1. 1 Social Inclusion Manchester Mental Health & Social Care Trust

2. 2 Aims & Objectives of Session To consider the problem of social exclusion as it affects people with a psychotic illness To examine the causes of social exclusion To explore the current position of people with SMI in relation to work and education To look at the government’s action plan to promote enhanced inclusion, with a particular emphasis on the needs of young people experiencing psychosis & their carers

3. 3 Social Exclusion – A service user’s perspective “ For some of us, an episode of mental distress will disrupt our lives so that we are pushed out of the society in which we were fully participating. For others, the early onset of distress will mean social exclusion throughout our adult lives, with no prospect of training for a job or hope of a future in meaningful employment. Loneliness and loss of self worth lead us to believe we are useless, and so we live with this sense of hopelessness, or far too often choose to end our lives…we are seen as a social burden”

4. 4 The Problem of Social Exclusion Adults with long term mental health problems are one of the most excluded groups in society When asked, many say they want to work – but fewer than a quarter do This is the lowest employment rate for ANY group of disabled people (Office for National Statistics 2003) This leads directly to social isolation, boredom, depression and suicide

5. 5 The Problem of Social Exclusion Social isolation is an important risk factor for deteriorating mental health and suicide. Two thirds of men under the age of 35 with mental health problems who die by suicide are unemployed (DOH 2001) Mental health problems can have a particularly strong impact on families – both financially and emotionally. They are twice as likely themselves to have a mental health problem if they provide substantial care

6. 6 The Cost of Social Exclusion Mental health problems are estimated to cost the UK over £77 billion a year through the costs of care, economic losses and premature death (Sainsbury Centre 2003) Over 900,000 adults in England claim sickness and disability benefits for mental health conditions, with higher rates in the North – more than are claiming Jobseekers’ Allowance

7. 7 What Causes Social Exclusion? Stigma & discrimination – despite campaigns, attitudes haven’t changed (Taylor et al 2003). Fewer than four in ten employers say they would recruit someone with a mental health problem (Manning & White 1995) Many people fear disclosing their condition, even to family and friends

8. 8 Group Exercise As a large group – Consider any portrayals of mental illness you have seen, heard or read about in the last few years Group these into positive and negative images and discuss their impact on the general understanding of the issues facing people with mental health problems

9. 9 What Causes Social Exclusion? Low expectations – professionals often display pessimism about what clients can achieve. There is limited recognition in the NHS that returning to work & overcoming isolation is associated with better health outcomes. Education & employment opportunities are not seen as key objectives by many health & social care professionals

10. 10 What Causes Social Exclusion? Lack of clear responsibility – It appears to be nobody’s actual JOB to promote vocational and social outcomes for adults with mental health problems Services don’t work effectively together to meet individual needs and maximise the impact of available resources

11. 11 What Causes Social Exclusion? A deficit in ongoing support to enable people to return to education/employment - £140 million per year is invested by health & social care in vocational and day services (Mental Health Strategies 2003). But not all promote social inclusion effectively Links with Jobcentre Plus can be weak People fear loss of benefits if they find work People lose the jobs they find because of poor support

12. 12 What Causes Social Exclusion? Barriers to engagement – Clients may have poor access to housing & transport Education, arts, sports and leisure providers are often not aware how their services could benefit clients and how they can make them more accessible Clients don’t want to use services alone but don’t like to ask for support Clients are actually EXCLUDED by law from jury service!

13. 13 Barriers to inclusion among specific groups Ethnic minorities – they may feel alienated from mainstream (predominantly white) mental health services and tend to seek help from these services later than white people They are more likely to disagree with their diagnosis They may encounter discrimination on grounds of both mental health & ethnicity when seeking work

14. 14 Barriers to inclusion among specific groups Young men – They are at a high risk of dropping out of education or work They may become involved in crime They are at particularly high risk of suicide If they have other complex needs (substance misuse, homelessness) they struggle to gain access to statutory services (Rankin & Regan 2004)

15. 15 Group Exercise In small groups – Read the brief case vignette List the ways in which Dennis may be experiencing social exclusion. Accompany each of these examples with an explanation as to why that might be happening

16. 16 Tackling Social Exclusion Some important measures are already in place to address social inclusion – Pathways to Work( DOH 2005) – ‘ a radical new approach to supporting incapacity benefit claimants back into work’ National Service Framework for Mental Health (DOH 1999) – recognises the importance of promoting social inclusion Disability Discrimination Act (1995) – outlaws discrimination of disabled people

17. 17 Tackling Social Exclusion Local initiatives – innovative examples, often led by the voluntary and community sector, exist that are having an impact on both health & work Successful local projects are characterised by close partnership working between agencies, a clear focus on the aspirations of the clients and strong local leadership.

18. 18 Tackling Social Exclusion – What else needs to be done? “Our vision is of a future where people with mental health problems have the same opportunities to work and participate in the community as any other citizen” The Social Exclusion Unit (DOH 2005)

19. 19 The Social Exclusion Unit’s Action Plan Stigma & discrimination – Mental health has not benefited in recent decades from the progress seen in tackling stigma and discrimination about race and sexuality A sustained programme to challenge negative attitudes and promote awareness of people’s rights (£1.1 million investment – 2004 – 5) Schools have been provided with practical teaching resources to challenge stigma

20. 20 The Social Exclusion Unit’s Action Plan The role of health & social care services – The advice that people get from professionals can set the tone for the course of their illness and its impact on their lives Support for re-integration into the community is an integral part of the work of effective mental health services. Early access to MH services regardless of age, ethnicity, gender or social status may reduce the risk of problems becoming more intractable.

21. 21 The Social Exclusion Unit’s Action Plan Health & social care services will tackle social exclusion through : Modernised vocational services, reflecting best practice from an evidence base Access to an employment advisor and social support for everyone with MI Redesigning MH day services to promote social inclusion Strengthening training on social inclusion for professionals and police/prison staff

22. 22 The Social Exclusion Unit’s Action Plan Employment promotes enhanced mental health The Pathways to Work pilots are testing the impact of a comprehensive employment support package including specialist personal advisers, help to manage illness at work and a £40 per week ‘return to work’ credit.

23. 23 The Social Exclusion Unit’s Action Plan Getting the basics right – There is little prospect of accessing work or community activities for people whose housing is unstable, who have problems with money and who are unable to access affordable transport New guidelines to Housing Authorities on lettings and stability for clients with MI have been given There should also be improved access to financial and legal advice

24. 24 Making it Happen To ensure that the action plan is implemented, strong leadership and effective coordination is required, at both national and local level Local implementation is to be undertaken by primary care trusts and local authorities, supported by the National Institute for Mental Health in England (NIMHE 2005) However, it needs better use of the expertise of the voluntary and community sectors to really make it all work

25. 25 Conclusion Social exclusion is a huge (often hidden or neglected) problem for people with mental health problems, their families and friends and for all of us It is caused by stigma, low expectations, lack of resources and poor coordination Some progress has been made to improve the situation Much more needs to be done. However, if improvements are achieved, they can have far reaching and lasting impact on all aspects of people’s lives