Saturday(!)’s melange of Mental Health and Health news,views and info.

The sun’s been peeking out, and it’s looking brighter in meteorological terms. A bit less cheery on the mental health front, but there we go…
A truly absurd amount of news and linky-poos, so let’s get cracking.
First up, a little reminder that the next NEt (North East together network, which encompasses the NTWSU&C network and its southern counterpart) network of mental health service users and carers and their groups across the region meets next Wednesday, the 30th of March, 2pm at St Cuthbert’s Hospice, Durham, DH1 3QF. Sketch map here. Agenda attached too.

Those of who who bother reading these missives ought by now (as opposed to those rascals who nick stuff and don’t acknowledge the source: please circulate, but cite your source…) to know that NEt also serves as a regional sounding-board for NSUN, the National Survivor User Network who are a thoroughly good bunch (if you haven’t joined, join ’em: it’s free: www.nsun.org.uk), user-run and led, and their last two newsletters can be read here and here.

Now courtesy of PJ at NEMHDU is attached a simply wonderful document from the saintly Department of Health relating to the function of GP commissioning consortia. Far be it from me to even think that the changes in terminology, the previously unannounced elements therein and the general lack of clarity or cohesion might might to an administration that comes across like it’s making things up as it goes along. By Tuesday of this week Andrew Lansley appeared to be formulating policy on the hoof as he appeared before the House of Commons Select Committee: for example "Patient participation Groups" seem to have been plucked from the ether. No idea as to how they fit (or quite possibly don’t fit) with existing user and carer groups, with LINks, local HealthWatch etc etc. Ah,well.

Next attachment is MHNE‘s latest bulletin, with lots and lots of good stuff in there. Thanks Gayle, and have made the amendment,Kate…Why not check out MHNE’s website too, as they’ve put video and all sorts on there now (good work, Gareth).

What is the next attachment, I hear you cry. It’s the flyer (front and back) for NIWE (a member of NEt), the regional eating distress charity, and their super-sounding fashion fund-raising event next Thursday, which will not only raise awareness of issues about body image,eating distress but also aims to fundraise and promote for aid agency Disasters Emergency Committee.

Now a rather groovy round-up courtesy of Maureen at NEMHDU of all kinds of news-y things.

A positive idea and programme has been sent through by Colin (Farr) from Groundwork. Worth checking out if you like football and can see its benefits to mental wellbeing, with the documents attached.

Time to Change is working with the Football Association and Premier League, Championship and Football League clubs to deliver mental health training to grassroots football coaches across England. We are recruiting trainers to lead these sessions and we need people with a passion for sport and with experience of delivering sports coaching, classroom training or similar. Ideally applicants will also have some experience of mental health problems – either personally, as carer for someone else, or through project work. One in four people will have a mental health problem in their lifetime, and this is a great opportunity to help make football more open about mental health.

The Trainer roles are paid (£60 for each two hour session). Trainers will be employed on a freelance basis. The deadline for applications is Friday 1st April. However contracts will be agreed with suitable applicants on a first-come-first-served basis. Early application is therefore encouraged. See attached for more detail!

Our last attachment comes courtesy of the NHS Confed, and an early report on personal health budgets (as opposed to those for social care) . The Govt is terribly keen on these and looking for a really rather rapid roll-out (alliteration alert). The report seems to indicate that this may not be the best of ideas, since there is an awful lot of concerns,problems and issues that are definitely not resolved.

It’s at this point in the proceedings that we delve into the rather more contentious and distressing content, that is to say, the various bit of news and analyses of political changes to health and social care and some strongly held opinions about incoming policy, cuts (and let’s be honest and call a cut a cut, and be careful typing that too) and their possible impacts.Look away now, if you think that everything is going along just peachily and have no concerns at all about the direction in which things may be headed. Of course you may disagree with the opinions and interpretations pointed to, but they do provide some food for thought.

SPN (www.spn.org.uk and look out for a joint SPN and NTWSU&C network meeting,probably in June) don’t seem shy of using the word cuts, and have put out the following:

”The impact of cuts on mental health services threatens to undermine much of the progress made in recent years. SPN is attempting to build a comprehensive picture of cuts in both NHS and adult social care. We would be grateful for your help in responding to the questions below and any information you are able to send us.

1. Are there any services in your area which have been withdrawn or reduced? Please list

2. Have any grants to community and voluntary services been reduced?

3. Do you know of any plans for further reductions in 2011/12 and 2012/13?

Please send the information to spn marked CUTS or by post to SPN, C/o SCIE, Goldings House, 2 Hays Lane, London SE1 2HB by March 30th. We will produce a report on the findings. "

Best wishes

The SPN Team

More NHS reform news, come in the shape of the prospect of entire care pathways being commissioned/out for tender, which would rather seem to run against the notion of patient/user choice, and the ability to construct an individualised package.

Some of those most vocal in their backing of the Government’s ‘direction of travel’ may not be exactly representative and may operate under rather misleading monikers, and there are certainly some interesting behind-the-scenes manoeuvrings going on by private sector multinationals.

It has to be said that the numbers of those expressing misgivings is growing. This lays out a decent critical analysis of some of Mr Lansley’s political problems*. The role of GPs is pivotal in all of this, but some do fear a shifting away from clinical priorities to business priorities.There could also be a major impact upon hospitals. Some say that even the PM is slightly taken aback by the Secretary of State’s approach. The BMA very publicly opposed Mr Lansley and trouble seems to be brewing on several fronts. A striking artcle in the BMJ points out some of the most contentious aspects and how they might be remedied (link is to a blog version, as the BMJ requires an athens or other log-in). It’s apparent that the proposed legislation as it stands has some worrying omissions (eg there is no duty on general practice commissioning consortia to provide comprehensive healthcare for all residents in geographically defined areas and fund them accordingly and on the basis of need).

An interesting piece of research (reported on here) establishes that the wrong kind of work can be worse for one’s mental health than no work at all. Very pertinent in the light of the work done in the UK by Black and Perkins, which maintains that good work is good for one’s mental health.Some in power crudely took this as meaning that all work is good for mental health, which it can be argued is an attitude underpinning some much-criticised policies,ignores the existence of stress etc at work, and the need for programmes such as Mindful Employer and Mental Health First Aid

Moving on now to the related delights of benefits and welfare reform.The many flaws in the (new) assessment process keep being highlighted. You can make your opinions known about the migration from Incapacity Benefits to Employment Support Allowance, including the Work Capability Assessment (hat-tip to Jane Noble and Lesley Crawford) to Parliament, but must do by the 14th of April and in no more than 3,000 words.Details here.

And a little more on our friends atos and their handling of mental health

Benefits and Work has obtained a copy of the guidance being used to train Atos health professionals to carry out the new work capability assessment.

We have discovered that claimants with mental health conditions face the possibility of being found fit for work on the grounds of being able to carry out the most basic of activities. In fact, if you can simply:

wash;
dress;
make a cup of tea; and
travel to the medical examination on your own

then there’s a real chance that you will already have scored zero for six of the seven mental health activities.

The mental health test is made up of activities 11 to 17 of the limited capability for work assessment. Below, we go through them in order to see how that simple list of activities may affect your chances of scoring enough points to be eligible for ESA.

Activity 11: Learning tasks
Claimants who can reliably learn how to do moderately complex tasks score no points for the ‘Learning tasks’ activity.

The guidance for Atos health professionals tells them that moderately complex tasks may include:

“Using a microwave oven
Making a cup of tea including filling kettle, putting tea bags in teapot, pouring into cup and adding milk and sugar
Playing CDs on a stereo
Using a Playstation
Using a computer for basic activities such as playing a game.

“More complex tasks should also be considered such as driving should be detailed [sic] and any previous tasks learned in training and employment should be considered.”

So, the ability to reliably make a cup of tea can be used as evidence that you should not score points for this activity. If you also listened to a CD whilst enjoying your morning cuppa then there’s even less chance of scoring points.

Activity 12: Awareness of hazard
In relation to ‘Awareness of hazard’, health professionals are told to look at your ability to cope with potential hazards, such as:

“Ability to cope with road safety awareness
How they manage if they live alone
Driving
Ability in the kitchen
Awareness of electrical safety
Responsibility for children/pets”

So, once again, your ability to make a cup of tea and to travel to the MEC alone without having an accident may make it difficult for you to score points for this activity.

Activity 13: Personal action
This activity looks at whether you can initiate or complete at least ‘two sequential personal actions’.

Atos health professionals are told that this activity is about the “ability to understand how to co-ordinate actions in the correct sequence such that they successfully complete any personal actions in a logical order for example washing before dressing.”

They are also told that:

“The concept of 2 sequential tasks could include showering, and getting dressed to go out.”

In addition, they are told that ‘personal action’ may include:

“ability to get up, washed, dressed and ready for work in the morning.”

They are also told that the sort of daily living activities they should look at include:

Making travel arrangements
Writing shopping lists
Organising finances
Planning a simple meal
Getting washed and dressed
Ironing clothes for the next day
Caring for children: preparing clothing, lunches etc.

The guidance is not entirely straightforward, however. At one point it explains that:

“Similarly, if a person perhaps with bipolar illness manages to wash and dress but then goes out and spends all their money on non essential activities, giving no consideration to issues such as bills, rent, food etc, they would not be considered to be initiating effective personal action.”

Nevertheless, it is clear that being able to get washed and dressed and travel to the medical examination centre can be used as evidence that no points should be scored for this activity.

Activity 14: Coping with change
The ability to cope with planned and unplanned change is another activity that claimants can score points for. However, Atos health professionals are told that:

“It would seem unlikely that a claimant who manages to attend the medical examination centre alone would meet the level of severity of functional restriction for anything other than CC(d) to apply.”

CC(d) is the zero scoring descriptor for ‘Coping with change’. So, once again, if you manage to get to your medical on your own, your chances of scoring points for this activity are very slim.

Activity 15: Getting about
This activity is about your ability to get to a specified place. If you can’t do it at all you get 15 points. If you need someone with you then you score 9 points if it is in relation to somewhere with which you are familiar and 6 points if it is somewhere unfamiliar.

Atos health professionals are told that the way you travel is not considered, so that if you cannot get somewhere by public transport but could get there ‘by other means’ then you will not score.

Although it is not specifically stated in the guidance, it is likely that someone who can travel to the medical examination centre unaccompanied will struggle to score any points for this activity.

Activity 16: Coping with social engagement
This activity is about engaging in social contact with unfamiliar people. Your problems have to be more than ‘mere shyness or reticence’.

Atos health professionals are told that:

“It would seem likely the person would require a companion to attend at the MEC due to the level of anxiety/communication restriction that this descriptor would normally be expected to reflect.”

In other words, once again, if you attend alone your chances of scoring points for this activity are very slight.

Activity 17: Appropriateness of behaviour with other people.
The final activity in the mental health test is less likely to be affected by your ability to wash, dress, make a cup of tea and travel to your medical alone.

You score points for “uncontrollable episodes of aggressive or disinhibited behaviour that would be unreasonable in any workplace.”

Astonishingly, however, Atos health professionals are told that:

“The descriptors relate to behaviour that would be considered [unacceptable] in an average workplace such as a call centre as this provides a more general concept rather than applying “reasonable” to one person’s standards as this may be subject to considerable variability. It is likely that the behaviour would extend beyond verbal aggression for the descriptors to apply.”

It may well be that Atos are quite happy for their call centre staff to display verbal aggression towards claimants or towards each other. But in virtually every other workplace in the country, verbal aggression is regarded as entirely unreasonable and is likely to be a disciplinary offence. Indeed, in some circumstances verbal aggression constitutes a criminal offence for which a custodial sentence can be imposed.

To advise health professionals that they should not generally allocate points where, due to a mental health condition, someone is verbally aggressive is extraordinary.

Simplistic and unreliable
And that’s it. Every mental health activity bar one potentially undermined by simply being able to wash, dress, make a cup of tea and attend a medical appointment unaccompanied. And the only activity left appears to involve a requirement that you physically attack someone or behave very bizarrely.

Of course, it may not always be that straightforward. There are issues such as your ability to carry out the activities repeatedly and reliably to be taken into account. And, in the case of some activities, the guidance is so imprecise that a range of different points may be possible.

But one thing is not in doubt: tens of thousands of claimants with genuinely debilitating mental health conditions will soon be found found fit for work on evidence that many people would consider flimsy, simplistic and highly unreliable.

And finally, don’t forget that the clocks move forward one hour this weekend

Cheers,
Alisdair

* Apparently a more entertaining, if rather more ribald (but curiously informed) musical critique can be found if you type "Andrew Lansley rap" into YouTube but don’t go there if you’re easily offended or can’t cope with rapid-fire vocal delivery.Obviously, the Network in no way,shape or form endorses the views expressed therein.

Alisdair Cameron
LAUNCHPAD Team Leader,
NTWSU&C n/wk co-chair (with Mish Loraine)
(for network business: ntwsuc)

LAUNCHPAD
Offices 210 and 211,
Holy Jesus Hospital,
City Road,
Newcastle upon Tyne,
NE1 2AS

Tel 0191 2330382 (personal mobile 07736074213)
E-mail launchpadncl
or alisdairscameron
www.launchpadncl.org.uk

agenda NEt mtg 30th March 2011.doc

Functions of GP commissioning consortia.pdf

MHNE Bulletin18th March 2011 (edited).doc

News and snippets 9.3.11.doc

Trainer JD v1.00.doc

Trainer application form v1.00.doc

Facing_up_to_the_challenge_of_personal_health_budgets.pdf

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