Cuts and reorganization: the reality of progressive mental health day services

I work for the NHS within Community Mental Health Services as part of a team whose remit was to enable service users to access educational and employment opportunities. We ran what I considered a unique and progressive service. We worked in a building not far from the city centre. We had an ICT suite where service users could gain qualifications and with our support create or update their CVs.

Within the centre we had a café where service users could gain work experience to gain relevant qualifications with currency in the catering industry. It was also a place where service users could come along for a hot meal, a coffee and a chat.

Our reception was also staffed by service users gaining work experience and relevant qualifications. We delivered in house courses in Building Confidence and Self Esteem. The team alongside ex service users also developed and delivered workshops to service users based on the Recovery Model. We worked closely with local education providers delivering courses such as: Rights and Responsibilities at Work, Working in Retail, Working in an Office, Working in Customer Services and Working in the Public Sector. We also worked closely with Welfare Rights who regularly delivered workshops and advice sessions on benefits, debt and housing issues. We also had thriving Art and Drama projects which rebuilt the confidence of people who had endured a variety of mental health difficulties.

The whole project was person-centred, the idea being that it was a sort of stepping stone which gave them renewed self confidence and skills to move on with our advice, guidance and support into mainstream opportunities to enhance their life chances.

Then came the reorganization. The reorganization was pushed through using ideas and progressive language originally developed through the previous New Labour government’s Social Inclusion Unit. Day Centres we were told were bad, they simply institutionalized people with mental health difficulties. The whole new focus was to create services without buildings.

During my time working in Mental Health Services I have seen some pretty awful places. Day Centres which offered patronizing services that oozed with boredom with no real progression for service users. Our project was not like this.
The NHS Trust I work for was at the time of our reorganization looking at squeezed budgets and the cost incurred in leasing buildings. They do have a building programme for new inpatients units, but as yet not one brick has been laid and in some instances planning permission is not yet approved, yet they closed the only inpatient ward in the City.

Our project has changed beyond recognition. Some staff will be taking pay cuts in the reorganization which has had a massive impact on morale.  We are now expected to record all service user contacts and outcomes from each appointment on 3 separate and different I.T. systems. But more importantly we can no longer deliver the range of opportunities to service users. Everything has to be accessed in the wider community. The café and service user reception has gone. We cannot make appointments to see service users in the building when we are offering advice, guidance and support. We now have to go out in twos to the service users home to ascertain from the service user what we can do for them to promote their social inclusion. The outcomes of the first contact with the service user are discussed at a team meeting and then a member of the team (an education worker, employment worker, volunteer coordinator, arts worker, sports worker) is allocated to the service user, depending on what kind of ambitions they have. This is followed by a telephone call to the service user and arrangements are made to meet them somewhere in the community. The advice from the trainers from the Social Inclusion Unit was that a café may be a suitable venue for the first appointment. Yes a public place when the service user may be disclosing personal and often quite distressing information.

As a team we are now finding that many opportunities in the community for our service users: colleges, arts projects, leisure centres, etc are few and far between because of the current round of cuts .The local council has made cuts to the passport to leisure scheme which helped people on benefits access leisure centres etc. The local colleges have changed the criteria for fee wavering for people on benefits meaning that many of our service users are unable to access educational opportunities. As the cuts start to bite deeper there will be fewer and fewer opportunities for our services users in the wider community

To make staff morale worse our building may be given to different teams within the Trust. We have recently heard that we may be supplied with laptops and work from our cars, dropping into Trust buildings to use docking stations to send data to the I.T. systems. We will probably end up as lone workers apart from one afternoon per week when we attend a caseload allocation meeting. It seems to me that our service has now been slimmed down to such an extent it is ripe and ready for privatization.

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