Mental health and the social model (plus a bit of nonsense from the Guardian’s sub-editors) (updated)

For the past 10 years or so, my work has been in the area of disability rights, especially from a user perspective.

One of the great privileges of that work is observing the reactions of people – disabled and non-disabled people alike – when they are introduced to the Social Model of Disability, and how it affects their attitudes and everyday life in the subsequent weeks, months and years.

To recap: there are various models of disability. The two most common are the “medical” model and the “social” model.

The medical model focuses on the medical condition of a person – their impairment; their condition; their disease. And it looks for ways for these to be diagnosed, categorised and ultimately cured. What flows from the medical model of disability is typically a focus on someone’s physical or mental condition rather than the person themselves.

The social model of disability puts the person at the centre. It says that a person is disabled by society around them – not just physical barriers such as steps or revolving doors, but also by attitudes towards disabled people (such as pity, charity or fear). Though a disabled person still has an impairment (i.e. in the broadest sense their condition), what makes them disabled is not their condition, it’s society.

Many important things flow from this shift in thinking, and it’s how people approach this shift in thinking that’s such a great privilege to observe.

(For anyone who is interested in more about different models of disability and their implications this guide is an excellent introduction, and I’ve written at further length about this here.)

Why am I blogging on this now? It’s because there’s a fascinating debate at the moment about how the social model of disability (or other models) apply, or not, or some version of it, specifically to the area of mental health.

The latest manifestation of this debate is prompted by the division of clinical psychology (DCP), part of the British Psychological Society, who will be publishing a statement that calls for a “paradigm shift” in how mental health is understood.

(Update: here’s the statement (pdf)).

It’s great that this professional body is engaging in the debate in this way. It draws on a significant literature that mental health users/survivors and others have been writing for a considerable time – see, for example, this paper from the Joseph Rowntree Foundation from 2010 or pretty much anything on the social model from the Centre for Disability Studies at Leeds. This is also a significant theme that runs through the literature on recovery and mental health (such as these papers from the Implementing Recovery through Organisational Change project).

It will be interesting to see how the debate progresses, and good on DCP for going with it.

In their usual subtle contribution to the issue at hand, the Guardian’s sub-editors have called this a “battle” between the British Psychological Society and the Royal College of Psychiatrists. To ensure maximum helpfulness, the Guardian also poses the question “Do we need to change the way we are thinking about mental illness?” and asks people from both “sides” to argue either “yes” (clinical psychologist) or “no” (clinical psychiatrist).

In understanding this to be a debate that perhaps can’t be characterised in such black and white terms, below are 3 principles I modestly suggest it will be useful to keep in mind:

1. It’s not an either/or between a social and medical way of thinking about mental health – these things are complicated, endlessly fascinating and subject to however people choose to perceive them from whatever their perspective might happen to be at any particular time
2. Let’s ensure that all people have a chance to contribute to and define this debate: it’s particularly important – paramount, actually – that people with mental health conditions themselves are central to the debate, with professionals, family, carers and others all contributing
3. We mustn’t forget that these debates – genuinely fascinating and important as they are – don’t always have an immediate impact on the lives of people with mental health conditions and their day-to-day experiences of public services. Alongside the theoretical debates, there is a lot we can all practically do to improve people’s experience of mental health services and their lives as part of their local communities.

Saving money as the priority (and one reflection on GOV.UK)

The same answer has cropped up in response to 3 different questions within the last week.

The questions were, respectively:

1. What do you believe the purpose to be of your role as a commissioner?
2. What is the purpose of GOV.UK?
3. What is the purpose of integrating health and social care, for example of the scale mooted during the launch of Labour’s commission into health and social care?

The answer in each of these 3 cases was, basically, to save money.

A generous reading of each of these cases is that saving money is perhaps the most notable thing people will be interested in, and so is the component of the work the respondent to each question chose to highlight first.

Taken at face value, though, the common answer to the 3 questions is one I wouldn’t give. At least, I wouldn’t give it as the primary reason for doing things. In fact, it would get the Family Fortunes “our survey says…”

treatment.

Saving money in public service reform is important, and I’m not advocating for profligate spending of public money. But I think we run 4 very great and related risks if we put this motivation ahead of good quality service provision:

• Undermining the fabric of the state by arguing we should spend the least amount of money possible on providing services
• Aiming to deliver public services for as cheaply as possible, irrespective of quality
• Missing or obscuring the fact that better quality services can often achieve better value / cost effectiveness as a by-product of being better quality services
• Forgetting what outcomes we want public services to support by determining what we’re willing to spend on them a priori.

Perhaps I’m being sensitive here, and we’re talking about shades of emphasis between better quality services, saving money and other measures of public service reform. But it’s something that’s been gnawing at me for the last week, so here it is in blogpost form.

(As an almost unrelated aside, and talking of things that have been gnawing away, I’ve hesitated including the GOV.UK example in this post.

I made a series of posts in the relatively private space of Facebook which said I’ve felt uncomfortable making public comments about GOV.UK. This is because of a combination of not wanting to be an arse (too late?), recognising they’re doing some great work and not wanting to be too publically critical of it as a result, but reflecting that I do have some worries about the whole enterprise (shared, it would seem, by other government-y types who aren’t directly involved with GOV.UK but have a professional and personal interest in its work).

The response to my Facebook posts, from a group of people that I know to include those very interested or directly involved in the GOV.UK enterprise, was virtually zilch. Similarly, the only tweet I ventured on the subject (via @ replies to specific people) garnered no responses at all.

I suspect this can be attributed to typical (defensive?) human behaviours amongst those leading or part of significant change processes, but nevertheless find it surprising that constructive criticism from a friendly, informed source can fall on such stony ground.

Partly to allay my paranoia that I am actually being an arse and so should rightfully be worried by appearing to be one, any engagement – ironically enough – from GOV.UK folks on the substantive point I’m making about the lack of engagement would be appreciated.)

e-Petitions: some headline figures

Just because I’m occasionally a miserable so-and-so, I thought I’d look to see what sorts of signature numbers e-Petitions attract. I should note straight up that I think e-Petitions are a superficial, trite and virtually pointless means by which people engage in the political process.

Overall, there are 14,382 completed e-petitions so far – all of which are listed here. This doesn’t include currently open e-petitions (of which there are 5,949) or rejected petitions (of which there are 17,525).

Of those 14,382 e-petitions which have been completed:

• 16 have received more than 100,000 signatures (i.e. 0.1% of petitions completed so far)
• 50 have received more than 10,000 signatures (0.3% of petitions completed)
• 75 have received more than 5,000 signatures (0.5%). Or, put another way, 14,307 have received less than 5,000 signatures (95.5% of all completed petitions)
• 239 have received more than 1,000 signatures (1.7%). Or 14,143 have received less than 1,000 signatures (98.3% of all completed petitions)
• 368 have received more than 500 signatures (2.6%). Or 14,014 have received less than 500 signatures (97.4%).

The impact of advocacy – call for evidence

In my new work role at the National Development Team for Inclusion (NDTi) (and on which more blogging goodness to come soon),  I’m getting right into it with a really interesting piece of work about advocacy and evidence of its impact.

We’re not looking directly at creating new evidence about advocacy: we’re looking to gather and review the evidence that’s already available about the impact of different types of advocacy for people who need support.

What we want to do is:

• Help to understand the impact of advocacy, and the benefits of investing in it against a range of different factors and outcomes
• Describe this in relation to different forms and types of advocacy to help inform decisions about what type of advocacy to invest in for which purpose
• Focus on gathering evidence of economic and financial impact (if such evidence exists), in order to help inform investment decisions in the current financial context.

The purpose of the work is to present the evidence that exists about advocacy in a more comprehensive and robust way than currently exists. It will also help provide evidence for organisations who deliver advocacy services about their existing and potential impact.

Full details of the work we’re doing is available here: the impact of advocacy for people who need support. If you know of evidence that could be useful as part of this review, please do get in touch using the comments below or via Twitter – @rich_w

Strengthening DPULOs Programme monthly update, no.11 (February 2013) #dpulo

This is the 11th monthly update about the Strengthening DPULOs Programme, which aims to ensure DPULOs can provide a strong voice for disabled people by being more sustainable. You can find all 10 of the previous updates here:

Since this is the first monthly update of 2013 this is something of a bumper edition of news, useful links and resources, which we hope you find useful.

“DPULOs Making A Difference: Disability Hate Crime”

As part of the Strengthening DPULOs Programme, we are developing the ‘DPULOs Making A Difference’ series. The series will comprise of collections of practical case studies which demonstrate how DPULOs have and are making a difference in their local communities.

We’re delighted the first in this series of case studies has been published: “DPULOs Making A Difference: disability hate crime”. The case studies are written by a DPULO – Access Dorset – and demonstrate how nine DPULOs have made a difference in addressing disability hate crime.

These have also been shared with all Police & Crime Commissioners and police forces. We’d also encourage you to share them with any relevant contacts you have, too.

You can download the case studies here: DPULOs Making A Difference: disability hate crime

If you are on Facebook, photos of the launch event are here.

A full overview of DPULOs

We have published a post that links together as much of the key information about DPULOs that we know about. This includes (a) What is a DPULO? (b) What DPULOs exist? (c) What value do DPULOs add? (d) What does the government think of DPULOs? (e) What evidence is there concerning DPULOs?

You can find the post and all the information it includes here.

DPULOs news

Below are some great news stories from DPULOs across Great Britain. If you have any news you’d like to share, let us know!

• There was a tremendous debate in the House of Lords about BME disabled people, including mention of the excellent Equalities National Council
• The Minister for Disabled People, Esther McVey MP, held a reception for DPULOs at the House of Commons – pictures
• Some good news about funding that a DPULO has got for its smartphone app for people with visual impairments
• Disability Cornwall has been awarded Investors in People Gold status
• Sharing DASH’s journey
• Shopmobility Lochaber’s experience of implementing PQASSO
• Wiltshire CIL: a DPULO following local people’s priorities
• An incredibly useful update from RUILS on their work on pooling Direct Payments
• Great to see a London DPULO representing disabled people’s voices on transport issues

Useful resources

One key part of the Strengthening DPULOs Programme is to share learning and useful resources. Our bumper edition of useful links and resources is below:

• The Office for Disability Issues has launched the Disability Action Alliance
• ODI has also recently published a very comprehensive piece of research that brings together a huge amount of research and statistics on disability
• Cabinet Office launches Commissioning Academy
• … and the most useful resources on commissioning and procurement around
• An old paper from Joseph Rowntree Foundation which has evidence that DPULOs increase Direct Payment uptake (pdf)
• Funding Central is a free funding database that any DPULO can use to find out what funding is available
• The Government publishes every contract opportunity over £10,000 on Contracts Finder

If you have any learning or resources you’d like to share or have any resources you’d particularly like, please let us know (contact details are at the bottom of this update).

Find out more about the Programme

To find out more about the Strengthening DPULOs Programme, you can visit our website.

We have 250 “likes” on our Facebook page. If you are on Facebook perhaps you’d like to like us, too? We regularly update the page with lots of information you will hopefully find useful, plus news from other DPULOs: www.facebook.com/dpulos

If you are on Twitter, you can share information and find out more about DPULOs using the hashtag #dpulo.

As always, we’d be grateful if you can spread the word and publicise this news throughout your networks / newsletters / websites etc. We’d also be grateful for any feedback you have on this regular email.

Contact us

For information, biographies, contact details and details of the areas covered by each of the DPULO Ambassadors covers, please visit the Ambassadors page.

If you have any questions about the Facilitation Fund or any part Strengthening DPULOs Programme, please contact odi.businessperformance@dwp.gsi.gov.uk

Please feel free to forward this information on to any DPULOs, networks or stakeholders you think might find it interesting. If you didn’t receive the original email, please share your contact details with us so you can receive our monthly emails.

Personal note

I’ll be leaving my secondment role with the Strengthening DPULOs Programme in the next week to take up a new role at the National Development Team for Inclusion (NDTi – www.ndti.org.uk), leading their mental health programme. One of the existing Ambassadors will take on the National Lead responsibilities (including the monthly bulletin!) and we’ll share further information on this as soon as we have it.

My personal thanks to everyone I’ve worked with and met in this role. It’s been a privilege working with so many great people and DPULOs, and I have every confidence you’ll carry on being a vital part of your local communities.

For info, you can still find me on Twitter @rich_w and on this blog!

#Dilnot: a principle and a precedent

What today’s announcement of a £75k cap on the costs of social care does is allow the coalition government to say at the next election that it has introduced an historic change in social care funding that no government has previously been able to do.

Politically, that’s a substantial achievement.

Of course, there are significant questions and details that arise from a £75k level of the cap (or £61k in today’s prices, since the £75k figure is at 2017 prices) and associated changes. People like Claudia Wood and Marc Bush are highlighting what these questions are.

But there is a principle and a precedent that we should today celebrate.

The principle is that a cap has been placed on how much someone has to pay for social care. That is, the government has (finally) drawn a line beyond which individuals won’t have to go to meet care costs during their lifetime. (That this is being paid for by a freeze in inheritance tax allowance is an admittedly very tasty cherry on top.)

The precedent is that of top-up tuition fees. Once the principle of top-up tuition fees of up £3,000 a year was introduced in 2003, the question then became one of where the line is drawn. That line was changed to £9,000 top-up tuition fees last year, and will probably change again in the future.

In the context of the social care cap, I am hopeful the precedent will work the other way: that once government sees in practice what the effect of the costs cap is it can adjust the level accordingly.

The “win” today is therefore the principle that the £75k has been introduced; the precedent of top-up tuition fees is a reason for optimism.

Cabinet Office launches Commissioning Academy

After highlighting some of the best resources available on commissioning and procurement last week, it would be silly not to mention the new Commissioning Academy, launched by the Cabinet Office at the end of last week.

The Commissioning Academy will:

bring commissioners from different parts of the public sector together to learn from the example of the most successful commissioning organisations. It will develop a cadre of professionals who are progressive in their outlook on how the public sector uses the resources available.

The programme aims to help commissioners deliver more efficient and effective public services. Success will mean commissioners embracing new and innovative forms of delivery, better outcomes for citizens and better value for money.

A brochure for the Commissioning Academy is here and a framework document, which summarises what commissioning means to the Commissioning Academy, is here.

You can find the Commissioning Academy on Twitter @CommissioningAc.

Demos’s report on pre-payment cards

I’ve just had a quick read of Demos’s report published today on pre-payment cards.

Recall that pre-payment cards (also called prepaid cards) are like debit cards, where funds are loaded into an account linked to the card and then spent by the card holder until the balance reaches zero. They can be used to make purchases, set up direct debits or standing orders, and sometimes withdraw cash at ATMs.

There has been an increased usage of pre-payment cards by local authorities, especially in the area of administering Direct Payments in social care, and the Demos report makes recommendations about them being considered for wider use, for example in benefits administration and other forms of public payments.

The topic of pre-payment cards is an emotive one, since it symbolises the concept of the state potentially or actually prescribing what Direct Payments or benefits can be spent on. This is fascinating in itself because, as the report highlights, pre-payment cards are essentially a question of the “nitty-gritty of implementation”.

Of course, I have views on pre-payment cards and whether they should be used. This comes from being pretty heavily involved in two areas of work – Direct Payments implementation and making the Right to Control a reality – and especially from the perspective of service users. I’m painfully familiar with the both the advantages and disadvantages that can arise in making payments to people or trying to integrate several types of payment. As I told the judge, I now know more about the appearances of money laundering than I probably should do.

For those interested in the issues, the Guardian has an article by Ally Fogg which covers a lot of the debate.

The wider point to make, though, is that Demos should be congratulated for at least bringing the topic out into the open. Pre-payments cards are a growing phenomenon and there is a need for an open debate on their merits and demerits, rather than their use growing in the absence of a debate.

It would be great if a space could be created in which this debate can take place that brings together users, public bodies, government and those providing pre-payment cards.

New consultation principles in practice (updated)

When the government’s new consultation principles were introduced last summer, it was noted that, though potentially good in principle (ironically enough), we’d have to wait for government to use them in practice to see what sorts of effect they would have.

A great post from Mike Harris on the Open Policymaking blog has summarised nicely what’s happened since.

At the time the new principles were announced, a few people called for some analysis on how long consultations lasted for under the new principles compared to the old rules. Mike’s post has an answer:

Between January and July 2012, 56.5% of the 253 government consultations held lasted more than 12 weeks, but between July and December 2012 only 26% of the 207 consultations did so.

Though a headline figure, that strikes me as worrying. It would be useful if more detailed figures were available on how long the 74% of consultations that were under 12 weeks lasted.

(Just because I’m that way inclined, I’ve submitted an FOI request to the Cabinet Office to ask them that exact question – will keep you posted with the results.)

Update: the data was actually in one of the Appendices to the Committee’s report on this topic! I should’ve read the appendices! Here’s the data, which I’ll analyse at a later date.

John Profumo: utterly contemptible little shit

… but probably not for the reason you’d think.

After being elected as an MP in 1940, Profumo voted against the Chamberlain government in the famous House of Commons debate on Norway. So angered was the government whip, David Margesson, that he wrote a letter to Profumo which included the memorable line:

I can tell you this, you utterly contemptible little shit. On every morning that you wake up for the rest of your life you will be ashamed of what you did last night.

(We’re keen followers of the intersection of swearing and politics here at arbitrary constant. Our favourite post on the topic is here, though many a selection can be found here. If you come across one you think we’d like, let us know.)