What am I really worth?

Mental Health Nursing,  May 2005  by Pollock, Laurence

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There is plenty of lip service paid to equality for mental health service users. But is their expertise really valued? In Doncaster Michael Ashman is on the staff of the local trust. It has made a big difference to him and to the health professionals he is working with. He talked to Laurence Pollock

Housing, education and employment: They are the building blocks of a secure, fulfilled life and personal self-respect.

But they are all potential casualties when someone experiences mental illness of any sort. While health professionals treat and support the mind, a service user's personal situation might be in f reef all. Interrupted studies, no job and inappropriate accommodation all undermine the difficult path back to full social inclusion.

Understanding has come slowly, hampered by the stigma of mental illness and employers' or landlords' misperceptions. It has often been health trusts and nursing schools that have experimented with employment possibilities for service users. Their expertise has been recognised as unique and an essential guide to both future health professionals and those j currently delivering services.

An employed role also offers a return to self esteem and modest income. But this model is not straightforward. Many of those who have helped out in the past have done so in a volunteer capacity, their efforts taken for granted and their status de-professionalised.

Now this is changing and some progressive health employers are appointing staff with mental health history backgrounds (essential to the person spec) to develop socially inclusive policies. At the same time accessing employment is not necessarily straightforward for those enmeshed in the state benefit system.

Michael Ashman, for instance, trained as an engineer but has a life time's experience of mental distress. He contributed ideas on service user involvement to both NIMHE and Doncaster and South Humber Healthcare NHS Trust (DASH). Today he is Service User Development Worker, a unique post with the trust aimed at guaranteeing a social inclusion strand in their mental health services. He also gives lectures to nursing students at Sheffield university, one of several service users boosting the Nursing School's strategic approach to social inclusion.

At Sheffield, he sometimes encounters students who have not heard of recovery.

'I have always firmly believed that recovery and social inclusion go hand-in-hand. I have to be able to access employment and decent housing - the things that other people can do without thinking twice. To me the advantage of having somewhere I can call my own cannot be overstated.'

In practical terms, recovery means, for instance, recognising that the Trust's crisis j resolution team is not well placed to address social exclusion issues. Michael added:

'Colleagues are very sensitive where we have people who are already in existing work j or education. We will do our best to maintain that situation.

'When we deal with someone with a long history of mental health problems we will transfer the social exclusion issues to another part of the service and make sure they stay on the agenda.'

Michael has been very involved in the trust developing an action plan with the local strategic partnership as required in last year's Social Exclusion report. It calls for a balanced perspective:

'I have to lay out some aspects of my life story and service user experience, pointing out the things that have excluded me. But I also have to point out the things that have included me - such as the creation of the post that I now hold.

'I think public sector bodies have an obligation to lead on this.'

He is optimistic about the future: Work already going on in many trusts (eg the Bradford Home Treatment team) and his own (leisure outings to ballet and cinema), the local strategic partnerships and the activities of NIMHE.

But there are complications around employment opportunities. Michael, five years ago when he first contemplated paid work found practically any part-time employment took him beyond the maximum allowed to claim housing benefit and council tax rebate. He was little better off but he says the value of a job and the status that came with it 'could not be overstressed.'

Even with a willingness to work for the sake of it, a service user Outsider' still faces obstacles however. Occupational health, for instance, is a sticky issue, according to Michael. He attended a network set up by NIMHE for people doing similar roles.

'Although they were NHS employees, and mental health problems were stipulated in their experiences, every single person had had difficulty with their occupational health department. I would like to see all NHS staff trained to handle those with mental health problems (who are on the payroll) the way staff are given manual handling training.'

Reintegrating those who have experienced mental distress - particularly severe episodes - is universally applauded. But there are perhaps too many employers, colleges and public bodies that hold back a little. They hope someone else will fund the posts and the support or train the folk in human resources to get with the system. Individual examples like Doncaster and national roll outs like NIHME and the strategic partnership action plans suggest, however, that the tide is flowing irreversibly towards building a warm house in mainstream society for those who experience mental health problems.

Copyright Community Psychiatric Nurses Association May 2005
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