LISA ARCHIBALD—2013 WINSTON CHURCHILL FELLOW

”COMMUNITIES THAT WORK” CATEGORY

CHALLENGING PREJUDICE AND DISCRIMINATION DIRECTED TOWARDS

PEOPLE WITH MENTAL HEALTH CHALLENGES IN COMMUNITIES

“He aha te mea nui o te

Ao? He tangata, he

tangata, he tangata”

“Let me ask you, what is

the most important thing

in this world?

It is people, it is people, it

is people”

ACKNOWLEDGEMENTS:

I DEDICATE THIS REPORT TO MY KIND, INTELLIGENT, REFLECTIVE FATHER, ARCHIE, WHO PASSED AWAY FROM MOTOR NEURONE DISEASE 6 WEEKS BEFORE I BEGAN MY FELLOWSHIP. I FEEL THANKFUL TO HAVE BEEN

GIVEN THE OPPORTUNITY TO TRAVEL THE WORLD, A CHANCE HE NEVER HAD.

THANKS TO: WINSTON CHURCHILL MEMORIAL TRUST FOR THE LIFE CHANGING OPPORTUNITY.

THE AMAZING STAFF, COMMITTEE AND MEMBERSHIP OF NEW HORIZONS BORDERS, SIMON BRADSTREET AND THE SCOTTISH RECOVERY NETWORK TEAM, MEG ROPER AND BVCV, GRAHAM MORGAN AND ALL AT HUG, THE

INSPIRING LORRAINE NICHOLSON, HILARIOUSLY FUNNY AND POETIC EDINBURGH JO, RON COLEMAN AND KAREN TAYLOR, GLENN MERRILEES, HELEN GRAY, SUE BAKER, MENTAL HEALTH FOUNDATION (SCOTLAND), DR RACHEL

PERKINS, JOAN BREE AND SEE ME, JANETTE WESTHEAD, GROW, LIKE MINDS LIKE MINE, MARY O’HAGAN AND THE PEERZONE TEAM, MARGE JACKSON AND KITES, MAGDEL HAMMOND AND CONNECT, CASSANDRA LASKEY AND

EVERYONE AT MATARAKI, COUNTIES MANAKAU DISTRICT HEALTH BOARD, BLUEPRINT, MIND & BODY, FRANK BRISTOL AND BALANCE, FELLOW SCOT SHAUN MCNEIL AND THE CHATTY JOSHUA PALMER AT WELLINK, THE

BRILLIANT CHRISTCHURCH MENTAL HEALTH FOUNDATION TEAM AND THE ASTOUNDING ALL RIGHT CAMPAIGNERS, SUE RICKETTS AND MHAPS, MY IPS MENTOR DAWN HASTINGS, COMCARE, THE VERY FUNNY GAYLE BRISLANE AND THE DEPRESSION SUPPORT NETWORK, VAL DOCKERTY AND HER HOSPITABLE FAMILY,

GRANT COOPER AND EVERYONE AT OTAGO MENTAL HEALTH SUPPORT TRUST, TE ARA KOROWAI, MARY EASTON AT JOURNEYS TO WELLBEING, SUPPORTING FAMILIES IN WHANGANUI, THE VERY KIND AILSA FENTON AND

EVERYONE AT FOOTSTEPS, PACT, RAEWYN CLARKE AND SOUTHLAND DISTRICT HEALTH BOARD, DESLEY CASEY AND CAN MENTAL HEALTH NETWORK. ALSO THANKS TO JULIE REPPER, STEVEN MORGAN, SHERY MEAD (IPS)

FOR THEIR INSPIRATION.

THANKS ALSO TO MY FAMILY AND MY FRIENDS WHO HAVE FAITH IN MY ABILITIES EVEN WHEN I DON’T.

“NEARLY NINE OUT OF TEN PEOPLE WITH MENTAL ILL HEALTH SAY THAT STIGMA AND DISCRIMINATION HAVE A NEGATIVE EFFECT ON THEIR LIVES. SOCIETY IN GENERAL HAS STEREOTYPED VIEWS ABOUT MENTAL ILLNESS AND HOW IT AFFECTS PEOPLE. MANY

PEOPLE BELIEVE THAT THOSE WITH A MENTAL ILLNESS ARE VIOLENT AND DANGEROUS, WHEN IN FACT THEY ARE MORE AT RISK OF BEING ATTACKED OR HARMING THEMSELVES

THAN HARMING OTHER PEOPLE” (MENTAL HEALTH FOUNDATION).

“The stigma of mental ill-health is based on ill-

founded prejudices which have been with us for

a long time.

People in Scotland with mental ill health are

discriminated against in day to day life.

Stigma and discrimination due to mental ill-

health should not still be with us...[It] damages

people’s hopes, lives and relationships

(SEE ME)

AN EXTRACT FROM “BARRIERS” BY GLENN MERRILEES

THERE’S PEOPLE THROWING INSULTS

THERE’S PEOPLE THROWING STONES

YOU CANNOT SEE THIS ILLNESS

NO SIGN OF BROKEN BONES

SO MANY NASTY COMMENTS

REMARKS ARE SO UNKIND

YOU CANNOT SEE THIS DARKNESS

THIS POISON IN THE MIND.

HEY LOOK, THAT GUY IS MENTAL

A LOONEY, WHAT A WASTE

YOUR BITTER, TWISTED

COMMENTS

LEAVE AN ACRID TASTE.

JUST REMEMBER I’M A VICTIM

TO THIS PAIN YOU CANNOT SEE

DEPRESSIONS MADE A HOME IN

HELL

ESPECIALLY FOR ME.

DO NOT JUDGE THIS COVER

YOU SIMPLY HAVE TO LOOK

I’M DROWNING IN A SEA OF PAIN

PAGES MISSING FROM THIS BOOK.

WOULD YOU BERATE THE LOWLY

CRIPPLE

AND CALL POOR SOUL A NAME

MY ILLNESS NEEDS NO CRUTCHES

HANG YOUR HEAD IN SHAME.

PEOPLE’S EXPERIENCES OF DISCRIMINATION IN SCOTLAND

“BECAUSE I HAVE A

MENTAL HEALTH

DIFFICULTY, NOBODY

TRUSTS ME, THEY

DON'T LISTEN TO ME,

THEY DON'T BELIEVE

ME, THEY DON'T

ACTUALLY THINK THAT

I’VE GOT A BRAIN”

HUG MEMBER, STIGMA:

MARKED BY SOCIETY?

DVD

“I’VE BEEN VICTIMISED AND BULLIED FROM

TEACHERS, PUPILS, THE WHOLE SHEBANG. I WAS A

VICTIM AT HOME AND A VICTIM OUT IN THE

COMMUNITY.

I’VE ALWAYS BEEN PICKED ON. I WENT TO A

FESTIVAL ONE YEAR AND SOMEONE CAME UP AND

SAID I WAS A PSYCHO AND A WHOLE BUNCH OF

THEM STARTED JOINING IN. IT WAS HORRENDOUS.

I WENT HOME AND GOT VERY DRUNK. I WAS

VULNERABLE, I WAS ISOLATED. I WAS TERRIFIED

BUT NOW I’M NOT. FOR ME NOW, I TELL PEOPLE, I’M

NUTS AND PROUD BECAUSE FOR ME IT DOESN’T

MATTER WHAT DIAGNOSIS I’VE BEEN GIVEN IT

DOESN’T DEFINE WHO I AM ANYMORE. I HAVE MY

VULNERABILITIES BUT I DON’T LET IT RUN MY LIFE

ANYMORE. I’M HAPPY TO TALK ABOUT IT. I WANT TO

TALK ABOUT IT. “

HELEN, SCOTTISH BORDERS

I’VE BEEN STIGMATISED AND TRAUMATISED

FUR WHIT, I’VE DONE NO CRIME

LABELS THRUST UPON ME

NOO I’VE GOAT TAE SERVE THE TIME.

I’M A VICTIM, I’M A TARGET

DEPRESSIONS DEADLY CURSE

YER LOOKS, YER TWISTED WHISPERS

IT ONLY MAKES IT WORSE.

WE’VE GOAT TAE STOAP THIS STIGMA

WIPE IT OFF THE PLANETS FACE

WE’RE JUST PEOPLE WITH AN ILLNESS

PART OF THE HUMAN RACE.

FROM “STIGMA” BY GLENN MERRILEES

LORRAINE NICHOLSON, ARTIST AND POET FROM PERTH, UK, RECENTLY TOLD ME:

“I DIDN'T KNOW ANYONE WHO HAD DEPRESSION SO STIGMA KICKED IN EARLY. PEOPLE DON’T TALK ABOUT IT SO I FELT I WAS THE ONLY PERSON IN THE WORLD EXPERIENCING THESE SYMPTOMS. I DECIDED TO TACKLE STIGMA AND IT WAS ONE OF THE BEST THINGS

I DID, I WENT PUBLIC… CONSEQUENTLY I REALISED I WASN'T THE ONLY ONE, LOTS OF PEOPLE WERE AFFECTED BY DEPRESSION BUT STIGMA STOPPED THEM FROM TALKING

ABOUT IT“.

GRAHAM MORGAN OF HUG SPOKE OF AN INCIDENCE OF STIGMA HE HAD EXPERIENCED A FEW YEARS AGO:

“FLYING HOME FROM SPAIN, I GOT TO THE AIRPORT, ARRIVED REALLY EARLY AND

SOMEONE WAS ASKING WHAT I DID. I SAID I WORKED IN MENTAL HEALTH. HE SAID “WHY DO YOU DO THAT?”. I SAID “I HAVE A DIAGNOSIS OF SCHIZOPHRENIA”. HE TURNED

AROUND AND SAID “PEOPLE LIKE YOU ARE SCUM AND SHOULD BE WIPED OFF THE FACE OF THE EARTH AND DON’T DESERVE TO EXIST”. THAT’S THE BIGGEST THING AROUND

STIGMA THAT I HAVE EXPERIENCED. BUT THEN THERE ARE OTHER ONES THAT ARE MUCH MORE CONFUSING, I THINK, IS THIS STIGMA OR IS IT NOT?”

I AM LISA ARCHIBALD, SERVICE MANAGER OF A MEMBERS

LED CHARITY WHICH FACILITATES PEER SUPPORT SELF

HELP GROUPS AND COLLECTIVE ADVOCACY IN THE

SCOTTISH BORDERS.

THROUGH EXPERIENCE OF LIVING AND WORKING IN

SCOTTISH RURAL COMMUNITIES, I HAVE BEEN

INCREASINGLY AWARE THAT MANY PEOPLE, FEEL

“ASHAMED” OF TALKING ABOUT MENTAL HEALTH AND THAT

THEY HAVE “HAD TO HIDE IT” WHEN THEY ARE STRUGGLING.

PEOPLE HAVE DESCRIBED TO ME THE FEELING OF BEING “A

VICTIM IN THE COMMUNITY” AND OPENLY CALLED

OFFENSIVE TERMS LIKE “NUTTER” AND “PSYCHO”.

The language we use in the world of mental health has long been debated and the

opinions vary enormously!

However, it is important to recognise that language can reinforce stereotypes and can

increase discriminatory attitudes.

“The whole concept of ‘mental illness’ as an explanation of distressing human

behaviour has come into question. Calling something an illness does not make

it one, and psychiatrists have yet to demonstrate the existence of the illnesses

they have named and defined” (Chamberlin, 1987)

New Zealand is a country that benefits greatly from the beauty of the Maori language

and their models of health which are far more holistic and less clinical

In Maori, they talk about“Tangata Whaiora” – People Seeking Wellness

Traditional Māori health acknowledges the link between the mind, the spirit, the human

connection with whanau (family), and the physical world in a way that is seamless and

uncontrived.

Until the introduction of Western medicine there was no division between them.

The Māori philosophy towards health is based on a wellness or holistic health model.

For many Māori the major deficiency in modern health services is taha wairua (spiritual

dimension).

For Maori and Pacific people in particular, they generally see “mental illness” as a

pakeha (white European settlers) construct. They instead view mental well being as an

equal contributory part of our health along with family (whanau), physical well being

and spirituality. There are fantastic examples of Maori and Pacific models of health

which are used across mainstream health & education departments in New Zealand

not just within the cultural services.

Te Whare Tapa Wha (Mason Durie)

The four cornerstones of maori health are family, physical health, mental wellbeing and spirituality.

Te Wheke (Rose Pere)

The concept of Te Wheke, the octopus, is to define family health. The head of the octopus

represents te whānau, the eyes of the octopus as waiora (total wellbeing for the individual and

family) and each of the eight tentacles representing a specific dimension of health. The

dimensions are interwoven and this represents the close relationship of the tentacles.

Te whānau – the family

Waiora – total wellbeing for the individual and family

Wairuatanga – spirituality

Hinengaro – the mind

Taha tinana – physical wellbeing

Whanaungatanga - extended family

Mauri – life force in people and objects

Mana ake – unique identity of individuals and family

Hā a koro ma, a kui ma – breath of life from forbearers

Whatumanawa – the open and healthy expression of emotion

Fonofale

This is one of the Pacific Island model’s of health. The roof reflects the cultural values and beliefs

that shelter the family for life.

The four pou (posts) connect culture and the family but are continuous and interactive with each

other.

Pou 1 is spirituality (not necessarily religion),

Pou 2 is physical health,

Pou 3 is mental health and

pou 4 is other factors in the person’s life.

Surrounding this are the aspects of environment,

time and context.

Te Pae Mahutonga: Mason Durie

Te Pae Mahutonga (Southern Cross Star Constellation) brings together elements of

modern health promotion.

These models of working are holistic, effective and view someone’s mental health as just

one part of their overall wellbeing, but they are all very culturally specific. They draw on the

beauty of the Maori and Pacific languages and spirituality, so are very appropriate for use

in New Zealand.

When spending time within some of the services in New Zealand who had a high

prevalence of consumers from the Maori communities, I was very aware that people would

draw similarities from their culture to mine as a Scot. For Maori people, ancestry and

genealogy is of huge importance. Many people I spoke with made comparisons between

the European settlers coming to New Zealand and the forced displacement of people

during the Scottish Highland clearances.

On a number of occasions, I was asked what clan I was from, referring to their Maori iwi

(tribes) and hapu (sub tribes/ clans). This made me very aware that as Scots, many of us

have experienced a loss of identity. However, as the move towards independence is taking

place it is becoming more apparent that Scottish people are re-embracing this aspect of

who they are. This could be an opportunity for a Scottish model of working to be introduced

that better meets the needs of our people using a language we can identify with.

The use of language and how people view mental health was a large topic of discussion

when I visited Mind and Body in Auckland.

Jim Burdett, Chief Executive:

“we are all on a continuum of human experience. We all experience wellbeing and

distress. It is an unsurprisingly appropriate human response to circumstances and

experiences, past and present”.

“you can reframe mental illness or create a new construct for mental illness.

Because it is something out there and the construct for a couple of hundred years

has been a scientific one that is to do with doctors, the health system and cured

with pills. But it is too universal to be anything other than a human problem”.

A fundamental human experience?

In the UK, most services are still constructed around scientific language, medication, care

plans, assessment and diagnosis.

New Zealand is instead generally viewing mental well health from a more holistic, human

experiential perspective. Therefore it is something we could all be affected by. Rather than

being seen a problem, challenge or something to “suffer from”, it is viewed more like a

journey therefore it is something we can move forwards from.

This approach is a key part of reducing stigma and discrimination.

After all, if it is reframed to be a “human experience” rather than about illness and deficit, it

reduces the likelihood that people will feel different which minimises the shame and guilt

people feel which often leads to self-stigma.

Dr Rachel Perkins is a UK psychiatrist (and former Winston Churchill fellow) who has lived experience of mental ill

health has written numerous papers on this subject. I was fortunate to interview her prior to beginning my

fellowship. Interestingly, Dr Perkins highlights the importance of the language used, preferring the terms

oppression, discrimination, exclusion or prejudice to stigma.

Dr Perkins believes that we need to create communities that can accommodate & provide opportunities for people

with mental ill health as equal citizens rather than medicating and treating individuals separately for their

"problems".

This viewpoint very much mirrors that of many of New Zealand’s services. It raises questions about whether the

current UK health system is meeting the needs of people by focussing mostly on medication and clinical input in

order to fix a problem seen to lie within the individual rather than addressing discrimination and prejudice that

happens in society.

Of huge concern is the observation that "People experience more discrimination in mental health services

than anywhere else“ (Dr Rachel Perkins).

This seems to be a common view shared by many people with experience of using UK mental health services.,

So how can we reduce this discrimination people are experiencing within the health service?

“Research shows that the best way to challenge stereotypes is through first hand contact

with people with lived experience of these challenges”. (Mental Health Foundation—

www.mentalhealthfoundation.org.uk).

However, first hand contact in itself is not enough, to be effective, the contact needs to “be on

equal terms with common goals in order to have a positive impact on attitudes and

beliefs” (Corrigan et al, 2011).

This is also called The Power of Contact and has been explored by Case Consultancy in 2005.

The Peer Worker and Consumer Advisor roles are valued and integrated in Australia and New

Zealand’s health services. These are roles which are reducing discrimination within the health service through the power of contact with people who have lived experience.

18

In 2005, Case Consulting Ltd published “The Power Of Contact”. This identifies the 3 fundamental

strategies for countering stigma and discrimination:

Education—replacing myths about mental distress with correct information

Contact—challenging discriminatory attitudes and behaviour through direct interactions with people

who experience mental distress

Protest—actions which suppress discriminatory attitudes and behaviours towards people who

experience mental distress.

The most important aspect of “The Power of Contact” is that it is not based on a one off interaction

but instead is about on going relationships.

The contact has to be:

• Based on equal status

• An ongoing developing of a relationship

• With mutually agreed goals

Scottish Recovery Network has supported the creation of Peer Worker roles in Scotland and we are

seeing some progress in this being now recognised as a valuable model of support.

However, while the Peer Worker role is progressing in the UK we still continue to have “service user

representatives” who are often untrained volunteers given a fairly tokenistic role in strategic

meetings and forums.

If we introduce paid, trained, supported “Consumer Advisers” posts (I prefer the title “Advisers

with Experience”) to UK health boards as they have done in Australia and New Zealand, we would

see the views of people who have experience being of equal contributory value to those of clinicians.

This will start to reduce the discrimination that takes place within the health services as it creates a

shift in the power balance and sense of “us and them” that exists. It will also make clinicians more

aware of the language they use in strategic processes which can often be discriminatory and deficit

based.

“It changes things from ‘once a consumer always a consumer’ to ‘once a consumer,

now a colleague’.

This is a cultural shift that helps everyone.

The introduction of a peer workforce is potentially the most effective catalyst for

synergizing cultural change in the services.

People who are open about their experiences and willing to be vulnerable suddenly

discover that there is a huge strength in that vulnerability. It reframes it. We slowly

change the world one relationship at a time.

The more we start the peer movement off about who we are, where we come from and

what’s happened to us is a whole different conversation in the services that have

been set up to describe what’s wrong with us.”

Frank Bristol, Consumer Advisor, Balance

New Zealand and Australia are also delivering some excellent awareness raising and educational

courses in communities, with employers and in services funded by Like Minds Like Mine (their

anti-stigma programme).

The best example I came across was MH101 by Blueprint (www.blueprint.co.nz) which had

outstanding results in terms of leading to long-term behaviour and attitudinal change in

participants.

I am fortunate that they agreed to share their materials with me and are open to discussing the

design of a culturally specific version of MH101 for delivery in Scotland.

DISCRIMINATION AND PREJUDICE DIRECTED

TOWARDS PEOPLE WITH MENTAL ILL HEALTH IS

NOT SIMPLY A UK ISSUE. ATTITUDES VARY

ACROSS THE WORLD AS THIS TIME TO CHANGE

(ENGLAND’S MENTAL HEALTH ANTI-STIGMA

PROGRAMME) MAP DEMONSTRATES. TO

RESPOND TO THE GLOBAL COMMONALITY OF

STIGMA AND DISCRIMINATION, THERE ARE NOW

MORE ANTI-STIGMA PROGRAMMES THAN EVER.

DURING MY FELLOWSHIP. I TRAVELLED TO NEW

ZEALAND AND AUSTRALIA TO EXPLORE WHAT

IMPACT THEIR ANTI-STIGMA CAMPAIGNS WERE

HAVING ON PEOPLE IN THEIR DAILY LIVES. MY

FELLOWSHIP HAS GIVEN ME THE OPPORTUNITY

TO SHARE LEARNING INTERNATIONALLY AND

ALSO TO HIGHLIGHT, WITHIN THIS REPORT AND,

THROUGH MY SOCIAL MEDIA FELLOWSHIP

BLOG, SOME EXAMPLES OF GOOD PRACTICE.

TACKLING STIGMA AND DISCRIMINATION IN

MENTAL HEALTH IS A GLOBAL CHALLENGE AND

WE CAN LEARN FROM SUCCESSES ACROSS THE

WORLD, IN PARTICULAR LIKE MINDS LIKE MINE

WHICH IS NOW 5 YEARS AHEAD OF SEE ME AND

INTERNATIONALLY RECOGNISED AS A SUCCESS.

The Like Minds Like Mine anti-stigma movement has been delivering education and training to

communities throughout New Zealand since 1997. Internationally it has been recognised as a ground

breaking programme. The campaign has been led by and has focussed on the participation of people

with lived experience of mental distress since it’s inception.

This is recognised as the main reason behind it’s success

Like Minds Like Mine has two strategies.

• A national mass media and communications campaign.

• Regional programmes which meet the needs of communities led by local organisations who can

create innovative responses to specific issues of stigma and discrimination.

The programme has 3 outcomes:

Individual outcomes—for people experiencing mental distress to have the same opportunities as

everyone else to participate in society and in every day life of their communities.

Organisational outcomes—to have practices and policies that ensure people are not discriminated

against

Societal outcomes—nationally valuing and including people who experience mental distress.

Like Minds Like Mine achieves these outcomes in 3 ways:

• By providing opportunities for direct contact with people who experience mental distress.

• By promoting people’s rights and challenging the organisations and communities who discriminate.

• By delivering evidence based education and training facilitated by people with lived experience.

Local services are funded to facilitate training, awareness raising sessions and educational opportunities

to groups of people who are in a position to influence the life decisions of people who experience mental

distress.

Specific audiences are targeted in order to meet the outcomes of the programme and make the biggest

impact on communities.

Targeted groups include employers, family, housing providers, the media, community leaders, criminal

justice and government agencies such as work and income (the NZ employability and welfare benefits

services).

The Mental Health Strategy for Scotland 2012—15 prioritises “extending the anti-stigma agenda

forward to include further work on discrimination” and to “focus on the rights of those with a

mental illness”.

A reassuring recent development has been the 2013 announcement from the Scottish Government

that together with Comic Relief it will invest £4.5 million into a 3 year anti-stigma and discrimination

national programme.

This new investment is therefore an ideal opportunity to direct additional resources into localised,

targeted education programmes led by people with lived experience in order to lead to attitudinal and

behavioural change. This approach has proven to be successful with the Like Minds Like Mine

campaign in New Zealand. This is the most effective way Scotland can challenge prejudice and

discrimination which will in turn improve the lives of people with mental ill health in communities.

Public education through people “speaking out” locally can help change the perceptions of what

someone with a mental illness looks like or acts like. Training in communities and with employers

such as Blueprint’s MH101 would also be helpful.

Scottish Recovery Network has developed a new nationally recognised award for peer workers.

Whilst it is no doubt vital that Peer Workers should access training which will enhance their practice

and confidence in their role, adopting a structured model of working or using a values framework such

as the one SRN have developed (Smith and Bradstreet, 2011; Scottish Recovery Network, 2012) is of

more value than accredited qualifications. It also allows workers to “stay peer” (Perkins) and retains

that their experience is what makes them experts, not a qualification.

In the United States where peer-involved services have existed for some time, leading commentator

and trainer Shery Mead has defined peer-support as a ‘system of giving and receiving help

founded on the key principles of respect, shared responsibility, and a mutual agreement of

what is helpful’” (Mead et al, 2001).

Most of the services I visited in New Zealand and Australia that were offering a Peer Worker service

had opted to work within the Intentional Peer Support model (IPS) which has its roots in the USA

with Shery Mead, a peer consultant.

Intentional Peer Support (IPS) focuses on the connection between two people in a peer relationship

concentrating on learning and growing. IPS is about two way relationships which differs greatly from

the traditional power imbalanced relationship of clinician-client.

The model sees the person, not the clinical diagnosis or label they are given and is about well being

not illness. The relationships are not friendships and have a specific purpose. However there is

compassion and emotional safety as the person accessing peer support feels encouraged, heard

and not judged.

There are some examples of services in England, such as Chard Intentional Peer Support group in

Somerset, who are using the IPS model successfully following training from Shery Mead.

Currently the Intentional Peer Support model is not being offered within services in Scotland. Having

this model available would provide a structure to the fantastic work already being carried out which

is primarily informal and based within the voluntary sector.

In March, I will travel to Vermont in the USA on a scholarship to complete the Intentional Peer

Support training with the view to becoming an IPS Facilitator so this model can be available to peer

services in Scotland.

During my fellowship, I visited a number of outstanding services. Too

many to be able to explore in detail. The full list of services I visited

are at the end of this report.

I have chosen a few of the more memorable visits which are

examples of good practice that we can learn from in Scotland and in

the UK.

In Auckland, I visited a number of peer run acute residential respite services with Magdel

Hammond, General Manager of Connect. I was fortunate to chat with one of the guests at the

newly opened peer led residential Rodney service, Piri Pono, who, after a 10 day stay was getting

ready to go home

“For the first time ever I am able to properly communicate. Having just a few people here

means you get to know each other well, we really care about each other. In hospital, there

are too many people. The staff work 12 hour shifts and just don't care. Here you have time,

people care. I have learned so much about my own needs and my own healing. It's homely

and the colours are neutral, it's like a home but better. It feels calm.“

Guest, Piri Pono.

Having access to a welcoming home run by peers that used non-clinical language was a very

effective an alternative to hospital. Instead of being referred to as service users, consumers, clients

or patients, people are “guests”. They receive biographies of the peer workers and can select who

they feel they would like to be matched with. Through my discussions with the staff and the guests,

it was obvious that Connect created an environment of healing.

Balance, Whanganui

Balance in Whanganui is a peer run mental health charitable trust that makes a huge difference in the lives of

those affected by mental health and addiction issues in that area.

The kaupapa (mission) of Balance is “to provide high quality peer support, education, advocacy and training to

people (tangata whai ora) affected by mental health and addiction issues” Balance does this by providing

intentional self care (WRAP) and purposeful relationships (Intentional Peer Support).

When talking about his own recovery journey, David, a Like Minds Like Mine co-facilitator and advocacy

worker with Balance described it using the Japanese proverb “fall down 7 times, get up 8”.

“I think [the peer work force] could be a huge part of driving the change” Frank Bristol

Mental Health Foundation, All Right Campaign, Christchurch

Christchurch is the largest city on the south island of New Zealand with a population of 341,000 people in

the region of Canterbury. Between 2010 and 2012, the Canterbury region experienced more than 4000

earthquakes registering 3.0 or more.

The earthquakes led to an enduring physical and mental health impact on people in Canterbury. Some of

the psychosocial effects of a natural disaster include insecurity, uncertainty and a feeling of having lost

control. People in Christchurch lost jobs, homes, schools, routines and possessions. 185 people lost their

lives and a reminder of this is the haunting “185 empty chairs” art installation which features in an area of

wasteland in central Christchurch.

An outcome of the earthquakes was an increase in

collaborative working and an increase in community

participation and mutual support in order to enhance

resilience

“People are grieving for a lost city. It’s

difficult to describe, measure or

articulate it. That’s what you are living

with day to day. What do we have to be

proud of? Where’s our city?”

Ciaran Fox, MHF

The Mental Health Foundation in Christchurch developed the All Right? Campaign which aims to

maintain and increase the mental health and well being of the people of Canterbury.

All Right? Is pitched at articulating to people how they can check in with themselves and others. “When

a crisis happens, people automatically check on each other – sharing water, running generators,

making soup. Humans have evolved that way, we are designed that way” Ciaran Fox, MHF

The most successful aspect of the All Right?

Campaign is that the messages are fun, upbeat and

positive. They are also placed where people are

affected. They have not presented it as an earnest

public health campaign but instead it is marketed

“like a coke ad”.

In addition to the positive messages that are presented across Christchurch to inspire hope, they

have also created “short bursts of all right”. These short video clips are present on social media

and you tube and are events/ stunts that catch the viewers’ attention instantly. The message is to

encourage people to think about how they are feeling but in a warm, empathic and gentle way.

The videos are funny, uplifting and inspiring.

Blueprint, Wellington

Blueprint have developed a one day workshop called MH101 which is aimed at giving people confidence to recognise,

relate and respond to people experiencing mental ill health. It focusses on the wellbeing of people and communities.

This resource can be used with employers, communities, families and services such as housing or welfare to give an

understanding of mental health and the importance of managing well being. As the training is co-facilitated by a person

with lived experience, it is successful in achieving that most important aspect of the “power of contact” when educating

people

“We educate people from a service user’s point of view, we challenge people within the training… A reason a

lot of clinicians don’t understand recovery is because no-one’s ever explained it to them and when you go to

medical school, you don’t get recovery training – it’s all D.S.M. and counselling” Sonja Goldsack, Blueprint

MH101 has been running for 5 years. Prior to it’s development, mental health literacy in the Department of Work &

Pensions, housing and A&E was really low as people had no access to training. The results are impressive – at the

start of the training, most people have a confidence level of 15-20% but by the end it is 70-80%. An important

measurement is that when the 3 month follow up takes place, there has been no reduction.

Facilitating MH101 sessions within services, communities and with employers is a really effective way of creating

attitudinal and behavioural change among people who previously had little understanding of mental health. This is

therefore one method that could reduce stigma and discrimination.

Wellink, Wellington

Wellink aims to create an environment that enhances recovery and wellbeing for people within the community who

experience extreme mental distress, as well as for their family, *whānau and other loved ones. The foundations of

our recovery environment include hope, positive use of personal power, self-determination and, most importantly, a

sense of belonging

Wellink have developed a very effective visual, interactive recovery tool based on the Te Wheke model.

“We want fully inclusive and diverse

communities that are accepting of

people with all differences, whether they

be mental health or whatever.

Connections with communities are

ongoing”

Shaun McNeil, Wellink

Peerzone, Wellington

Peerzone was created by Mary O’Hagan and Sara McCook Weir who have developed eighteen

workshops for people to explore their recovery and wellbeing in a fun, safe, peer group setting.

They currently run Peerzone programmes in New Zealand and Australia. This service offers an

intentional practice tool for peer workers who can facilitate PeerZone as part of their work.

In her paper “Peer Support in Mental Health and Addictions: A background paper” (2011), Mary

O’Hagan reinforces that the two key values most unique to peer support are “reciprocity” and

“experiential knowledge”. She refers to some of the oldest examples of peer support taking

place in the indigenous traditions such as Maori healing rituals and Aboriginal sharing circles.

However, it is now becoming more recognised with the best known examples being the Alcoholics

Anonymous 12 steps programme, Mary Ellen Copeland’s WRAP and Shery Mead’s Intentional

Peer Support. Within the report, it is cited that “peer respondents said the best type of

agencies to ‘house’ peer support services are small, non-profit, community or peer-driven

with a flat hierarchy and consensus decision making” (O’Hagan et al, 2010)

Kites, Wellington

The Kites service empowers consumers to take part in decision making processes. They offer a fantastic “buddies”

service which is a peer support programme which increases community participation for people who have been in

hospital.

They are also developing Toka Tu which is an evaluative tool for NGO’s (voluntary sector organisations) providing peer

support. Tōka Tu is about understanding what resources and support peer support providers need to evaluate their

effectiveness and so evidence their value

Kites are Like Minds Like Mine providers. They facilitate local, targeted training and education in order to reduce stigma

and discrimination associated with mental distress.

Toka Tu is the name chosen for this project, and comes from the whakatauki:

“Ahakoa akina a tai, akina a hau, he toka tu toka ahuru tatou”

“Although the tides and winds may come crashing down on us, like a rock we stand resilient and

comfortable in the face of adversity”

Conclusion

Referring back to the 3 ways of challenging discrimination according to Case Consultancy’s Power of

Contact, we can break the priorities down into the categories of education, contact and protest.

Education—replacing myths about mental distress with correct information

How can we do this?

• We should develop local, targeted educational programmes like MH101 which will provide

communities, employers and services with correct information and will challenge discriminatory

attitudes. These should not be one off sessions but should be part of a programme of delivery in order

to build relationships. The programme should be facilitated by people with lived experience.

• We should work with the media to include positive recovery stories in their publications in order to

counter balance the negative stereotyping tabloid stories that often link mental ill health to criminality.

We should consider introducing local stigma-watch groups to challenge this issue as they have done

in New Zealand.

Contact—challenging discriminatory attitudes and behaviour through direct interactions with people

who experience mental distress

How can we do this?

• We should continue to grow a peer work force which is independent, trained, supported and

working within a structured, intentional model (such as IPS) and with a values framework. A more

holistic model specific to Scottish culture should be developed but drawing on the importance of

spirituality, culture and physical wellbeing as with the Maori and Pacific models (Appendix 1)

• We should introduce the posts of “Advisors with Experience” within each local authority area who

can advise and guide health boards and clinicians on best practice. This will encourage

practitioners to be recovery focussed and consider their use of discriminatory language.

Protest—actions which suppress discriminatory attitudes and behaviours towards people who

experience mental distress.

How can we do this?

• We should have local, targeted anti-stigma campaigns which are based in grassroots services.

This will allow the work in each service to be tailored to the identified needs of each geographical

area. This has been effective in New Zealand who have accepted that the needs of one area in the

country may vary greatly from the needs of another due to cultural diversity, population, rurality

and attitudes.

• We should be discouraging the use of negative, deficit based language which reinforces

discrimination by creating distance between people who are perceived as “well” and people

perceived as “ill”. This is particularly relevant to the health sector. The challenges of emotional

distress are experienced by not 1 in 4 but 1 in 1. Everyone at some point in their life will

understand what it feels like to be struggle to the point that they are not sure how to cope. That is a

natural human response to the challenges of life, a “human experience”. By talking about the

spectrum of emotional wellbeing to emotional distress, we can make the subject less taboo and

people are likely to ask for help sooner and therefore less likely to reach crisis. It will also help

address the issue of self-stigma.

“Madness can cause terror, confusion and despair. But so can grief or dying in

pain for a just cause; so can the path towards spiritual enlightenment or being

falsely accused. The difference between these states and madness is that society

legitimises them and allows for the possibility of growth or recovery”

(Mary O’Hagan, Peerzone).

References:

Well? What do you think? (2008) The Fourth National Scottish Survey of Public Attitudes to Mental

Wellbeing and Mental Health Problems, Davidson et al, 2009. www.scotland.gov.uk

Perkins, R & Repper, J (2013) Prejudice, discrimination and social exclusion: reducing the barriers to recovery for people diagnosed with mental health problems in the UK. Neuropsychiatry, p377-384.

Consultation on the involvement of people with a mental health problem in See Me and Challenging Stigma, HUG, 2013

Policy Into Practice, National Mental Health Development Unit, Public attitudes: annual national survey pf attitudes to mental health in England.

TNS (UK) for CSIP, 2008, Attitudes to Mental Illness research report, London Dept of Health. The Mental Health Strategy for Scotland 2012—15 Opening doors, Kites (2006)

O’Hagan, M (2011) Peer Support in mental health and addictions. Like Minds Like Mine Best Practice Guidelines: For delivering education and training to counter

stigma and discrimination associated with mental distress. Kites, 2012

Like Minds Like Mine National Plan 2007-2013

“Stigma: Marked by Society?” HUG DVD

The Power of Contact, Case Consulting Ltd, 2005

Corrigan (2011) Best Practices: Strategic Stigma Change: Five Principles for Social Marketing Campaigns to Reduce Stigma.”

Huxley, P. (1993) Location and stigma: a survey of community attitudes to mental illness: enlightenment and stigma. Journal of Mental Health UK, 2, 73–80.

Peterson et al (2009) Stepping out of the shadows: Insights into self-stigma and madness, CASE Consulting Ltd

Repper, J and Perkins, R (2003) Social Inclusion and Recovery: A Model for Mental Health Practice, Bailliere Tindall

Chamberlin, J (1988) On our own, MIND

Kirwen, J (2010) All Blacks Don’t Cry: A story of hope, Penguin

Woodhouse A & Vincent A (2006) Development of Peer Specialist Roles: A literature scoping exercise: SRN & Scottish Development Centre for Mental Health.

Media coverage following my fellowship

A list of services visited:

Grow, Brisbane, Australia

Blueprint, Auckland, NZ

Mind and Body Consultancy, Epsom, Auckland, NZ

Connect, Auckland, NZ

Counties Manakau District Health Board, NZ

Balance, Whanganui, NZ

Journeys to Wellbeing, Palmerston North, NZ

Te Ara Korowai, Paraparaumu, NZ

Kites, Wellington, NZ

Peerzone, Wellington, NZ

Wellink, Wellington, NZ

Depression Support Network, Christchurch, NZ

Whatever It Takes, Napier, NZ

Mental Health Foundation, Christchurch, NZ

MHAPS, Christchurch, NZ

Blueprint, Christchurch, NZ

Comcare Trust, Christchurch, NZ

The Apartment, PACT, Dunedin, NZ

Otago Mental Health Support Trust, Dunedin, NZ

Grow, Dunedin, NZ

Southern District Health Board, Invercargill, NZ

Footsteps, Te Anau, NZ

CAN mental health network, Sydney, Australia