Change that leads to better lives

At the heart of Action – 25 years of NDTi

So NDTi is celebrating its 25th birthday, and, like an unexpected scent, this has jogged my memory. Where was I that summer, and what was going on in mental health services?

Heart of action blog

Looking back evokes nostalgia mixed with pride in what we have achieved together, and regret that we haven’t made more of our opportunities. Just like life, really.

In the 25 years since those visionary days, NDTi has consistently championed the employment agenda for people who need support. We have evaluated services, facilitated discussions about performance indicators, shown how personal budgets can support job ambitions and set out the economic case. However, this week, as I watch yet another local mental health employment project close prematurely, we, alongside other visionaries in the field, nurse our collective frustration. When will lessons be learnt and stay learnt?

Back in 1992, my friend Marion and I were trying to find support for a new mental health employment service that would offer rapid jobmatching and onsite support to both employer and employee. For a few years in the 1970s, our local JobCentre had seconded Danny Rowthorne to work fulltime at the psychiatric hospital, while Nancy Wansborough and Philip Cooper had surveyed 1200 people across England who had used mental health services and were now in fulltime employment. Together, we had the evidence that people with mental health issues could contribute to the economy, yet the local service system seemed unwilling to make it happen.

This was the year that Survivors Speak Out and the National Advocacy Network published training materials on user involvement in mental health services. The first meeting of the Nottingham City Wide Patients’ Council took place, building on the foundations of the Alleged Lunatics' Friend Society that began in 1845. I had began to trawl mental health services around England to find examples where people using services were involved in recruiting staff and holding keys to the mental health building, office, filing cabinet and safe.

The conviction that people who use services should occupy a respected role alongside professionals to coproduce the community and its services has now become commonplace. However, this wasn’t always the case. With the help of Steve Dowson’s prodigious knowledge of the international evidence base, NDTi has championed the use of what are now known as personal budgets, and amplified the call from others who have prompted services to listen more carefully to people. Together we have demonstrated that those with mental health issues can and should guide research, speak at conferences, evaluate service quality and employ their own staff. The underpinning values championed by NDTi, that the person is an expert in their own life, that restoring control and choice to the person themselves is almost always the best thing to do, and that people make a meaningful life in the context of an asset-rich community, has provided a rich soil for the growth of the Recovery movement.

Back in 1992 we were still learning how to make this a reality. I was looking for ways to turn a day centre inside out, so that it became a safe place to launch a life ‘beyond the service’ - contributing and networking with other citizens; being included in all the affairs of the community; navigating and defeating stigma and discrimination at every level.

My search led me to the NDT(as NDTi was formerly known), where I joined a learning set run by Anne O’Brien. The focus was learning disability, rather than mental health, but the processes of exclusion and their solutions looked portable, so I excitedly carried off the intellectual and ethical booty.

In consequence, NDTi was at the heart of the action when the inclusion agenda peaked in mental health following publication of a report by the Social Exclusion Unit. Since then, our efforts to transform day services into dedicated teams of inclusion champions has faded, squeezed by budget restrictions and austerity politics. Yet even here, I can see some survivors pushing up through the hard and lifeless slabs of workload pressures, cuts and despair. An inclusive life is still an essential part of numerous recovery plans and many teams pursue these skills and practices. Asset-based approaches to community recognise that people are citizens first and service users second; coproduction demonstrates that people are not passive, cavernous mouths of hunger waiting to be fed, but rather, they are resourceful inventors. Again and again, NDTi has harnessed the wisdom of people with mental health issues to shape communities and improve services.

In 1992, the task of closing the Victorian long-stay asylums was incomplete and we had no Care Quality Commission, no Equalities Act, no Direct Payments provision, no Green Light Toolkit, no statutory advocates, no peer support workers, no Recovery movement, no commitment to parity of esteem.

While we might very well ask to what extent the promise of these things has been fulfilled, we can also track each of these streams back to their source. Change has been possible and every time, it is clear that these good things have their beginnings in committed, passionate people who insist that their neighbours who live with mental health issues are whole people, valuable citizens, and resourceful contributors.

Looking forward, we picture the population growing older, the UK slipping out from the harbour of Europe into uncharted waters, and those who wish to lock down our fortress nation denying hospitality to our guests. We shall need to grip our beliefs ever tighter.

For 25 years, it has been the privilege of NDTi to hold fast to a driving conviction; to promote an unshakeable belief that every neighbourhood, every family, every workplace, every friendship network, every public service has the potential to lay down stigma and treat all its people with the common courtesy and dignity that they deserve.

This blog is part of our celebrating 25 years of NDTi's commitment to change.

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