This blog post by Mark Brown originally appeared at OneinFourmag.org on June 30th 2011. The dilemma it discusses is one that has proven increasingly prominent for The New Mental Health: How do we support the new while valuing the more established in a time where there is not funds for both?
While much of the debate about health in England has been focused on the progress (or not) of the health bill through parliament reorganising the way that health services are run in England, those of us involved in mental health know that there is more to services than the NHS.
As this excellent piece by Mary O’Hara in The Guardian this week illustrates, the current economic and political climate is posing smaller organisations significant challenges.
These are often organisations that have come into existence because they have recognised a need that the NHS was not meeting. These can be anything from therapy services to art groups to advices services. As I’ve said in a previous post, there is no single frontline in mental health. Mental health is something that touches on all areas of life.
At present there’s a feeling of hatches being battened down, of feet being stamped down quite decisively on the funding hose that used to carry the flow of money that previously kept smaller organisations in business. As I’ve said, despite glimmers of hope, there’s not as much money in mental health as there should be.
I was at an event discussing mental health and big society last week where there was a marked scepticism for the idea that large state organisations would release some of their budgets to fund and support organisations from the community and voluntary sector. The view was that when it came down to it, large providers would generally choose to look after the jobs of people already working for them, rather than lose the jobs and enable others to deliver the service.
It’s a good an honourable thing to try to protect the interests of the people that work for your organisation and a good and honourable thing to try to keep the show on the road. With the public sector going through a period of being ‘slimmed down’ by the current government, it’s understandable that public sector decision makers will be looking to prop up their own houses.
But is this what’s best for people with mental health difficulties? And what about the community, voluntary and other organisations that fall outside of the public sector but which deliver well loved services?
It’s here that lies the dilemma of our title.
Walking in two directions at once
Working as we are at a time of much reduced available funding, many of us trying to make sure that people with mental health difficulties don’t lose out from this current situation find ourselves captured on the horns of a series of dilemmas. In a mental health and Big Society discussion we had today as part of the process of refining our thinkpiece (out next month*), a mental health policy specialist described this feeling as ‘trying to walk in two directions at once’ and it’s a good description of the dilemma many of us face.
Some of us believe that there are possibilities for the current situation, especially the set of ideas and possibilities arrayed around Big Society, to bring about positive change in the way mental health services are delivered. This can mean we find ourselves arguing that the public sector should share some of its funds. In essence we find ourselves saying ‘make cuts to the public sector and give the money to other places.’ This is something that many of us find difficult to say.
At the same time, it’s our impulse to campaign hard to minimise cuts to services, even when we may feel like those services are not meeting our needs. In essence, we feel as if we should campaign to protect services that we support in principle but which we actually don’t like in practice.
Many of us would also like to find new and better ways of meeting the needs of people with mental health difficulties and supporting people to find solutions that suit them to the challenges that they face Sometimes these methods might be less specialist, less stable or less expensive. A good example of this is setting up a regular social drop-in where people had a chance to meet and find common ground to replace a now-closed day service provision. We sometimes feel that by finding alternatives that work and speaking proudly about them we are somehow betraying the case for the funding of services that are more specialist or more expensive.
Similarly within the broader debate about the opening up of public services, many of us want to see the smaller local organisations that we use surviving, but not at the cost of other more traditional state services that we use. We do want more choice but not if that means reduced quality. Many of us want greater access to medical treatments and interventions, but not at the cost of the community, charity and voluntary organisations that we love and rely upon.
This moment of reorganisation and redefinition does present us with opportunities to take forward many of the things we’ve been wishing for in mental health (see this and this report from our conference in May for more) but at what cost?
With the quality of life for those of us with mental health difficulties at stake, the dilemma is not an abstract or theoretical construction.
Even if we look at this period as an opportunity to move thinking around mental health services and opportunities forwards, by using this moment pragmatically to further these aims, it’s still a period where we will have to decide to do one thing over another or to follow one path while declining to follow others.
How do we make those choices? And how do we make sure that it’s people with mental health difficulties that don’t lose out?
*Actually, the Big Society thinkpiece came out in December 2011 and was finally titled ‘Better mental health in a bigger society?’ You can read it here.