Self Help vs. Service Delivery

The following is an out-take from our pamphlet ‘Better mental health in a bigger society? (published by Mental Health providers Forum in December 2011 and available for download for free here) This unused section looks at where people with mental health difficulties in the community fit into the mental health world.  It originally appeared online at

The NHS provides medical services well, and most people wish them to continue to do so. The idea of medical services provided by non-medical staff is not what this paper is about.

There is great potential for people with mental health difficulties working with existing NHS structures to develop new and innovative ways of supporting others with mental health difficulties. There has traditionally been confusion within the NHS and within the wider community of people with mental health difficulties and those that support them as to how to classify projects, groups and organisations who deliver mental health related services which are not, in themselves, medical. This has led to a prickly relationship between the NHS and other community based organisations.

This in part has arisen from the idea that mental health is simply a medical issue, rather than being a medical issue with significant social aspects. Coming from an approach schooled in medical thinking, organisations and groups that have come together in ways that arise from the experiences of people with mental health difficulties and those that know them can seem chaotic, fragile and to lack a strategic focus. This is the reality of groups that come together voluntarily and which reflect the on the ground responsiveness and knowledge of life with mental health difficulties that services can sometimes lack.

Organisations and groups closer to the ground have both numerous advantages and significant disadvantages when compared to services developed within the NHS. Such groups often exist to meet needs defined by themselves, their members or users. They are often extremely good at identifying gaps in provision or support and filling those gaps. This can be defined as the self-help aspect of the Big Society where people come together to find solutions to their own problems. It is important that groups like these are nurtured and supported, and that mental health services endorse and enable such groups. It is also important that these groups should not be considered substitutes for services, or treated as extensions of services.

A significant area of difficulty lies in the funding, resourcing and supporting of groups and organisations led by people with mental health difficulties. These groups may be in a position to be contracted to deliver services, but need additional support and expertise to do so effectively – seeing them solely as additional means of service delivery can neuter their potential to deliver real innovation and change. Often the process of securing service delivery contacts lies beyond the reach of groups that have come together to meet specific community needs. Reconfiguring these groups or organisations as service deliverers often removes their potential to remain flexible and to innovate.

The objective for all NHS services must be to create the optimum situation for these organisations to grow and develop, as it will be these groups that increasingly will be the conduit between the NHS and the community, and will enable the NHS to meet goals within mental health that otherwise would be difficult to achieve. Organisations, projects and individuals need to be supported from within the NHS to make a difference both within its services and without. This will involve both bringing such self generated projects, groups and organisations into the NHS as partners while also ‘opening up’ the NHS to be able to utilise and respond to these self determined groups as they arise.

The question all NHS staff need to be asking is ‘If someone did have a great idea, would they be able to get to me to tell me, would I be in a position to recognise it and could I help it to happen?’

The question that people with mental health difficulties need to be asking is ‘If the NHS was to support me to find ways of meeting my own needs, what would that support look like and what would I expect?’

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