25. 25

26. 26

27. Knitting together the bond of trust
27

28. 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
28

29. 1. Start with the whole woman - gendered and holistic
2. Offer a positive and comprehensive model of
support - every woman is a one-stop-shop
3. Build a bond of trust - create the means for woman
to do real work together
4. Be a new kind of community - women, working
together, to improve lives and communities.
29

30. 3. Self help
30

31. 31

32. Peer support is critical and will guide us to better solutions
32

33. “Don't forget to tell them that we had our first PFG
camping trip last Sunday - it was amazing... we are
planning Mad Fest which will be our mental health
festival for next July. Music group started and we have
our own band... we also now have a community garden.
And we have started a partnership with the church to
have the church hall to do other crazy things in - we are
doing pull up a pew - taking a church seat with us to
have a cuppa and a chat about how people are feeling.
Just incorporating into a proper company and our Jude
is now the Chair of Doncaster CCG's Mental Health
Alliance (A woman who didn't leave the house for five
years)”
33

34. 34

35. The future professional?
35

36. 36

37. 4. Social justice
37

38. 1. Income inequality
2. Debt
3. Stigma
4. Multiple social problems
5. Real poverty
If mental illness is an illness is
social justice the cure?
38

39. 39

40. Income inequality is correlated with mental illness
40

41. 45% of people in debt have mental health problems compared
to 14% of people who are not in debt
Developing unmanageable debt is associated with an 8.4% risk
of developing a mental health problem compared to 6.3% for
people without financial problems (i.e. a third higher)
Relative risks for people in debt: alcoholism (2x), drug
addiction (4x), suicidal ideation (2x)
Professor Martin Knapp, 2012 Tizard Lecture
Debt is correlated with mental illness
41

42. Chick Collins on the ‘Scottish Effect’
Social stigma is correlated with mental illness
42

43. 43

44. 44

45. 45

46. 1. Human Rights - Better fundamental legislation
2. Clear Entitlements - Its‘my budget’
3. Avoid Crisis - Family support, lower thresholds
4. Full Access - No‘special’funding for services
5. Choice & Control - Freedom, capacity
6. Fair Incomes - Enough for citizenship
7. Fair Taxes - No‘special taxes’, no charges
8. Sustainability - Rethink health/social care split
46

47. 5. Mental health
reform
47

48. 1. Where is the recognition of the social justice
factors that impact on mental health?
2. Can we be confident in the effectiveness of
medicine to treat mental illness?
3. Can we be confident in the helpfulness of the
mental health system?
4. Do we know how often do our crisis responses
make things worse?
Does our current response to mental illness
make sense?
48

49. 49

50. 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
50

51. Rather than reducing inequalities itself, the initiatives aimed at
tackling health or social problems are nearly always attempts
to break the links between socio-economic disadvantage and
the problems it produces. The unstated hope is that people -
particularly the poor - can carry on in the same circumstances,
but will somehow no longer succumb to mental illness,
teenage pregnancy, educational failure or drugs.
Wilkinson & Pickett, The Spirit Level
We ignore the social and economic dimension
51

52. Many treatments lack supporting clinical evidence
http://clinicalevidence.bmj.com
52

53. 53

54. We often create more crises by inappropriate responses
54

55. Annually, there are 10,000 people placed out of area for
mental health reasons and approximately 11,000 people
with learning disabilities are also placed out of area per
year. Nationally, the National Mental Health
Development Unit (NMHDU) estimated that out of area
placements for mental health cost £690 million per
annum, therefore the combined cost of out of are
placements is likely to be more than twice that amount,
that is over £1.5 billion (NMHDU, 2011). Of the total
number of residential and nursing care placements for
mental health each year, 22% are out of area.
Alakeson and Duffy, Health Efficiencies
We move people and money out of
communities
55

56. 1. Peer support
2. Personalised support
3. Relationship work
4. Entitlements and control
5. A focus on supporting citizenship
We can see some of the main elements of a
reformed mental health system
56

57. Fund Life,
not services.
...there is a role for
services - but in an
equal partnership
with people and
communities
57

58. 58

59. For more information:
Web: www.centreforwelfarereform.org
Twitter: @CforWR and @simonjduffy
Blog: www.simonduffy.info
Facebook: centreforwelfarereform
Campaign: www.campaignforafairsociety.org
© Simon Duffy. Rights Reserved. Full copyright details at www.centreforwelfarereform.org
59

60. We are wanting to identify and share peer
support innovations that are currently being
developed or are operating in WA. If you would
like to attend the Peer Support Symposium
please subscribe to our newsletter and contact
admin@comhwa.org.au
www.comhwa.org.au
Peer Support Symposium
60