Mental Health and Welfare Rights Symposium

Improving Mental Health and Wellbeing – The role of advice and advocacy

National Symposium – 20th of May 2011

This is a summary of the key note address I gave – in my role as Chair of Sheffield Mental Health CAB

Sheffield Mental Health CAB had organised this symposium in partnership with Sheffield Health and Social Care Trust and Citizens Advice.

There is a strong evidence base that shows the strong correlation between debt and mental illness. Which makes it all the more unacceptable that Government Policy does not create a positive and supportive environment to ensure that as a minimum all people with acute mental health problems have access to specialist welfare rights provision as a matter of course.

The evidence appears in official Department of Health documents such as “Improving Efficiency and Quality in Mental Health” which is a supporting document to the Cross Government Strategy “No Health without Mental Health” which was launched in 2011.

This publication uses much of the work done by people like Martin Knapp at the London School of Economics. So we see in the document information about who is likely to be in problematic debt:

“8% of the general population are in problematic debt, this figure rises to 24% for those people with moderate mental ill health such as depression and 33% for those with a Psychosis.”

There is also detail about how debt support services can help people recover from mental ill health and of the resulting savings to the NHS and gains to personal well being and productivity which outweigh the costs of providing the debt support service. The detailed calculations behind these costings are in the “Impact Statement “ (February 2011) produced as part of the Mental Health Strategy.

However, this evidence does not go far enough. The impact statement fails to show the relationship between interventions and how by doing a number together there will be greater efficiency gains.

This is one of the reasons why “No Health without Mental Health” hardly mentions the importance of welfare rights services and instead focusses on provision of Cognitive Behavioural Therapies – which taken in isolation appear to have a bigger impact than debt support.

I think that this completely misses the point. Universal access to good welfare rights services would be likely to make other clinical interventions such as CBT more effective, by helping to relieve people of one of the main factors that is causing them anxiety – personal debt.

Of course those of us who work in the welfare rights sector know that Debt Support is just one element of a good welfare rights service. There are a range of other services which are not recognised in the governments mental health strategy. These include Housing Advice, Support and Advocacy to address issues of personal harassment or discrimination and advocacy work with clinicians and others for people who are clients of the mental health service. All have a role to play. Not least because the experience of many people with an acute mental health problem is of heightened vulnerability, prejudice, difficulties with communication and  so on.

At the moment it is the exceptional care trust and PCT (I suspect that Sheffield Health and Social Care Trust and PCT are one of the few) who support a coherent in house welfare rights service that works directly with people while they are on the wards and in day centres. Helping them address their financial liabilities, secure their housing and address other concerns – that will mean that when they return to the community they are more likely to have a secure home and a degree of financial security.

The same situation applies to community provision – there are shining examples such as the almost 100% coverage of GP surgeries in places like Derbyshire and the Wirral. Experience shows that many of the people who use these services have diagnosed mental health problems. Even here these services are vulnerable – they are often funded from public health budgets. It should be a ‘no brainer’ this is a primary care service – helping people to live successfully in the community and should be funded by GPs directly. Despite these examples it is the case that most PCT areas do not have such provision.

So what can be done?

Some starters for 10 – at a national level we need

• A clear narrative that sets out what good provision for people with mental health problems should look like. A cornerstone to this provision should be good access to welfare rights and advocacy provision in the communities AND on the wards and in the day centres of acute care NHS provision.

• Further development of the evidence base to empower local commissioners to invest in welfare rights provision for people with a mental health problem.

• A programme of development funding to support further innovation and capture and disseminate existing good practice from within the welfare rights sector

What do you think?