http://www.aidsdrugsonline.com/en/aids-hiv

Shaping current and future social care policy and practice.

The JRF welcomes the current government consultation on adult social care leading up to Green Paper publication in early 2009.

There is currently a unique opportunity to expose and challenge assumptions underpinning the current system. It should enable radically different ways of framing 'social care' in relation to human rights, citizenship, voice, choice and control, equity, fairness and sustainability.

Beyond early 2009, we are keen to add to the debate and provide fresh thinking and insight on core issues likely to affect us all in the future. Our view is that changing demographics and the predicted rise in numbers of much older people presents an opportunity for all generations to think radically about the kind of society we wish to live in by 2020.
Key Issues

* The concept of 'obligations' and the 'intergenerational contract'. What obligations do families and friends have? Do we work effectively to foster these? What are the gender issues and implications? How do ethnicity, nationality and religion shape obligations and expectations – within and outside family and friend networks? Authors: Kalyani Gandhi & Helen Bowers. Published on 11 September 2008, available now.
* The concept of 'care'. What does care look like in a ‘good society’? Do we have the right language, the right imagery? How might a new vision for social care move on from ‘white and western’ models and assumptions about care? What questions need to be asked and debated in relation to BME communities and social care, or increasing numbers of single households and complex structured families for example? Author: Peter Beresford. Published 18 September 2008, available now.
* The concept of equity. Equity across ages; equity across income groups; equity between user groups; equity between users and their carers. Equity in the context of human rights and citizenship. What is the impact of user-directed care on equity? What are the acceptable trade-offs in outcomes and equity? Author: Justin Keen. Published 25 September 2008, available now.
* Gender. Women are the majority of care workers, unpaid carers and older people. How far is the personalisation agenda based on an implicit assumption about women’s roles and responsibilities? In developing a new vision for adult social care, what thought needs to be given to the role of women and gender more generally? Authors: Hilary Land & Sue Himmelweit. Published 2 October 2008, available now.
* Lessons from overseas and devolved administrations. Particularly on the core underpinning principles for social care. For example, how have the principles of equity, fairness and entitlements been used to underpin systems in other countries? How would these translate to England? Authors: Caroline Glendinning & David Bell. Published 27 November 2008, available now.
* What are the parameters of the state, individual, family and community responsibilities? (We are particularly interested in the responsibilities of neighbourhoods and communities). Where does the state’s responsibility lie in the context of the changed, changing and complex nature of life, families and communities in the 21st century? Author: David Brindle. Published 27 November, available now.

http://www.jrf.org.uk/work/workarea/future-of-adult-social-care

This factsheet outlines the range of community-based health and social care services for people with mental health problems and for those supporting them, such as friends and family members, often described as carers.

Introduction          
What is community mental health and social care?    
Do you have a right to a service?       
Assessment of your need for a service      
Rights to information and confidentiality      

Community-based mental health care   
GP services
Emergency departments
Community mental health teams (CMHTs)
Crisis resolution teams (CRTs)
Assertive outreach (AO) teams
Day services
Early intervention in psychosis services (EI services)
NHS Direct

Community-based social, housing and voluntary sector services
Befriending schemes
Carer support
Community day services
Direct payments
Employment projects
Supported employment
Home help and 'Meals on wheels'
Housing with care and support
Residential care homes
Hostels
Self-help and peer-support groups
Social service support
Therapeutic communities

Information and advice
Citizens Advice
Local involvement networks (LINks)
Advocacy  

Useful organisations

Further reading         

References          

Introduction

This factsheet is mainly for users of community-based services and their carers, but will also be useful to health professionals who provide mental health care.

The factsheet should help you to take the initial steps to find a community service. It outlines your rights to an assessment of your needs for a service and any rights you may have to receive a service. It also describes the different services that are available in the community, what to expect from them and how to access them. Sources of further information and details of useful organisations are provided at the end of the factsheet.

What is community mental health and social care?

Care and support provided to a mental health service user or vulnerable person living in the community (i.e. not currently in hospital) is divided into:

• health care, which is the responsibility of the NHS
• social care, which is arranged by local authority social services.

In broad terms, 'health care' describes care that is needed to treat a diagnosed health condition.

In the past, health care and social care were separate. Health care mainly happened in hospitals, clinics and general practice surgeries, while social care was run by local authority social services departments. Both services might sometimes be offered at the person's home (e.g. doctor's home visits, district nurses, visits from social workers and home helps). Voluntary sector services were a third, mainly separate, source of help which included things like drop-in centres and advice centres.

Nowadays, health and social services, and the voluntary sector, are becoming more intermingled because of government policies and new ways of financing services. For example, primary care trusts (PCTs) can pay for some social and voluntary sector services, while local authorities can pay for nursing care. Community mental health teams (CMHTs) run by the NHS employ professionals from both health and social care. However, the distinction between health care and social care is still important. This is partly because care provided by the NHS is free of charge to the person, whereas local authority social services departments can charge on a means-tested basis for the services they arrange.

Government policy is in the process of changing to enable more choice for service users, and to be more oriented towards recovery, diversity and social inclusion. In particular, the new policy direction of 'personalisation' [1] may lead to far-reaching changes in how social services are delivered.

The  Mental Health Act 2007 is also having an impact on services in the community. See the Mind web document MHA Briefing 1: Amendments made to the Mental Health Act 1983 by the Mental Health Act 2007.

Do you have a right to a service?

There are not many clear rights to receive a service. The usual process is for your needs to be assessed (see section 'Assessment of your need for a service'); if you meet certain eligibility criteria you may be offered a service. However, you do have a right to an assessment for health and/or social care. Carers also have a right to an assessment. People aged 65 or older should have a single assessment that covers both health and social care needs.

Documents such as the National Service Framework [NSF] for Mental Health [2] provide strong policy guidelines on entitlement to services. The NSF states that any individual with a 'common mental health problem' (i.e. a mental health problem that is not a psychosis) should have 24-hour access to local services as necessary to meet their needs. They can also use NHS Direct (see below and 'Useful organisations') for advice and referral to specialist helplines or local services.

Assessment of your need for a service

Everyone who may be in need of services is entitled to have their needs assessed. Assessment is a process in which a trained professional or professionals will find out more about your needs and decide whether or not you are eligible for a service and if so, which service(s) you should have. An assessment does not automatically lead to the provision of a service.

There are different kinds of assessment:

• If you need a service for your own mental health, you are entitled to a community care assessment and/or a mental health assessment.
• If you need a service because you are caring for someone with mental health needs, you are entitled to a carer's assessment.

Community care assessment
If you think that you need community care services, you can ask your local authority social services department to assess your needs. A carer, friend or relative can also ask for an assessment on someone else's behalf.

If you have been receiving mental health services, you may be on the care programme approach (CPA) (see section on CPA below). In this case, a community care assessment should be provided.

If you are not already on the CPA, a community care assessment is arranged by social services, with help from health care staff. Your assessment should take place within a reasonable time after service providers are made aware that you may need support. The local authority assessors then decide whether you will get a service. Their decision depends on how they have assessed your eligibility for the service, and what they assess to be your level of need. Eligibility criteria can be set to take account of the local authority's available resources, but local authorities must provide a service for people at real risk. Assessors can also take into account whether anyone else can reasonably be expected to provide your needs.

Local authority social services can provide services such as a laundry service, 'Meals on wheels' and home helps (see below). The Supporting People programme can give advice on this (see 'Useful organisations).

Care programme approach (CPA) assessment
If you have been treated as an inpatient of psychiatric services or by a community mental health service such as a CMHT, you may be offered a CPA assessment.

CPA is a way of coordinating community health services for people with mental health problems. When you have had a CPA assessment, one person, called a care coordinator, will coordinate all aspects of your care. Care coordinators are sometimes called keyworkers or case managers. Your care coordinator will write a 'care plan' with you, which details your needs.

According to the NSF for mental health, people on the CPA should be able to access services 24 hours a day, 365 days a year. However, access may mean being able to reach someone by phone and may be patchy according to area and resources.

Mental health assessment
GP assessment: Unless you are in severe crisis, your family doctor or general practitioner (GP) is typically the first person to see for an assessment of your mental health. Your GP will probably make a diagnosis of what is wrong and may offer medication and/or refer you to a specialist - who could be a doctor or a counsellor - for further assessment of your needs. More information is given in the section 'GP services'.

Emergency assessment: This is the procedure if you (or someone you support) are in imminent danger of harming yourself or others and refusing treatment. The Mental Health Act 1983 provides for emergency assessment which can happen in the following ways, with or without your consent:

• You could go (or be taken) to the Emergency department at a local hospital (see 'Emergency departments' below).
• You could phone the emergency number at your local social services department.
• The police may take you to a place of safety where you can be assessed.

The Mental Health Act 2007 makes changes to the procedures for emergency assessment in terms of patients' rights and which professionals are involved. For more information see Mind rights guide 1: admission to hospital.

Carer's assessment
Local authorities have a duty to assess the needs of people who provide or intend to provide a substantial amount of care to a vulnerable person. This includes emotional care and support. This does not mean there is a duty to provide services - this will depend on eligibility criteria. The NSF for mental health states that all individuals who provide regular and substantial care for a person on the CPA should have an assessment of their own caring, physical and mental health needs. This assessment should be repeated annually, and the carer should have their own written care plan, implemented in discussion with them. [3]

Rights to information and confidentiality

Under the Data Protection Act 1998 you have a right to see all records held that relate to you and to have copies made. The maximum fee that can be charged for this is £10 for computer records and £50 for copies of manual records or a mixture of manual and computer records. There are some exceptions where information can be kept from you; for example, if your doctor decides that something in your file might endanger you or someone else. More information can be obtained from: http://www.nhsdirect.nhs.uk/articles/article.aspx?articleId=1309

If you feel that the information about you is incorrect in any way you should first try to approach the health professional concerned to discuss this. If this is not helpful, you can make a complaint under the NHS Complaints procedure; if that fails, you can approach the Information Commissioner's Office (see Useful organisations).

Confidentiality is a basic principle in the relationship between health professionals and patients. All staff working for the NHS have a legal duty to follow the NHS Code of Practice on Confidentiality. Each professional organisation has its own confidentiality policy. You are entitled to ask for a copy of this.

When information about a service user needs to be shared with a friend or family member, the service user should be asked for their consent. This consent should be informed, that is, the service user should fully understand what they are agreeing to. More information can be obtained from http://www.sdo.nihr.ac.uk/files/adhoc/54-briefing-paper.pdf

Community-based mental health care

GP services

The first person for most people who are experiencing mental health difficulties to go to for advice is a GP. According to the Government, GPs play a central role in the care and treatment of people with mental illness. [4] One in four GP consultations is with people with mental health problems. [5]

You can also see your GP if you feel that you are heading towards a mental health crisis (see Mind's Crisis services factsheet. Even if you are referred to more specialist help (such as a psychiatrist or CMHT), your GP will play an important role in your care by, for example, prescribing medication, continuing to care for your physical health and so on.

If you are worried about the mental health of someone you care about, you can make an appointment with your GP to discuss your concerns.

What to expect: If you visit your GP to talk about your mental health, he or she will ask you questions about the difficulties you are experiencing and will then assess your mental health needs and may even make a diagnosis. Your GP can then advise you on different treatments such as medication, counselling, cognitive behaviour therapy (CBT) or local self-help groups. They can also talk things through with you and offer more general advice relating to exercise, relaxation and diet. For many people, the majority of their care will be from a GP.

However, if things are particularly difficult or complicated for you, your GP may refer you to more specialist mental health services, such as a psychiatrist, psychologist, social worker, mental health nurse, mental health worker or CMHT. Some of these services may be based in your local health centre or GP surgery.

The appointment with your GP is confidential; your family won't be informed about what you have said unless you ask for your GP to contact them.

How to access: Make an appointment with your GP in the usual way. You may feel more comfortable if you take a trusted friend or relative with you. This person might take an active role in helping you to explain to your GP how you feel and what is happening. It is a good idea to be prepared to talk through the different options available to you so that you can find the treatment and support that best suits your needs.

If you are unhappy with your GP, or feel that you can't talk to him/her about the difficulties you are experiencing, you can make an appointment with a different GP in the same surgery or ask to see the practice nurse. You can also change to a different practice altogether.

Emergency departments

Emergency departments (also known as Accident and Emergency or A&E) are not just for people with physical health problems. If you are experiencing severe mental health problems, a mental health crisis or feel in danger of hurting yourself, you can go to your nearest hospital Emergency department for help. However, Emergency departments are not always the best places for people in crisis, as the health professionals there are not always sensitive to the needs of people with mental health problems. It may therefore be wise to take someone with you, such as a friend, relative or advocate (see section about Advocacy). Some areas have specific psychiatric emergency clinics although these are not common.

You could also ask your GP, social services or Citizen's Advice Bureau if the crisis resolution team (CRT; see below) can help you, or if there is a non-medical crisis house in your area.

If someone you care about seems in need of immediate help and you don't know where else to go, you can accompany them to your nearest hospital Emergency department.

What to expect: When you arrive at the Emergency department you will need to see the receptionist and briefly explain your difficulties. You will then probably have to wait to see someone, usually a mental health nurse or psychiatrist, who will assess whether you are a risk to yourself or others and what kind of care or support you might need. They will then arrange for you to receive the treatment or care you need. For example, they might put you in contact with local mental health services such as a CMHT (see below), or they might refer you to the inpatient psychiatric ward of the nearest hospital; although the latter course of action is only likely if you need immediate treatment, further assessment or are considered a risk to yourself or others.

How to access: Go to your nearest hospital Emergency department. If you cannot manage to get there by yourself ask a friend to take you, or telephone for an ambulance.

Community mental health teams (CMHTs)

Most people with mental health problems will be treated and supported by their GP. However, if your problems are more serious or complex, your GP can refer you to a CMHT. This is a team of mental health professionals who support people with mental health problems living in the community. The team may include psychiatrists, social workers, psychologists, community mental health nurses, occupational therapists, counsellors, mental health workers, outreach workers and so on.

CMHTs can offer medication, counselling or other mental health treatments. They can also help with a whole range of other issues or difficulties such as benefits, relationships, employment, problems with daily living and so on. This is because the team is made up of experts from many different fields.

If you support a person who is under the care of a CMHT, you may also be able to get support for yourself. Helping carers to cope is an important role of CMHTs. This support can include information, advice, encouragement, education about mental health and being put in contact with local support groups. As a carer you can also be involved in decisions about the care and treatment of the person you are supporting; although this can only occur with that person's permission.

What to expect: CMHTs differ between areas. Most CMHTs will have a team base such as offices or a clinic. They will usually be willing to work in different places with you, such as in your own home. Once you have been referred, someone in the CMHT will assess you to see whether the team can help you and, if so, what kind of treatment and support might help. This assessment will usually happen over a few sessions. Together you can then decide which members of the CMHT might be most useful to you. When you start to see people in the team you will usually have one-to-one meetings. You should also be able to reach someone on the telephone outside of standard office hours.

Most people referred to a CMHT are assigned a named keyworker. Your keyworker's job is to make sure that you are getting all the support and treatment that you need, and that the different people involved in your care know what is happening. This means that your GP will be informed about the care and treatment you are getting. Your keyworker will only share information about you with the CMHT and your GP.

How to access: Most people are referred to a CMHT by their GP. You may also be referred via the hospital Emergency department, by your psychiatrist, from a psychiatric hospital ward, or by your social worker, the police or your probation officer. Depending on where you live, you may be able to refer yourself. If you are worried about someone you care for, you may be able to refer them to a CMHT. To find out whether you can self-refer, or refer someone you support, contact your local council's Social Services department for advice.

Crisis resolution teams (CRTs)

CRTs are a fairly new development in mental health services. They provide intensive and rapid support for people aged 16-65 years old who are experiencing a mental health crisis and who, without the team's help, would be admitted to a psychiatric hospital. Sometimes the CRT can support people in their own homes, shortening their stay in a psychiatric hospital. For people in the community, CRTs arrive quickly -  ideally within an hour. The team is then available 24 hours a day, seven days a week. Support continues for as long as it is needed or until the person transfers to another service. This is usually just two or three weeks; although the length of time varies.

CRTs are made up of people from a variety of different fields; for example, psychiatrists, mental health nurses, social workers and support workers. The team looks at all the different reasons for a person's crisis. They then work with the person to develop interventions that address all aspects of the crisis. The team focuses on people's strengths, helping them to develop strategies to maintain their mental health and to prevent crises in the future.
If you support someone who is under the care of a CRT, the team will also work with you, providing you with support and information.

What to expect: Most areas should now have a CRT; although they sometimes work under different names such as 'home treatment teams' or 'crisis teams'. If you are referred to a CRT whilst living in the community, someone from the team will visit you very quickly, usually in your own home. The team will consider whether you are experiencing a crisis because of a mental health problem and whether, without the support of the team, you would need to go to a psychiatric hospital. They will consider whether you need immediate help. If you seem to be a risk to yourself or others, they may decide that you need to go to a psychiatric hospital.

If the team can help you at home they will put together a crisis management plan. This can include different treatments and supports such as medication, practical help, counselling and education in important mental health issues. They will then visit you frequently, often each day. The team will continue to consider the kind of help you need, and will stay in contact with you until the crisis is over. It is likely that you will then be referred to someone else, such as a CMHT or your GP.

You may also be referred to a CRT while you are in a psychiatric hospital. This means that the team will provide intensive support in your own home, enabling you to leave hospital. Again, the treatment and support will include things like medication and education in mental health issues.

How to access: The Government has stated that everyone in contact with mental health services should be able to access a CRT. [6] Some people will be referred to the team while they are in a psychiatric hospital. Most people living in the community will be referred to a CRT by their GP or CMHT. Depending on where you live, you may also be referred via your local hospital Emergency department, or by social services, voluntary organisations, the police or probation services. It might also be possible to refer yourself, or to be referred by your family or friends. This is particularly likely if the CRT has treated you in the past.

Assertive outreach (AO) teams

Some people don't feel able to use standard mental health services such as psychiatric hospitals, CMHTs or CRTs. This can be because of negative past experiences of mental health services, mistrust of mental health professionals or feeling that services have little to offer.

AO teams provide intensive, flexible and ongoing support to people aged 18-65 years old. Unlike other mental health services that usually offer appointments in health centres and offices, AO teams see people in the place that they choose, ranging from a supermarket to a police station to the street. By working in these different ways, AO teams aim to build long-lasting and trusting relationships.

AO teams are made up of people with a range of different backgrounds and skills, such as psychiatrists, mental health nurses, social workers, therapists and drug and alcohol counsellors. They can provide help and support in many different areas, including mental health, accommodation, benefits, money, physical health, practical support, education, training, employment or helping people find something meaningful to do during the day. An AO team may help you to feel more stable so that you need to spend less time in a psychiatric hospital. [7]

What to expect: If you are referred to an AO team you will be assessed to determine whether you are likely to benefit from the service. AO is usually given to people with a history of severe mental health problems who often end up in psychiatric hospitals but don't like to, or who don't feel able to use standard mental health services. They may also have a range of other problems, such as drug or alcohol misuse, homelessness or getting into trouble with the police. If the AO team is able to work with you, you will be assigned a care coordinator who will oversee the support you get. You should also be able to telephone a worker outside of standard office hours. The team will work with you to develop a care plan, based on your strengths and preferences.

AO teams work with far fewer clients than CMHTs do. Contact can be intensive - up to seven days a week if it is needed. There is no time limit, and the service is available for as long as you need it. If or when it is considered appropriate, your care might be transferred to your GP or CMHT; however, you should be able to go back to the AO team if you need to.

How to access: Referrals to AO teams will vary depending on where you live. Most people will be referred to an AO team by their GP or CMHT. It is also possible that social services, mental health workers, the CRT, the police, probation services, housing services or voluntary sector services can refer you. You may also be able to refer yourself, or be referred by a family member or friend. You can find out more about AO from your GP or your local council's Social Services Department.

Day services

Day services are undergoing a process of radical change towards more socially inclusive services which will no longer be hospital based.

Many hospitals provide mental health day care, usually in a separate 'day hospital' attached to the hospital psychiatric unit. The staff team may be comprised of psychiatrists, mental health nurses, nursing assistants, occupational therapists, art therapists and so on.

What to expect: Day care is similar to the programme offered to inpatients and can include therapeutic activities such as occupational therapy and group therapy. The broad aim is to support clients to develop and maintain social integration, improve confidence, access local facilities and reduce isolation. There may be classes and activities such as art therapy, anxiety management, managing depression, anger management, confidence building/assertiveness training, and stress management. The aim of these courses is for clients to develop effective strategies to deal with their difficulties.

How to access: Patients may be referred to the day hospital after being discharged from a psychiatric unit. People may also be referred by the psychiatrist at the outpatient clinic or can be referred from other specialist services, such as the CMHT (see above).

Early intervention in psychosis services (EI services)

EI services are another new type of mental health service. Their aim is to prevent psychosis by intervening at an early stage. There is some evidence that early intervention can prevent psychosis and can help to prevent some of the worse consequences of psychosis, such as periods of unemployment, misuse of drugs or alcohol, getting into trouble with the police or becoming depressed. [8]

EI services are aimed at people aged 14-35 years old who are showing signs of experiencing a first psychotic episode. The service aims to support recovery by treating existing problems, and by working on strategies to help prevent problems from coming back. A variety of health professionals may be involved in the service, including psychiatrists, mental health nurses and psychologists. Many different types of support and treatment may be offered, including therapy, support with day-to-day living, help with drug and alcohol problems, information on local services such as self-help groups, and access to education and work.

EI services should also be able to support people who are supporting someone else through their first episode of psychosis. This might include involvement in decision making, understanding future plans, education on mental health and family therapy.

What to expect: All young people who experience psychosis for the first time should have early and intensive support; [9] however, availability varies depending on where you live. You will probably be assigned a keyworker to oversee your support. You should have a care plan which will cover areas important to you, not just your mental health. You should be able to see a member of the service somewhere where you feel comfortable, and someone should be available to speak to you on the telephone outside of normal office hours. The service should also be able to support you if your mental health becomes worse and you are in crisis. EI services can also refer you to other services that you might need such as a CRT, AO team or psychiatric hospital.

How to access: You don't have to be absolutely certain that you (or someone you are caring for) are experiencing psychosis in order to be accepted by an EI service. Instead, the service should be able to determine whether there is any possibility that you are experiencing psychosis. Sources of referrals will vary; for example, GPs, CMHTs and other mental health services (such as the CRT) and the hospital Emergency department. NHS Direct may be able to advise you about this.

NHS Direct

NHS Direct is a telephone advice line for people who are concerned about their physical or mental health. It provides a wide range of information and advice (e.g. details of mental health telephone helplines and local services). The advisers can send you information in the post (available in many different language), and provide you with web addresses for relevant organisations. They can discuss treatment options, medication issues such as side effects or what to expect from different services. The NHS Direct website (www.nhsdirect.nhs.uk) also provides information about mental health.

If you support someone with a mental health problem, or are worried about someone you care about, NHS Direct is a useful source of help, advice and information.

What to expect: When you call NHS Direct you will speak to a health adviser, who will ask for your name, telephone number and address. You can remain anonymous, but you will usually need to give a telephone number so that someone can call you back. The adviser will ask you about the problems you are experiencing or the information you seek. If you want medical advice, they will need to know how urgent your need is and will either put you straight through to a nurse, or will arrange for a nurse to call you back. If you need information, your call will be transferred to the information team, or someone will call you back. You should always be told how long to expect to wait for a call.

NHS Direct is a confidential service. The advisers will only tell other people what you have said if they believe someone is at risk.

If you call NHS Direct when you are experiencing a mental health crisis you will be put straight through to a nurse. Depending on what is happening, the nurse may call an ambulance, give you details of your local 24-hour CMHT, or call them on your behalf. In the rare cases where there is an immediate risk of harm to yourself or others, the nurse may call the police.

How to access: Contact NHS Direct on 0845 46 47. NHS Direct has general information on their services that they can post out. This is available in many different languages and they are able to access a translator for any language very rapidly. You can also visit www.nhsdirect.nhs.uk

Community-based social, housing and voluntary sector services

Befriending schemes

These are run by voluntary organisations including many local Mind associations. Volunteers are trained to give support and friendship on a one-to-one basis, either for an agreed length of time or on an ongoing basis.

How to access: You can ask to be part of a befriending scheme, and a referral is not usually needed. To find out whether you have a local befriending scheme call NHS Direct, visit your GP or practice nurse, or contact your local day centre.

Carer support

If you are supporting someone who is experiencing mental health difficulties, you may need help to carry on doing so, to care for your own health and to manage the balance between your caring role and other commitments.

Social services may be able to provide respite care. This could include taking over the caring work at times to provide you with a break; or offering practical services such as help with cleaning, or taxis for hospital appointments.

How to access: This is usually decided through a carer's assessment.

Community day services

Community day services such as drop-in centres are often run by voluntary organisations and may offer support, counselling, information about benefits, groups, classes and social activities.

How to access: Your doctor or care coordinator may refer you after an assessment, or you may be able to just turn up (self-referral).

Direct payments

If you have been assessed as being in need of social services (not health care), you may be entitled to receive a direct payment. With a direct payment, you choose what your budget is spent on and what services you receive, rather than care coordinators (or similar others) deciding for you.

How to access: This is typically through an assessment by someone who is usually your care coordinator or care manager within the CPA. They will have to decide whether they think you will be able to manage this yourself. You cannot be forced to receive direct payments instead of services.

Individual (personalised) budgets
This is another way in which you can receive money directly to enable you to pay for social care and services. This scheme is currently being extended to most of those who receive community care.

How to access: This is typically through a needs assessment, as with direct payments above.

Employment projects

Employment projects are usually based in a sheltered workshop and are largely for people with mental health problems.

Work might include printing greetings cards, working in a café or on a farm, or learning to use a sewing machine. Ongoing support is provided by a professional caseworker. This type of work is unlikely to affect your entitlement to benefits, although it is wise to check beforehand.

How to access: Your GP, mental health worker (or other care coordinator), local day centre or NHS Direct will be able to tell you about any employment projects in your local area.

Supported employment

Supported work is more flexible than employment projects. You could be working in a sheltered workshop or a large organisation. You will be supported while you work and may have opportunities for additional training. The Job Centre scheme New Deal has a supported element. Many projects are run by voluntary organisations; some are arranged through social services departments.

How to access: You may be able to refer yourself to one of these projects, or you may require referral from a specialist mental health service. Your GP, mental health worker or local day centre will be able to tell you about supported work schemes in your area.

Home help and 'meals on wheels'

Local councils can provide services such as laundry, 'meals on wheels' and home helps if social services think this will help you stay in your home or community.

How to access: Access to these support services is usually via a community care assessment.

Housing with care and support

These schemes provide furnished housing for people who can live independently but benefit from having access to support workers.

How to access: This is typically through a community care assessment. The service is means-tested, which means that you may have to pay to use it.

Residential care homes

This is 24-hour care provided by residential social workers, nurses and mental health support workers. Care homes are for people who need a high level of care and find it hard to manage in their own home.
How to access: This is through a community care assessment. The service is means-tested, which means that you may have to pay to use it.

Hostels

These provide short-term housing, with the aim of encouraging independence while supporting your needs. Workers include nurses, social workers and mental health support workers.

How to access: Access is usually following a community care assessment. The service is means-tested, which means that you may have to pay to use it.

Self-help and peer-support groups

Self-help and peer-support groups enable people to meet and share information, friendship and support. They often bring together people with a similar mental health issue, on a short- or long-term basis. Groups may be open to new members when forming, but may then close to new members to allow a sense of safety to be created.

How to access: Information may be held in a variety of places such as GP services, mental health services (such as a CMHT), the MindinfoLine, NHS Direct or your local day centre (see 'Useful organisations').

Social service support

If you are worried about yourself or if you support someone experiencing mental health problems, your local authority social services office can provide help and information.

How to access: Contact the duty social worker at your social services area office. You can find the number through the town hall, telephone directory or NHS Direct.

Therapeutic communities

These are shared houses where people usually stay for an agreed period of time. A residential therapist will usually help clients to work through and recover from mental health problems.

How to access: People are usually accepted following a community care assessment; however, the service is means-tested, which means that you may have to pay to use it. If you are interested in joining a therapeutic community, find out where your nearest community is (e.g. through NHS Direct) and contact someone there for specific advice.

Information and advice

Citizens Advice

Citizens Advice Bureaux and other welfare rights and advice centres offer free independent and confidential advice and support on a range of issues. These can include employment, housing, benefits, legal problems, debt, discrimination, immigration and others.

How to access: Visit www.citizensadvice.co.uk or look in the telephone book for details of your local service.

Local involvement networks (LINks)

LINks are made up of individuals and community groups who work together to improve local health and social care services. LINks find out what local people think of their services and can work with the service providers to make suggestions for change and help ensure that changes happen.

Every local council has employed an independent organisation to set up, advise and support the LINk in its area.

How to access: For information on your local LINk, contact your local social services department. For more information on LINks in general, visit www.direct.gov.uk/localinvolvementnetworks

Advocacy

Advocacy is about enabling people to say what they want, understanding their rights and obtaining the services that they need and are entitled to. People are entitled to be in control of their lives but, through mental health problems for example, may find that their ability to exercise choice or represent their own interests is limited. In these circumstances an advocate can help to make sure that your views are heard, respected and acted upon.

Advocacy support is needed in the mental health services because people who use these services can feel disempowered by the rules, procedures and health professionals who provide services. Advocates can help while you are in hospital as well as when you are living in the community.

Advocates are trained and experienced; often they are users or past-users of mental health services. They may work voluntarily or as paid workers. An advocate can help you to find the information you need to make an informed choice or decision. An advocate can also accompany you to a meeting about your services, and can represent your views if asked to do so. Advocates can sometimes help with problems with benefits, debts, police matters and your legal rights.

How to access: Citizens Advice, local Mind associations or national Mind, NHS Direct, your local mental health services, or your GP surgery/health centre may be able to tell you if there is an advocacy project in your area, or you could try looking in your local telephone directory. You can also go to the new LINks for information (see above).

Useful organisations

Carers UK
20 Great Dover Street, London SE1 4LX
tel: 020 7378 4999 (general)
carers line: 0808 808 7777
email: info@carersuk.org
website: www.carersuk.org
Carers UK aims to support, represent and fight for carers. They provide information, undertake campaigning and research, and host an online forum for carers.

Citizens Advice
tel: 020 7833 2181
website: www.citizensadvice.org.uk
Local Citizens Advice Bureaux provide advice on a wide range of issues by telephone and face-to-face. Details of local offices can be found via the website above. Alternatively, visit the following website for online advice: www.adviceguide.org.uk

Department of Health
tel: 08701 555 455
website: www.dh.gov.uk
The Department of Health (DH) is the Government ministry responsible for all health-related issues in the UK. The website provides the latest DH-related news and publications.

Directgov
website: www.direct.gov.uk
Directgov is a government website providing a wide range of general information as well as allowing users to search for information on local services.

Early intervention services
www.nimhe.csip.org.uk/our-work/early-intervention.html and www.csip-plus.org.uk/RowanDocs/EIupdateOct2006.pdf
The national Early Intervention (EI) in psychosis programme is funded by the National Institute for Mental Health in England - part of the Care Services Improvement Partnership (CSIP), and Rethink.

Information Commissioner's Office
Wycliffe House, Water Lane, Wilmslow SK9 5AF
helpline:  08456 30 60 60 or   01625 54 57 45
web: www.ico.gov.uk
The Information Commissioner's Office regulates and enforces access to personal information, and encourages access to official information. They can help you to find out what information is held about you and help you to access it.

Mental Health Care
web: www.mentalhealthcare.org.uk
This website is aimed at anyone providing support to someone experiencing mental illness. It contains information about mental health and mental illness, research findings from the Institute of Psychiatry and South London and Maudsley NHS Foundation Trust, and personal stories written by carers.

LINks
web: www.direct.gov.uk/en/HealthAndWellBeing/HealthServices/PractitionersAndServices/DG_071867
Local Involvement Networks (LINks) help people to influence and improve the way their local services are delivered. You can get involved in many different ways, from making comments through to more active engagement.

Mental Health Foundation
London Office, 9th Floor, Sea Containers House, 20 Upper Ground, London SE1 9QB
tel: 020 7803 1101
web: www.mentalhealth.org.uk
The Mental Health Foundation (MHF) is a national charity. The MHF conducts research, provides information and engages in campaigns with the aim of improving the lives of people with mental health problems. There is a Scottish MHF office that looks at mental health in a Scottish context.

MindinfoLine
Mind, PO Box 277, Manchester M60 3XN
tel: 0845 766 0163
email: info@mind.org.uk
The MindinfoLine provides a confidential information service about mental health issues such as where to go for help, medication, alternative treatments, advocacy and legal issues. You can write, telephone or send an email to receive information.

National Council for Voluntary Organisations (NCVO)
tel: 020 7713 6161
email: ncvo@ncvo-vol.org.uk
web: www.ncvo-vol.org.uk
The NCVO is a national charity providing support to people and organisations who work in the voluntary and community sector. This includes information, a free helpdesk service, lobbying and networking events.

National Institute for Mental Health (NIMHE)
Room 8E44, Quarry House, Quarry Hill, Leeds LS2 7UE
tel: 0113 254 5127
email: ask@csip.org.uk
web: www.csip.org.uk
NIMHE is the mental health programme of Care Services Improvement Partnership, which implements change and improvement in care services. Information on current events and consultations are available on the website, under 'National programmes'.

NHS Choices - Find service
web: www.nhs.uk/servicedirectories/Pages/ServiceSearch.aspx
This web page allows you to find services where you live, including mental health services and Emergency departments.

NHS Direct
tel: 0845 46 47
web: www.nhsdirect.nhs.uk
NHS Direct can provide information and advice on a wide range of health issues via telephone, email and the internet. They may also suggest further sources of support and send information in the mail.

Rethink
Head Office, 5th Floor, Royal London House, 22-25 Finsbury Square, London EC2A 1DX
tel: 0845 456 0455
advice service: 020 8974 6814
email: info@rethink.org or advice@rethink.org.uk
web: www.rethink.org
Rethink is a national mental health charity that provides information and advice, and engages in research and campaigning on mental health issues. They also provide services at a local level, such as advocacy projects.

Royal College of Psychiatrists
National Headquarters, 17 Belgrave Square, London SW1X 8PG
tel: 020 7235 2351
email: rcpsych@rcpsych.ac.uk
web: www.rcpsych.ac.uk
The Royal College of Psychiatrists is the professional body representing psychiatrists throughout the UK. Their website has a useful mental health information section.

Samaritans
PO Box 9090, Stirling FK8 2SA
tel: 08457 90 90 90
email: jo@samaritans.org
web: www.samaritans.org.uk
The Samaritans provide confidential and non-judgmental support to people who are feeling overwhelmed by emotions or distress and/or who may be feeling suicidal. They are available 24 hours a day by telephone, email, letter and face-to-face.

Social Care Institute for Excellence (SCIE)
Goldings House, 2 Hay's Lane, London SE1 2HB
tel: 020 7089 6840
email: socialcareonline@scie.org.uk
web: www.scie-socialcareonline.org.uk/
SCIE's aim is to improve social care services for adults and children in the UK. They try to do this through research and disseminating information on good practice. They have lots of high quality information on social care services that is available to the public.

Supporting People
Communities and Local Government, 2 Victoria Street, Glossop SK13 8AB
web: www.spdirectory.org.uk
Supporting People provides housing-related services to help improve people's quality of life and create stable living environments. Their website provides a searchable directory of helplines and local services.

Together
Together national office , 12 Old Street, London EC1V 9BE
tel: 020 7780 7300
email: contactus@together-uk.org
web: www.together-uk.org/
Together is a national charity that works with people with mental health problems to help them get what they want out of life and increase their happiness.

UK Advocacy Network (UKAN)
Volserve House, 14-18 West Bar Green, Sheffield S1 2DA
web: www.u-kan.co.uk

UKAN is the national organisation for service user-led advocacy, and the website gives information on local advocacy groups, self-help groups and forums.

Further reading

Mind factsheets and legal briefings

• Who's who in mental health: a brief guide
• Carers factsheet: How to access services, information for carers
• Children and young people and mental health
• Crisis services
• Legal briefing: Confidentiality and data protection
• MHA Briefing 1: Amendments made to the Mental Health Act 1983 by the Mental Health Act 2007

Mind booklets

(available to purchase from Mind Publications on 0844 448 4448 or publications@mind.org.uk)

• How to cope as a carer
• Mind guide to advocacy
• Minds rights guide 1: admission to hospital
• Mind rights guide 6: community care and aftercare

Other publications

Rethink Factsheets (download or order free from Rethink shop at 0845 456 0455)

• Assertive Outreach (Rethink 2007)
• Crisis Resolution (Rethink 2006)
• Getting more from your GP Practice (Rethink 2004)

Early intervention for people with psychosis (NIMHE Expert Briefing 2003)

Mental Health Topics: Assertive Outreach (SCMH 2001

The Mental Health Team (Royal College of Psychiatrists Mental Health Information 2006) 

References

[1] Department of Health (DH), 2007, Putting People First: A Shared Vision and Commitment to the Transformation of Adult Social Care, London: DH.
[2] Department of Health (DH), 1999, National Service Framework for Mental Health: Modern Standards and Service Models, London: DH.
[3] Department of Health (DH), 1999, National Service Framework for Mental Health: Modern Standards and Service Models, London: DH
[4] Department of Health (DH), 2001, The Mental Health Policy Implementation Guide, London: DH.
[5] Department of Health (DH), 2000, The NHS Plan: A Plan for Investment, A Plan for Reform, London: DH.
[6] Department of Health (DH), 2000, The NHS Plan: A Plan for Investment, A Plan for Reform.
[7] Department of Health (DH), 2001, The Mental Health Policy Implementation Guide, London: DH.
[8] Smith J, Shiers D and Purdy R, October 2006, UK Early Intervention Community: An Update on a Growing Social Movement Delivering Better Life Outcomes for Young People, Care Services Improvement Partnership (CSIP) and National Institute for Mental Health in England (NIMHE): http://www.csip-plus.org.uk/RowanDocs/EIupdateOct2006.pdf.
[9] Department of Health (DH), 2001, The Mental Health Policy Implementation Guide, London: DH.

Written by Jan Wallcraft and Angela Sweeney August 2008
Dr Jan Wallcraft is a freelance researcher and consultant on service user perspectives in mental health. Angela Sweeney is an independent survivor researcher and consultant who has been involved with the mental health service user/survivor movement for 15 years.

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