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Mental health - it’s time for a new paradigm

By Vern Hughes - posted Monday, 10 October 2005


Maxine Drake in Western Australia is leading the development of steps towards mutually structured, consumer-centred support models. Their first venture is a kind of mental health co-operative based on contributory principles where consumers pool resources to fund supports in emergency situations, designed by themselves with support people appointed by themselves. Enterprises tailored explicitly to employment of people with mental illnesses are also on their agenda.

Our service system lacks this kind of mutual entity, which should have been put in place as an accompaniment to de-institutionalisation. It wasn’t - because our service delivery tradition is provider-centred and oriented to dispensing supply-side provisions to “clients”. This tradition is still an obstacle to the development of advanced peer-support models.

The third reason why the de-institutionalisation process broke down was that the financial assets that flowed from the closure and sale of institutions were never transferred fully to resource community supports. The rigorous scrutiny that follows large-scale financial transactions in other parts of government was never applied here, which reflects, at least in part, the absence of a well-developed sense of “voice” for this community, with some commensurate political clout. The resourcing of community supports has never been adequate, and has never been focused strategically on relationship-forming activity of the kind that can generate peer and family-supported independent living.

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Four insights remain critical to turning the public debate on mental health away from the old paradigm of managing  disadvantaged people by conscripting them into programs:

  1. People with mental illness desperately require social capital (expressions of trust and reciprocity on which a life can be built) as a stepping stone to recovery. This requires mutual, peer-based forms of support and organisation around which wider supports and specialist interventions should be developed. We should not begin with the specialist interventions in the absence of mutual community-based supports - to do so is to repeat one of the critical mistakes of the past.
     
  2. People with mental illness also need relationship-forming opportunities in civil society, which can only be achieved outside service delivery agencies of the “professional-client” type. Civil society associations like churches, service clubs, sporting clubs and arts groups are the most likely settings for these relationships.
     
  3. Enterprises which actively want people with mental illnesses to work in them are needed, and there are a number of successful models emerging in Australia and overseas. The public policy priority in employment creation for people with mental illnesses should be on support for this kind of enterprise creation.
     
  4. Brokered packages of direct funding for individuals who pool resources from several funding streams are our best antidote to the fracturing of the service system around service types and disciplines (psychiatric interventions, housing, social support, respite, employment and training) because it allows for enterprising uses of these funds which would otherwise be tied up in programs. Integrated financial packages should be payable to brokering entities chosen by people with mental illnesses and their carers, including brokering entities formed as mutuals of consumers.

Consumers and carers have been largely invisible in the public debate about mental health. We need to find a loud collective voice that is distinct from the service providers that can drive a new social and public policy consensus around these insights. We need a voice that is as influential in politics and government as that of large industry and trade union interests. The numbers are there for us to do it, what we need is leadership and organisation.

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About the Author

Vern Hughes is Secretary of the National Federation of Parents Families and Carers and Director of the Centre for Civil Society and has been Australia's leading advocate for civil society over a 20-year period. He has been a writer, practitioner and networker in social enterprise, church, community, disability and co-operative movements. He is a former Executive Officer of South Kingsville Health Services Co-operative (Australia's only community-owned primary health care centre), a former Director of Hotham Mission in the Uniting Church, the founder of the Social Entrepreneurs Network, and a former Director of the Co-operative Federation of Victoria. He is also a writer and columnist on civil society, social policy and political reform issues.

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