This is a critical time for mental health in Scotland. In the current climate of austerity, funding crises and shrinking services, people affected by mental health problems find it increasingly difficult to get the right kind of support when they require it.
The problems are well-known. There are serious shortcomings in the provision of accessible, acceptable, quality care and support through the life course: key elements of the right to the highest attainable standard of health. People’s right to a decent standard of living is negatively affected by the lack of joined-up and integrated thinking, which results in support systems based on silo mentalities and the interests of different sectors and services rather than the views and goals of people and communities.
People affected by mental health problems experience high levels of stigma and discrimination and are isolated and excluded from community life. They are poorer, die younger, and have far less access to employment and learning opportunities than other sectors of society. The realities of people’s lives do not reflect the well-intentioned strategies aimed at tackling these issues, and many parts of the legal and policy framework are no longer fit for purpose.
So what can we do about it?
As Henry Ford said, “If you always do what you’ve always done, you’ll always get what you’ve always got.” Transformational change is imperative.
In recent years, rights-based and recovery focused principles and practice have grown in prominence in mental health. Person centred and strengths-based, they come with an expectation of new, more progressive and innovative ways of working. SRN believes that mainstreaming rights and recovery approaches can help establish a common language and unified way of thinking to bring about the shift that is needed. Rights and recovery are neither identical nor competing approaches however they have a lot in common and complement each other well. Using them in tandem will achieve stronger and more sustainable change than either approach would realise on its own.
Supporting recovery principles and taking a recovery approach (in particular using the lived experience of people in recovery to develop policies, plans and support) can help empower people to realise their rights. The rights-based approach can help promote and realise recovery because it helps to redress the structural inequalities in society that hinder people’s recovery.
Recovery focuses on peoples’ strengths rather than deficits and recognises them as experts by experience with an active role to play in directing their lives. This has a lot in common with the human rights model of disability. Most recently championed by the UN Convention on the Rights of Persons with Disabilities (UNCRPD), it builds on the well-known social model. It recognizes people with disabilities as ‘rights holders’ (subjects of rights) and the State and others as ‘duty bearers’ with responsibilities to respect, protect and fulfil rights. Instead of framing people with disabilities as passive objects of charity or impaired and in need of clinical intervention to be ‘fixed’ to fit in with the rest of society, the human rights approach treats the societal barriers faced by people with disabilities as discriminatory and provides opportunities for redress. By calling for society to change in order to accommodate human diversity, the human rights model alters the balance of power, helping people help themselves so that they can fully participate and claim their rights.
Recovery and the UNCRPD model of disability are paradigm shifts: they recognise people with lived experience as equals in society and are aimed at enabling their full, equal and meaningful participation. They challenge the charitable and medical models of disability, which are unfortunately still very prevalent and continue to perpetuate the imbalance of power between those providing and those accessing services and support.
To date, ways of working have been described as either ‘rights-based’ or ‘recovery focused’. However we think that many of these could be considered both, for example:
- Addressing mental health in a more equal and holistic way (joined-up, integrated support for people and communities across the board – health, social care and security, housing, employment, education – based on what they require rather than the separate interests of different sectors)
- People getting the kind of support they require at the time they need it (non-mainstream alternatives in addition to traditional clinical services, community-based, peer involved, self-management and personal outcomes approaches)
- People are fully involved (co-production at all levels)
While it’s encouraging that some of this practice is underway, it’s also widely recognised that it is extremely patchy and much more needs to be done.
Human rights and personal recovery aren’t just aspirations or meaningless principles, however without practical application they threaten to remain just that. Embracing their connections can help deliver the transformational change required in mental health.
For more information about rights and recovery, read the SRN Briefing Paper (October 2015): http://www.scottishrecovery.net/Latest-News/connecting-rights-and-recovery-in-mental-health.html
Lucy Mulvagh – Network Manager, Scottish Recovery Network