Pathfinders: Summary article in Health Issues Journal

Pathfinders: New Research on Consumer Participation in Mental Health

By ALLAN PINCHES
(Article first appeared in the Health Issues Journal in December 2005. By 2012 some circumstances may have changed, including some impovements.)

http://www.ourcommunity.com.au/files/OCP/Pathfinders.pdf

A consumer-based research project suggests that consumer consultant projects have been very effective agents for innovation and change in Victoria's Area Mental Health Services - probably more than any individual stakeholder could have expected.

This has been despite considerable barriers, including a severe shortage

of funding and resources, stresses on consumer workers in a difficult role, and problems gaining acceptance within some service cultures.

This article describes some of the findings from this research project.

Aims

The Pathfinders project was undertaken as part of my Bachelor of Arts in Community Development.

It aims to help in building a much-needed information base in relation to consumer participation and consumer consultant-based advocacy work in the mental health field. The project aims to provide something of an overview of progress so far and identify possible action strategies to strengthen and enhance these projects.

Consumer consultants are diverse and multi-skilled workers with personal experience of being consumers (or service users or patients) of mental health services in Victoria.

They are employed to go "back into the system" to facilitate a range of consumer participation activities, aimed at enhancing consumer rights, empowerment and gaining more say for clients in their own treatment,

as well as other consumer led improvements in mental health services.

One of the motivating factors behind this research project was that there had been many and varied accounts of the consumer consultant projects at Victoria’s 22 Area Mental Health Services. These accounts seemed somewhat sporadic, often contradictory, lacked a wider overview, and it was often difficult to draw thematic analysis or learning opportunities from them.

As a consumer consultant, I was determined to help provide a strong information resource for these projects, and it also seemed important for it to be largely consumer-generated.

As with much of the good new models and innovative projects going on in the health and human services field, much of this work tends to go under-documented. The Pathfinders project aims to address at least some of the aspects of this problem.

Methodology

A key factor to this research was having an agency placement with the peak consumer group, the Victorian Mental Illness Awareness Council (VMIAC), which over a long period, has helped put consumer needs and wants on the map.

The project was partly guided by two meetings and further telephone contact with a very experienced Critical Reference Committee comprising five consumers and two service provider staff.

The interviewees mainly emerged from informally "putting the word out" for participants. Semistructured individual interviews were held with five consumer consultants/advocates, two service provider managers, and two senior service staff. A further 11 consumer consultants took part in a

workshop session. Three case studies with three very experienced consumer consultant/ academics were included to illustrate issues involved with working as educators of clinicians, gaining financial control of projects, and equipping consumer consultants with skills for their role.

The research followed a structure, or progression addressing problems and solutions. Participants

were asked:

* to identify achievements in their projects;

* about what factors had helped or hindered the results;

* to speak in more detail about problems, barriers and

constraints encountered;

* to identify possible causes of these problems and by inference try to generate some possible

solutions; and,

* in the event further changes were possible on the ground, what new participation developments or

projects they might visualise or hope for.

The Pathfinders project also included a literature review that made considerable use of consumer generated material, part of which traces the history, achievements and potential of the mental health consumer movement.

The Pathfinders project found substantial and widespread evidence of much progress, and many success stories, over the past decade or so for consumer participation in mental health services, despite a lack of resources and other significant barriers.

Funding and Resources

Funding and support was described as having many direct and indirect effects such as shortage of paid hours for consumer consultants and sitting fees for other active consumers for advisory groups or projects, and low rates of pay. Consumer consultants, who may be part disability pensioners, can find themselves at risk of Centrelink's "poverty traps." Some local projects reported a shortage of necessary office equipment, such as computers, or even a dedicated workspace.

Published materials such as newsletters, books, and flyers were sometimes poorly finished and lacking appeal, due to inadequate printing budgets. However, the research shows how consumer consultants and active consumers made limited resources stretch a surprisingly long way.

Severe funding limitations for VMIAC have restricted its ability to provide support, coordination, training, and government liaison services for consumer consultants in the field, despite many heroic efforts. The research found that many consumer consultant respondents warmly embraced the idea of consumer consultant projects having a central "nucleus" or strengthened support base, which could well be within VMIAC.

A more immediate and critical concern for VMIAC, is the difficulty of accessing adequate funding, especially "developmental" type funding. This has meant that VMIAC often finds itself trapped within a reactive role rather than having the resources to do more agenda-setting research, policy

development or systemic advocacy work. Much of the existing resources and staff time are necessarily used for individual advocacy for consumers having trouble in the system - another chronically undersupplied need.

There has also been a lack of funding for public events, conferences, public relations campaigns, or publications like those of group with more resources.

A number of suggestions came out of the study including:

1. The need for more consumer consultants to be employed in the Psychiatric Disability Rehabilitation and Support (PDRS) services in addition to the larger coverage that currently exists in

clinical Area Mental Health Services. PDRS services also want dedicated funding for this purpose.

2. VMIAC could establish a Consumer Information Library and Clearing House, including on-line access and with enhanced services for consumer or other researchers. At present the large collection of print materials is languishing, with insufficient staff time to look after it.

3. The establishment of a consumer publishing unit that could publish and distribute consumer generated materials. This valuable but often forgotten "grey literature", which often lacked organised circulation and struggled to gain profile alongside the professional publications.

4. The need for services to recognise the benefits of, and seek to provide opportunities for, consumers to be actively involved in education and training of service staff.

Consumer Consultants

The role of consumer consultants also comes with inherent complexities and difficulties, and

they face a number of barriers in their work including:

1. Consumer consultants stretching commitments way beyond allocated paid working hours, putting themselves under heavy stresses that is unhelpful or hazardous to their mental and physical health.

2. Larger allocation of project working hours, larger operating budgets, and sufficient money to pay consumer members serving on committees or special projects may ease this burden and allow for more job-sharing between consumers at local services.

3. Lack of administrative support or adequate office space and equipment can be a problem at some services. Some consumer consultants spoke of time they could be using for specialised consumer-knowledge work being filled with generic tasks..

4. Working in isolation from other consumer consultants and lack of effective support or professional supervision It has been suggested that having consumer consultants working in teams should be the norm.

5. Consumer consultants and representative need access to high quality and relevant training.

6. Consumer consultants being denied access to actual clinical meetings (such as handover or case reviews) can, according to some, hinder their ability to get to know how the services work. If consumer consultants had access to such meetings (even on occasion or with special conditions

attached), this could allow consumers to have a greater "say" in relation to the quality and effectiveness of treatment, and support methods within services.

7. Difficulty gaining direct access to service consumers through mail-outs of surveys - or perceptions that clients might be reluctant or discomforted to be approached in waiting rooms -means that staff, such as case managers, could play a key role in helping build some of these bridges,

and some of them are willing and able to do so. Factors such as these have meant a high attrition rate from these projects over time.

8.  On a more positive note, consumer consultancy can be viewed as a new hybrid form of work, which is becoming much more of a mainstream feature of the way mental health area services manage and provide services. Consumer participation is becoming an increasingly accepted and expected part of service planning, development and quality improvement.

The very role of the consumer consultant, in terms of representing consumers as the prime stakeholder group, can be argued to have a certain built-in credibility - because of shared experiences and knowledge with the subject group - and have made it their concern to gain a studied understanding of some of the issues at hand.

Service Cultures

It is interesting to note that, perhaps contrary to expectations that funding and resources would bethe biggest barrier; the most significant determinant to success in consumer participation projects was identified by consumers as the area of staff attitudes and service cultures. A major determinant of success was said to be:

'..whether services would listen to and recognise the value of consumer perspectives - or constantly act in ways which frustrate the attempts of consumer consultants and reps to try to discuss often difficult issues and get changes made.”

Some consumer consultants spoke of negative or tokenistic expectations or responses towards their projects and a few said the services where they worked seemed "resistant and entrenched" against consumer perspectives, with some maintaining a strong "us and them mentality" and leading to

frustration for consumers.

However, the levels of support varied across Victoria and in probably a majority of local Area Mental Health Service; at least some staff and managers can be considered supporters or "allies" for consumer participation.

Some of the suggested means for making services more consumer-friendly, which come from consumers interviewed include:

* consumers being allowed greater control over the development of their own treatment plans;

* consumer knowledge being used to enhance and widen various debates for improving services;

* consumers and staff being more aware of the consumers' rights within the system;

* services becoming better equipped in providing services to diverse groups in the community,

including people from culturally and linguistically diverse backgrounds, youth, people with dualdiagnosis (mental illness and drug problems) and other needs groups;

* building up over time a capacity for consumers to be involved with actual service provision, culminating in employing consumers working on treatment teams (with a client's informed consent) as Peer Support Workers or Assistant Case Managers, as happens in some services overseas;

* staff adopting more self-reflective practices in communicating with consumers - important in both information provision and interpersonal style; and,

* encouraging acceptance of consumer participation as an integral part of service planning and

operation.

Emerging Change

 

Interestingly, over the ten-year period in which the relationships between consumer consultants and services became closer and more trusting in many localities, projects have been able to become increasingly developmental and work more within the framework of partnership.

This contrasts to the more rights - based approach to advocacy that was, probably understandably, a more predominant mode in the earlier stages. The quality of relationships has varied widely, according to many informants to the study, and there are still areas where there are problems or

fluctuations, and other areas where the work is powering ahead.

The workforce itself has really changed in many ways. One of the standout findings, perhaps the largest trend noted within the research, were the many reports indicating much improved communication and information provision practices of mental health services staff.

Many serviceprovider staff are perceived as being more consumer aware and having more self-reflectivepractices. There also seems to be a much more intensive rigour in terms of intellectual engagement, communication skills, ethical values, empathy, resourcefulness, resilience, perseverance, and more.

There is also some evidence emerging that services which put a high premium on consumer participation - such as the award winning initiative of placing trained consumer representatives on staff selection panels in Melbourne's Northern Area Mental Health Service - may be more likely to

attract high quality, motivated and consumer-aware staff, could produce better morale and an enhanced service environment for both clinicians and consumers, and could more readily move towards a therapeutic partnership, which could also involve carers and other services in the community.

Factors for Success

The research found there were some factors that active consumers and service providers

identified as promoting success in projects. These included the project:

* being presented in ways perceived as constructive;

* making a compelling case for areas of change or improvement;

* having an evidence base strongly tied to consumers' experiences and reflections;

* being readily translated into practical actions, with consumer

service dialogue informing every stage of implementation;

* being pro-active, seeking to bring genuine improvement in

services and better outcomes;

* being respectful of persons, and the contribution all stakeholders can make, avoiding stereotyping others' positions;

* aiming to build communication and new understandings, rather than being unduly adversarial,

hyper-critical and blaming;

* staying open to new ways of conceptualising issues, allows thinking "outside the square," going

"back to the roots" of issues and rebuilding from the ground-up;

* being conducive to building partnerships for creatively working towards change; and,

* building on and enhancing strengths, while seeking to minimise problems in the system and

resultant problems.

Beyond that, the effectiveness of consumer participation activities largely seems to revolve around:

* the quality and authenticity of the knowledge emerging from consumer experience;

* the ability of consumer representatives to draw parallels, demonstrate relationships, and extract principles and practical strategies for change and improvements within service provision; and

*skilfully applying the consumer knowledge through various processes involving problem solving, gap and opportunity identification, development of new and more effective service models, treatment methods, community linkages, education campaigns, community development projects, etc.

Conclusions

One finding that has crystallised for me is just how well accepted consumer participation programs have become, how deeply influential they have become in service planning and development, and the whole culture within many services.

An important part of this is to have a number of active consumers on hand who become skilled in making problem and solution analyses in virtually any meeting or forum they find themselves.

It was also clear that the consumer consultant model could have wider applications across other types of services, - such as advocacy within disability, health, and primary health services.

Many consumer advocates in the mental health field are proud of the achievements so far in developing the consumer consultant model and how this consumer participation, combined with other elements of movement building, could make a difference within policy making forums, in services, in communities, and people's lives.

Like so many mental health active consumers (including people doing many and varied roles in the consumer movement) I am proud of the way that people with mental illness were working away at campaigning for social change, using new methods and strategies that could be adapted by other groups.

As a result of this research, a report, "Pathfinders - Consumer Participation in Mental Health and Other Services: Evidence - based Strategies for the Ways Ahead" was written.

The report identifies 18 key result categories in consumer consultants projects and lists 55 action strategies for strengthening consumer participation projects throughout Victoria. Other sections seek to identify factors believed to have promoted success; identify barriers and constraints facing consumer participation projects and their possible solutions; and provide a short history of the consumer

movement.

* To order copies of "Pathfinders - Consumer Participation in Mental Health and Other Services:

Evidence Based Strategies for the Ways Ahead" can be obtained free online at http://www.ourcommunity.com.au/files/OCP/Pathfinders.pdf

I undertook this project in part fulfilment of my Bachelor of Arts in Community Development at the Victorian University of Technology, from which I graduated in 2004. I have been an active consumer for more than two decades and a consumer consultant for eight years. As a former

journalist, I have become a well known writer and speaker on mental health consumer issues; many of my articles can be found on the blogspot which has delivered this article to you.

© Allan Pinches 2005. This article appeared in the Health Issues Journal in the Summer 2005

edition.

Pathfinders: Consumer participation research

CLASSIC CONSUMER RESEARCH:

PATHFINDERS:

Consumer Participation in mental health and other services: Evidence based strategies for the ways ahead.

Now download for free
at Our Consumer Place: 


http://www.ourcommunity.com.au/files/OCP/Pathfinders.pdf

An essential research report from Allan Pinches, Consumer Consultant for Mental Health, for anyone with a vital interest in consumer participation in mental health and other services:

• Achievements of mental health consumer participation: including 18 key result areas.
• Factors which have promoted the success of the many local Victorian projects.  
• Barriers and constraints -- identifying key problems such as: resourcing issues, systemic barriers, impacts of service cultures and environments, personal strains on Consumer Consultants in often difficult and demanding roles, and expressed needs for better resourcing and enhanced support systems.  
• Practical problem solving examples.  
• More than 55 suggested action strategies for a major strengthening of consumer participation projects.  
• Case studies on several outstanding and innovative consumer participation projects.
• Rich contextual quotes highlighting major themes from Consumer Consultants in interviews and workshops, and some observations from service providers. http://www.ourcommunity.com.au/files/OCP/Pathfinders.pdf

Email: allan.pinches@bigpond.com.au

            allan.pinches@yahoo.com

Spirituality a Missing Link in Psychiatry.

by Allan Pinches


Psychiatry is marked by its almost total disregard of spirituality, in considering the mental health of individuals.

As mainly agents of psychiatric orthodoxy, psychiatrists do us no favours by dismissing spiritual factors from the equation. The standard medical model of mental illness is based on rather mechanistic and reductionist theories about physiological, biochemical and genetic factors, rendering us "biochemical units in a state of dysfunction" -- and where they do consult psychology, ego-based psychological theories devoid of any concept of "soul" predominate.

The imperatives and needs of the soul are left unattended. Perhaps these things do not appear tangible enough for some psychiatrists to bother about and perhaps they are difficult for them to access because it requires a high degree of experientially based understanding, personal development, empathy, spiritual insight, and "talent" to factor in matters of spirituality and soul in a therapy setting.

What a bitter irony that the word "psychiatry" is derived from the Ancient Greek word "psyche" which literally meant "soul." With a few rare and honorable exceptions, psychiatrists can hardly be described as Doctors of the Soul.

Mental illness experiences and breakdowns often give a greater relevance and immediacy to the person's own spirituality, whatever form it may take. A breakdown can compel us to do the necessary spiritual work, nurturing our inner world, and honouring the Unconscious, as the source of great creative ideas and energies. Spiritual factors may be involved in the development of the condition, how people will experience and cope with it, and what sort of recovery they can expect to make.

I believe there is a need for more holistic and empowering approaches to treatment, with a restoration of the proper place of "therapy" programs and one-to-one counselling, rather than medication being the first and only resort.

Some alternative healing approaches such as Reiki or other massage methods, meditation, affirmations, and creative exploration therapies such as drama for self awareness, art, music, journal and creative writing, reflective story telling and creative voice and movement can have a very positive effect on a person's mental wellbeing.

Widest definition of spirituality

In discussing the spiritual aspects of mental illness, I am using the widest possible definition of the word spirituality. Basically this embraces matters of the spirit or the soul and our personal understanding of and relations with God, the Universe, or the Higher Self. While I borrow key ideas from many areas, I am not advocating any particular religion or code of beliefs. I believe there is wisdom to be found in the whole diversity of spiritual paths. An essential distinction between spirituality (as an experience) and religion (as a set of beliefs), is the personal and individual nature of one's spirituality.

Healthy spirituality infers to me a sense of wholeness, wellbeing, being comfortable with life and its challenges, right actions, and having love for ourselves and others. Afflicted spiritual aspects include low self esteem or self hatred and a poor orientation - or lack of love -- for ourselves, others and the world.

A breakdown, far from being the "end of the road" it may seem in the darkest days, can be a catalyst for change and development in our lives, possibly opening out to new ways of being in the world.

A key message I want to convey is that far from being some meaningless "mishap," a breakdown is intrinsically bound to the whole questions of meaning, purpose and identity.

It also cannot be divorced from socioeconomic factors, the stresses of modern life, personal history, class, education, occupation, race, religion and a host of other factors. The glaring lack of true "community" in today's social reality is, I believe, a major factor in the upswing in the incidence of mental illness seen in recent years.

Living in a mass-society where stress is endemic because of irrational and self-defeating practices based on competition, rugged individualism, masculinist aggression and officially encouraged greed and materialism. Such a social environment affords little opportunity for self-exploration, contemplation and development of a true individuality. Rather than the "luxury" these things are often held to be in our system, they are vitally important for fostering optimum mental health. Treatments and rehabilitation programs should reflect this principle.

Nowadays there are very few places of retreat or genuine sanctuary for people to go to when they need time out, and spiritual reflection. It seems that many who would have once gone to a monastery or on a pilgrimage, now end up in virtually the only available "sanctuary" provided today, the psychiatric hospital.

It seems a common pattern that many people's breakdowns follow periods of intense spiritual exploration and attempts at self realisation. This seems to occur far too often to be overlooked in considering the nature and causation of mental illness, and discovering workable, individualised approaches to achieving recovery. In fact some psychiatric practitioners seem to believe that a strong interest in spirituality is in itself a symptom of mental illness.

Spirituality now a divergeant path in an increasingly complex world:

There has been an enormous diversification of spirituality over the past five decades mandated by a tidal wave of scientific, technological, political, social and economic rapid change. There are many dilemmas relating to values and morality, and more sophisticated debates about issues which were once perhaps too narrowly and simplistically defined. Changes in spiritual modes have brought opportunities for personal spiritual growth and realisation, but also bring many possible complications to individual lives, particularly the young, and have created an atmosphere of spiritual confusion. Many people have been painfully caught in the middle of a clash of paradigms, western materialism versus (broadly Eastern) spiritual values.

The spiritual confusion that marks the final years of the 20th Century affects every aspect of our lives.

We increasingly sideline organised religion in today's world, making way for a new "rationalism." While there may be some positive aspects to this, we may have lost a large part of the moral and spiritual resources organised religion provided. Where there was once "faith" in a higher power, "certainty" about life's meaning and sacredness, and a strong belief in the power of love to overcome problems in the world, there is now growing secularism and something of a spiritual vacuum.

Increasingly this void is leading to a growing interest in alternate spiritual paths including Eastern religions, ecologically based alternative philosophies and a burgeoning Spiritual Supermarket running the gamut from "born again"Christianity, tele-evangelism, spiritualism, to New Age philosophies, and "mind powers."

While there are "New Age" teaching systems of genuine value and of real help, there are also many blind alleys, false prophets, and mind bending "trips" which can mislead people and prevent learning of true and authentic spiritual knowledge.

The rise of Christian fundamentalism in recent years has also brought problems, with rather simplistic solutions being promoted for complex and multi-faceted problems. The Bible writers could not have been expected to anticipate the conditions of the modern world, and fundamentalists tend to stick to literal interpretations of scripture, creating problems with applying these teachings in today's infinitely more complex times. However, many Christian principles and the Gospels still have much to offer.

All of this has enormous impact on the psychological wellbeing of individuals. It often occurs to me that the people most markedly affected also tend to be those who have the most highly developed social consciences and genuinely care about the welfare of their fellow humans.

It takes a long time for the person to learn to navigate their course in a supposedly "rationalist" world system which dismisses spiritual endeavour as worthless and even misguided or "crazy." There are many pitfalls, disappointments and obstacles in this world for the spiritually inclined. There can be the dual problems of not only being misunderstood by others but also not clearly understanding ourselves. Confusion, breakdowns, highs and lows can follow, often leaving the person in a "nowhere" state for some time.

Major experiences and many setbacks on the "road toward enlightenment":

Many spiritual seekers search, work and struggle towards the enlightenment, the desire for which animates their hearts and minds. For many people this becomes the main preoccupation in life, a burning ambition, and they can seem strange and different from their friends and family. This can be a source of conflict in some people's lives, and lead to all sorts of twists and turns in life's road.

Spiritual exploration often involves a period of "emptying" or melancholy, when one is approaching a big spiritual experience and some people can't handle this stage because of possible lack of support or guidance at this crucial time. Some people "break down" at this stage.

It seems to be a recurring theme common to all religions that spiritual transformation can only happen after the person has "died to their old self" and become "reborn" into a new, transcendent awareness. Essential to these teachings about a metaphorical "death" is the relinquishing of ego-based attachments like materialism, selfishness and manipulation to gain power over others, replacing these things with loving compassion. Some spiritual teachers say the ego or I-self must be eliminated altogether to allow the person to identify with a Higher Self, which is often said to be "at one" with the Universe.

This metaphorical "death" process can be extremely painful, often leading to what has been described as the "long dark night of the soul." Part of the problem, I believe, is that our whole social, political and economic systems are based on ego demands and gratification, and attempts to subjugate the ego do not "gel" with the prevailing system. Many spiritual seekers run into severe problems, obstacles and conflicts. This is not to say that these teachings are invalid-- they can be very helpful and enlightening-- but it must be acknowledged that it is very difficult to live by Eastern teachings in Western capitalist societies.

Some people get lost in the sensations of spiritual experiences, and seek after yet more sensations. This is regarded by genuine spiritual teachers as a mistake. They would point out that the object of spiritual endeavour is not in having a wonderful ego-trip. Unfortunately many, if not most seekers go through a stage where their egos become inflated by the new experiences, as the ego strives to take all the credit for everything that is happening.

Perhaps some people have spiritual experiences such as an "awakening" or "Satori" which their mind and body are not adequately prepared for and become "freaked out" by it. This can happen particularly if people are getting most of their learning from books, without personal guidance by a teacher, who would usually oversee the person's preparations for spiritual experiences, and carefully guide the person's progress.

Some people get lost in the complexities of religion and confuse archetypal ideas with personal reality. So ideas like the "Christ Consciousness" being potentially available to anyone, or God dwelling "within" can be distorted into mistaken beliefs, that one is, in fact, the returned Christ, or Mother Mary or God. Sometimes this can be explained as a self-consolation for a terrible life, feelings of inferiority and insignificance, or wishing and hoping for Heavenly justice in a world of seemingly endless pain and suffering.

Or the person may break down after some sort of life trauma, such as a job or relationship setback, which sharply derails spiritual work when they are in a vulnerable state.

Some people on the spiritual path do not pay enough attention to the need to remain "grounded" during their meditation and exploration, and could lose touch with consensus reality or relate so closely to alternative paradigms that they sound "mad" when they attempt to explain themselves.

Use of illicit drugs, which sometimes accompanies some forms of spiritual exploration can also add to the person's vulnerability to mental illness.

Many, but certainly not all, mental illness experiences can be attributed to "spiritual crisis" situations.

Mental illness, spiritual crisis and learning life lessons:

Perhaps it is better to regard a breakdown as part of a "healing crisis" rather than an illness in its own right. Many lessons will be learnt and wisdom gained in the "deepening" processes of the soul, which often follow a breakdown.

We ask ourselves questions about:

• how to love and be loved;

• loving ourselves;

• our relations with the Infinite;

• whether there is a God and what are our obligations to it, and our expectations of it;

• the meaning and purpose of life;

• discovering our real interests;

• following our soul urges, rather than what we are told to do;

• setting priorities of what things are most and least important to us;

• how we can relate meaningfully and get along with others;

• helping ourselves by helping others;

• how we can find true happiness;

• how to find peace;

• how we can be true to ourselves, in the ways we live;

• right actions as usually the most practical and productive behaviour;

• and how to go beyond the conventions of a manifestly sick social order.

Spirituality has a great deal of relevance to all these sorts of questions.

It seems to be a recurring theme in most eastern religious systems that one can experience a transformation or raising of consciousness, to a new, transcendent awareness, sometimes called Cosmic Consciousness. A Cosmically Conscious person is said to be "at one" with God or the Universe and in a state of full enlightenment. The main object of such enlightenment is said to be to serve humanity.

There may be occasional new flashes of insight. Soon there are "peak" spiritual experiences, which involve a deep sense of peace and wellbeing. Later, after much practice and reflection, there may be a spiritual awakening, where one feels "touched" by the divine, with an inner explosion of love and bliss. The new initiate experiences a powerful and euphoric sense of oneness with the Universe and an immediate connection with all living beings. Such an experience, which can come on suddenly, is sometimes called Satori, and is regarded as a foretaste of Cosmic Consciousness.

For some spiritual seekers a key realisation has been that social change starts from within each individual and then radiates outwards to others. Rather than religious ideas being used as a dogmatic means of social control, the new spirituality can serve to liberate the person and empower him or her to find loving compassion, meaning, satisfaction, pleasure and happiness in their lives.

Compare this to the old fashioned religious teachings which encouraged feelings of guilt, frowned on pleasures, turned sexuality into a "sin", promoted fears of God's wrath and hellfire and brimstone horror stories, and taught that life, with its sorrows and inequities was something to be endured until, after death it would all be made right by going to heaven. Life has a way of teaching us that heaven and hell are not so much places as states of mind in the here and now. Living and thinking creatively opens up many options for creating our own kind of personal world, which we can share with others.

With a breakdown, there is often a dis-integration of personality and confusion in the thinking processes, in the early stages. All the ingredients of identity, meaning and purpose go back into the melting-pot, and a longer "ferment" stage follows. In a long process much information and experiential learning grow into a new understanding of life. This understanding is often of a more fundamental nature: "I am human and I have unconditional worth." In computer parlance, we can describe the process as the data being gathered, processed, re-integrated, and a new synthesis emerging on the screen.

Over time, a new synthesis can develop in us, a sense of true self can build up, wisdom can grow, and perhaps a realisation that the world's priorities need not necessarily be ours. That we can be ourselves and pleased and proud at that. The seeker is then likely to justify his or her life's quest with the argument that spiritual work is just as valid as any other form of work or vocation, and that society and the planet needs its thinkers, dreamers, poets, artists, writers and seers of visions.



An afterword for mental health workers and other helpers:

Spirituality is inevitably both a "minefield" and a source of strength and inspiration to many mental health consumers.

This demands creative responses from support workers, case managers or doctors, who may be required to help reverse some of the damage of some consumers' over-identification with the "dark shadow side" of religion, sometimes arising our of early traumatic religious "abuse" experienced in families of origin.

Some consumers become fixated on concepts such as fundamentalist "hellfire and brimstone" scenarios, eternal damnation and the threat of a terrible Doomsday at any time now, or may feel compelled to "take up their own cross" and try to function in a harsh secular world while living out roles of religious figures. This is not conducive to a smooth passage through life, to say the least.

Some people become extremely depressed because of a delusion "bubble" bursting, as they return to a more everyday type of consciousness, but find the world and its problems all too horrible compared to the shining heavenly utopias of their former "waking dreams" that doctors call delusions. Some sufferers can spend years "trapped between worlds."

Some ways for spiritual seekers to avoid mishaps:

There are sometimes mishaps in spiritual searching, and the mental wellbeing helper needs to constantly highlight concepts such as:

• the need for having proper instruction from a recognised teacher, in spiritual learning. Not just books, which can be a haphazard way to learn;

• preparing the mind and body for spiritual experiences;

• the need to remain "grounded" while following spiritual or meditation practices, to avoid "spinning out" or losing touch with the common world; and,

• the concept of the need to strive for balance in all things, as a way of flowing with, rather than against, the basic tendency of nature and all natural systems to seek to return toa state of balance.

Indeed these imperatives are important in the healing process itself..

People going through mental suffering need a lot of very sensitive support and gentle guidance. It is important for workers to try to help the person reduce the damage of "afflicted spirituality," and start to heal, without interfering with destroying the underlying good and unifying aspects spirituality can offer.

This is very tricky, and may involve a gentle, long-term process involving a progressive re-orientation to approximated "consensus" reality and encouragement that the (so-called) "real" world is not such a bad place really, and try to instill hope that the person WILL gradually re-acclimatise to the everyday world. (Not that anyone would want recoverers to turn around and imitate the many desensitised and numb "normals" who calmly munch on their dinners while the world continues its orgy of death and destruction on the nightly TV news.)

Generic spiritual concepts can be helpful:

A useful frame of reference for support workers is a very wide and generic version of spirituality that recognises and respects the diversity, and often individual flavour of religious beliefs.

It is possible to work with concepts such as;

• an often eclectic comparative religion studies and mythology;

• the Universe;

• a Higher Power, which can reside both within and without;

• the importance of respect for others and other creatures.

• nature's bountiful beauty, healing powers, wholeness, and imperative to seek balance.

• notions of the common good as defined by traditional and International conventions;

• the practical and pragmatic good outcomes of right actions, as well as ethical benefits;

• the need many people have for a personal God and creator who loves them and has promised them Heaven after this life, if they live good faithful lives.

• Another key idea is philosophical stance of believing in the essential goodness and nobility of the human spirit, at its best.

Folk stories and fables, or having creatively facilitated "story telling" sessions about our lives or our ancestor's lives, or even an imaginary life we would like to have, can also be very rewarding for consumers. Such approaches tend to stimulate individuation processes and reinforce ego strength, which are often weakened in mental health consumers.

Allan Pinches is a former metropolitan newspaper journalist and a mental health consumer consultant.

This article previously appeared in 1996 on a previous website by the author, and highlights from the archives from 1996 to 2011 will be transferred to this blog.

In search of true Planetary Sanity

In warning about the many environmental dangers associated with climate change, Prof Ross Garnaut and Prof Tim Flannery, and a growing number of public academics and community thinkers, are beginning to sound like a new breed of modern day prophets.

Their messages are as wise as they are scientific; profound as they are practical.

If humanity is to avoid complete environmental disaster as the result of climate change, we must all change our thinking and behaviour in fundamental ways.

But it could also be that worrying circumstances could actually hasten long overdue changes in human affairs, and even bring some disguised blessings -- although this seems a rather faint hope.

This is not just about being “nice” or trying to live up to some impossible utopian dream. This is about matters of survival for life on the planet.

Because the problems and difficult issues the world faces are complex and multi faceted, “visionary” sounding suggestions for unified efforts aimed at overcoming problems like climate change can easily sound naive or even silly.

However, while I can’t fully develop the ideas right here (and hopefully others will be thinking in similar ways,) I believe that it is precisely because there are so many complex factors – ie, causes, effects, mechanisms, scientific, political, sociological, individual, actions, non actions, etc – that many unconventional but possibly “breakthrough” ideas might have more chance of working than we might have first thought.

We need to follow through on new ways of thinking about both global and local problems and possible solutions, and form new platforms from which we can launch broadly-based practical action strategies.

There is a need for people of all nations to strive to become a united world community and no longer allow to continue the injustices and social and economic distortions which inevitably cause the huge gaps between rich and poor countries and unequal societies. There is potentially plenty to share, but to our shame, there is a lack of political will to do so.

We must learn to be wise and not steal from future generations the resources they will need for their survival. We need to recognise the many imperatives for maintaining biodiversity and practicing conservation, and to stop viewing human supremacy as a normal state of affairs.

Each person will have to learn to be less self-centred and show more concern about the needs and wishes of other people, whether they happen to be “people like us” or from very different backgrounds. To advance human affairs in a positive way it is important that we take into our hearts the truth that all people are intrinsically equals. We share a common humanity and common needs, and we all rely on the sustenance of the living Earth.

People will have to become less materialistic, less concerned with money and possessions, and recognise the need for other values such as sharing, community life, caring for the natural environment, and a spirituality.

We must listen to the counsel of the Indigenous people who speak of our belonging to the land and not the other way around. We are not separate to or above nature – and to continue with the delusion that we can endlessly exploit the earth with impunity is to invite disaster.

It is important that all people realise and act upon the belief that change cannot come from governments alone – that we all personally need to participate in decisions and make the necessary adjustments, and even sacrifices, to create the conditions to avoid the likely catastrophes of climate.

It is important to learn how many questions about environmental policy and climate change resolve to a question of enlightened self interest – or doing the right thing rather than in effect being our own worst enemy.

Governments, interest groups, business leaders and individuals must liberate themselves from short-term, expedient political agendas, rigidly and cynically tied to the electoral cycles. Instead there is a need for long term thinking and action, with more wisdom and courage.

These messages may seem idealistic or over-simplified, but now more so than ever, to change is to survive.
– Allan Pinches, October 2008

Reconciliation is something we consumers and service providers need

by Allan Pinches,
Consumer Consultant for Mental Health.

RECONCILIATION is a word which features prominently in the nation’s public agenda and consciousness. I believe there are strong parallels that can be drawn between the reconciliation process involving Indigenous and non Indigenous Australians, and the need for reconciliation between mental health consumers and mental health service providers. And there would be many benefits from such a process.


Reconciliation in both the Indigenous/ non Indigenous and mental health areas would involve the building of bridges of UNDERSTANDING, TRUST, AND RESPECT between the relevant groups. The reconciliation debate of recent years refers to a proposed shift in power relations, in which a power elite learns to share power with a historically disempowered group, and discovers areas of mutual need, shared benefits of the new partnership and enrichment of their respective cultures.

Mental health consumers, whilst existing as an extremely diverse group, include many people of exceptional wisdom, creativity and insight, who often by painful necessity are exploring many heartfelt, alternative, community minded ways of being in the world. This kind of knowledge and experience would greatly enrich the culture and humanity of the mental health services they use and the wider society, if only the barriers of fear, ignorance and stigma could be torn down.

Mental health clinical and disability support service providers can help to build the much needed bridges between consumers and the wider community, by becoming more attuned to the knowledge, wisdom and deep humanity of people who have experienced mental illness. This is a major key for success in efforts to build in consumer participation in the planning and development of mental health services in recent years – with a notion of consumers and service providers working in partnership to improve the quality and effectiveness of mental health services. The peer support that naturally exists among consumers could be encouraged, built upon and resourced, to good effect.
It’s interesting how the microcosm often reflects the macrocosm, in almost a holographic way. In our society we all need reconciliation with what we might call our higher selves, in our relations with each other as individuals, in our communities, within our society, between nations and in our ecological relationship to the Earth.

The various camps have a deep need for each other, because, whether we are conscious of this or not, as human beings we are all connected and we are all in a myriad of ways inter-dependent. Seemingly in human societies and organisations, where rugged individualism currently rules, it is an all-too-easy and expedient option for those in power seek to control and coerce people rather than understanding them, listening to them, and responding to their needs and wants. It seems that people exist to serve the social - political - economic system, rather than the other way around, and most curiously, in the system, the "tail wags the dog."

Western science, technology and enterprise -- and some enlightened social interventions within a framework of self-determination and Community Development hold the potential to greatly enhance the health and wellbeing of Aboriginal communities. Just one small example is the way video making has been rapidly taken up by Aboriginal communities in the Northern Territory as a community development tool, an educational device, and a force for reclaiming and promoting traditional culture and spirituality. The recent huge explosion in Aboriginal contributions to the media, the arts and popular culture are increasingly recognised as positive, healing and enriching to the whole society.

Similarly, we could propose that providing access for mental health consumers to video, publishing, community radio, public performance, the Internet, access to the media, and other means of communication are some ways to build bridges of social and cultural exchange. In turn, professionals’ knowledge of medical model psychiatry and psychology is greatly enhanced by a compassionate understanding of consumers in their social, spiritual, thinking and feeling dimensions. So much can be gained from an appreciation of the subtle realms of consciousness, which are rendered understandable and meaningful through the lived experience of individuals.

Australia’s non Indigenous population stands to gain enormous spiritual, cultural and human riches through cross communion with Aboriginal people and their communities – if all members of the dominant group can a muster the courage to move through the pain and emptiness inherent in the often difficult and despairing journey toward reconciliation and healing,. The first step is seeking to understand and own some of the collective responsibility for past wrongs.

Inherent in genuine reconciliation processes is the need to listen, and understand beyond differences. I think this need is reflected in social institutions as well, including governments, the media, community organisations, churches...or the mental health system.

So many of the problems in the world today can be sheeted home to our collective avoidance of submitting ourselves to moral and ethical self-examination and moving through often painful transformative processes that are needed if we are to find personal, social and political healing.

The revered explorer of the soul dimensions of psyche, Dr Carl Gustav Jung once observed that madness could most often be attributed to "the avoidance of legitimate suffering." I believe that this applies just as strongly, if not more so, to whole societies, not only individuals. And catastrophes such as the horrific events in America on September 11, 2001, make it all the more necessary for all people of the world, together with our elected leaders, to work through some of the moral and ethical dilemmas that stand between our current troubled reality and true reconciliation, peace and sustainability.

And we need to build a more empowerment and humanity into the way consumers experience mental health services. We need to place before each other the gifts of reconciliation.

“Making it Real” – Some Consumer Considerations for PDRS and Specialist Agencies in Developing Employment Related Programs

By Allan Pinches,
Consumer Consultant for Mental Health
(Extended version of an article which first appeared in the March 2004 issue
of New Paradigm, the journal published by Psychiatric Disability Services of Victoria (Vicserv) Inc.

As a Consumer Consultant who has been around PDRS and clinical services for a long time, and from my participation in many strategic and developmental planning processes, I want to share some suggested consumer-based considerations for employment related programs and services for people with psychiatric disabilities.

These suggested consumer-considerations seek to build upon the important place given to employment, prevocational and educational needs of consumers within the worldwide Principles of Psychosocial Rehabilitation. The suggestions would have applications for PDRS services or specialist agencies running employment related programs, or for employment related aspects of Key Support work.

These suggested consumer-considerations also seek to condition the responses of PDRS and other agencies to growing demand from consumers for improved access to employment, and other pathways toward fuller social and economic participation. There is also an attempt here to promote more positive outcomes for consumers within a changing social and political environment. I also set out number of reflections based on my own personal experiences, and link these with a wider context as I see it this stage.

Based on my research, developmental involvements and conceptual work in the mental health field, some suggested key consumer-considerations would be:

• The development of a co-ordinated consumer advocacy voice for employment development.

• Inclusion of a range of value-added elements for people with psychiatric disability in employment related programs, aimed at providing “real” work experience and “real” accredited education and training, aimed at increasing consumers’ chances of a “real” working future (to the extent that is possible for each person.)

• Providing a wider range of employment types and skill bases in projects, to help advance the employment and prevocational programs in PDRS settings. Many consumers have expressed disappointment that all too many local “work projects” seem stuck in “stock standard” default models such as certain types of "gardening/ mowing crew" or “cleaning service” projects. Many consumers have substantial work and educational backgrounds, and many have skills and talents, and often express the need for a broader range of employment access supports and pathways.

• Adaptability of the employment program or service to consumer participants’ varying and individualised needs, abilities, interests and aspirations, is an important element to be considered.

• Employment related services and programs would need to be designed and targeted in ways that take into account distinctly different configurations of needs of various groupings of mental health consumers, such as: young people’s needs compared to the needs of more long-term consumers who carry the burdens from formerly more “institutionalised” services; or particular needs of consumers from Aboriginal and Torres Strait Islander communities; or the many particular issues faced by consumers from Culturally and Linguistically Diverse (CALD) backgrounds.

• Understanding and responding to the lived experiences of consumers in the program design and implementation, can add some positive dynamics for effective programs.

• Personal development, psychosocial rehabilitation and key support work remain an integral requirement in the makeup of any employment or prevocational program for people with psychiatric disabilities. This has implications for service design, resourcing, and staffing profiles and levels.

• Encourage confidence building through “doing” and also by assisting the participants to develop strategies for negotiating through many of the barriers within job search, work, education and training processes.

• Program settings which assist consumers toward meaningful re-connection and re-claiming of roles within the wider community are important.

• Opportunities for peer support, social events and recreation are important, and help make employment related programs more personally achievable, empowering, and sustainable for individuals.

• Practical focus is essential -- but equally important are more subtle and personalised elements of fostering hope, giving encouragement, helping people “discover” their hidden strengths and start re-visioning their futures.

• Consumer participation in ongoing management, planning, administration and

developmental work towards the project for interested consumers -- both because of the intrinsic and well documented benefits of consumer participation, and also to provide opportunities for consumers to gain valuable experience in “entrepreneurial” development.

• Community linkages of various types for the project and its participants -- including councils, TAFE colleges and universities, community groups, local businesses/ employers, Commonwealth Rehabilitation Service, vocational guidance, specialist placement services, etc, -- providing employment, education and training opportunities and social connections for consumer participants.

• Vocational counselling and support in creative exploration of employment, training and education options, including assistance with job search activities and matching of skills and experience to work options.

• Possibility of developing Prevocational, Employment, Education and Community Linkage units within local PDRS service systems, providing a range of options, including dedicated programs and improved methods of and linkages and access to a range of employment and related options for consumers.

• Flexible modes for supporting consumers in mainstream workplaces or education facilities, including ways of respecting participants’ choices around issues of disclosure and privacy. Negotiation and discussion of such issues would be an important stage of the setup process.

• Defined pathways are needed for participants to “graduate” from all types of employment and prevocational programs and “move on” to further options.

• An “Exploring Options” approach, structured into these types of programs can develop in participants a long-lasting life development skill base, a forward looking approach to life, and ready method to pursue self-determined progress.


“Making It Real” – How These Approaches Can Promote Positive Consumer Experience and Outcomes:

From my personal experience as a consumer who was involved with Edith Pardy House's lawn mowing community voluntary work group and the Home Maintenance group, which were among some of the Richmond Fellowship of Victoria's early work projects for residential rehabilitation clients in the 1980s, I am well aware of many benefits that can flow to consumers from being involved with work related programs and activities.

There are many clear benefits, ranging from the positive health and wellbeing effects of physical activity; the rehabilitation value of maintaining work routines, purposeful activity, motivation, achievement, and learning; the self-esteem and optimism that can arise from doing something positive for oneself and others; and the enjoyment and challenges of working along side others; and the empowering and encouraging experience of re-connection and re-claiming a place within the wider community.

My involvements with these quite basic work tasks often did help to relieve the depression and boredom, or even sense of futility that can often be part of the experience of psychiatric disability.

It was a major plus factor that this work, which was mostly without any pay, was carried out for elderly or disabled people in the local Emerald Hill-Sandridge community who could not do these things for themselves, so there was a sense of making a valued contribution to the wider community.

This was usually very helpful to my self esteem as a consumer participant, and the connection with those people in the surrounding community was welcome but not always easy thing to do. The RFV had a number of fairly innovative work training and employment projects, by the standards of the time, in the 80s, which made quite a difference to a number of consumers before the funding for work projects stopped.

Other PDRS services over the past two decades have developed a range of employment related programs, some of them working to very sophisticated and diversified models, occupying varying degrees of priority within a service mix. Some services make employment a key focus, while others give it a much lower priority -- partly depending on factors like variations in local issues, areas of need, existing social infrastructure, available resources or organisational philosophies. A number of specialist community-based agencies to facilitate employment access for people with psychiatric disabilities and other disadvantaged and disabled groups were developed over the same period, and more recently the Job Network’s many community providers have been contracted to take over the role of the old CES.

Among my friends and fellow consumer activists I know quite a few people who have found work programs, in many forms, incredibly helpful and meaningful in their lives.

I know quite a number of people who are working part time in community sector/ disability caring jobs, as well as consumer consultancy. I know consumers who say they have benefited from Bromham Place Clubhouse and the Transitional Employment Program (TEP) of the Mental Illness Fellowship and had many new doors opened. I know people who have been able to successfully re-enter part or full time employment after undertaking the training programs offered by Work Link or Job Futures, to name just two prominent programs. I know people who have found their way back into employment through Work Supply Company and other similar supported employment programs. Some friends have mixed accounts of their experience Sheltered Workshop type employment facilities, notorious for their sub-minimum rates of pay, but some of these programs with added social and recreational elements were more positively, even warmly remembered.

I also know a few people living isolated lives “in the community” who say they miss the friends and social life they had in the old days of outpatient Industrial Therapy at Larundel Psychiatric Hospital.

I have certainly known quite a number of consumers whose lives were made richer and more interesting by being introduced to gardening and horticulture in various ways, and the “gardening gangs” were a source of personal pride and a small but appreciated bit of pocket money for some people. The new RFV “Sprouts” horticulture project for youth residential rehabilitation clients in the Northern area, has some of the strengths and value added elements I have featured in this article, and some of this material was originally developed by me as a Consumer Consultant, in response to and an extension of early versions of the project proposal.

I would like to add the observation that from my own experience and research, the relationship of consumer participants in some “work projects” to the daily realities of the work -- and probably like many employment and education options -- can be full of complexities and contradictions.

For a participant on a day by day basis, it is very easy for work projects to become a matter of sterile routine and repetition. It can take on a sense of not leading anywhere definite. A person can become disillusioned with low monetary rewards for quite hard and often dirty work. For a participant, especially when depressed, it is possible to fall into patterns that seem like soullessly “going through the motions.”

However, it is also paradoxically true, that these same daily rhythms and the slow circularity of the routines may actually be salutary in some ways, and can help some of us at times to postpone lingering suicidal thoughts, for just another day, with the idea of “we’ll see how things go in the next few days” and perhaps over time allowing some more hopeful cycles to set in, and maybe inching forward, painfully slowly, along the path of recovery. As I said, these are complex matters, and progress takes time.

I think this is why all of the value-added factors providing life-enhancement as well as employment and training structural elements that I have highlighted are so important, to help unlock many of the benefits consumer can get from a program. It takes time, patience, understanding and caring from service providers and friends of the consumer, to support them in this often difficult journey, with its slow progress, occasional reversals, fluctuating confidence and hopes, wonderful breakthroughs and new achievements, and satisfaction of successes when they occur, magnified in many ways by the sheer difficulty of their achievement.

In my own life, I had worked as a metropolitan newspaper journalist for six years up to the age of 23, when I had a serious breakdown which resulted in a several years “in the wilderness” of unemployment, loss and grief over the loss of a much- loved career and an overwhelming depression. Eventually I did find pathways to recovery, in many ways, with help from friends and caring workers, and my vocational efforts have taken me to some interesting places.

I have worked in a the Employ-Working Effectively Co-Operative’s community publishing group which was part of a unique hub of employment activism and community development in the 1980s, which included occasional paid assignments but was consistently rich in experience, mentorship and training.

At another time, I worked for a period as a Disability Awareness Worker for RESPOND – North West Region Council on Disability, in Broadmeadows, through the Community Employment Program (CEP).

I also took part in the Work and Education Program at Northern Metropolitan TAFE, Collingwood Campus, and discovered the untold potential benefits that can flow from even “basic introductory” courses in computers or office skills. The WEP included somewhat radical and empowering elements like community radio, video making, desktop publishing, B & W photography, and advanced “cold canvassing” job search techniques. Many of the participants were social activists, just as marginalised by their brilliant non-conformism as anything to do with long-term unemployment. Sadly, all of three of these programs are now defunct due to funding cuts.

I have been working a number of years part time as the Consumer Consultant for Northern Area Mental Health Service and do a lot of other semi-voluntary consumer advocacy in the mental health field. I have recently completed my Bachelor of Arts (Community Development) at Victoria University of Technology after nearly a decade of a patchwork-quilt pieces of study, very part time and with some long breaks, and thankfully always being welcomed back.

I can personally attest that graduated goal setting, with a progression of goals being pursued over time, of increasing levels of challenge, is a very good method for the more formal aspects of an employment or prevocational program -- but the non linear aspects of rehabilitation and recovery, well documented in the literature, and the aspects of programs aimed at assisting people in the realisation of their human potential, and assisting them to gain greater control over their lives and destinies, are also vital elements for employment related programs.

It is very important, in my view, for any work with individuals to resonate with their own personalised systems of meaning and purpose, and to assist them to make the link between the activities day by day and steady progress toward achieving their goals.

But not just goals-- also their hopes and dreams. Because in reality, without these seeming “wispy intangibles” drawing us forward, no-one would get very far in life’s endeavours.

To give a personal example, I think a large proportion of my progress towards work and study came from things I told my mother I was “going to” do, hoping to please her or at least not disappoint her too much. I think most other consumers would have similar reflections, and as often as not it might be about encouragement or a fresh approach to some issue from a caring support worker. This infers a “shared journey” of the consumer participant and worker, characterised by trust, respect of persons, honest communication, shared learning, constant exploration of potentials in every person and willingness to constructively seek to overcome difficulties.

“Wasn’t reform supposed to mean doing something good?” -- Consumers are among advocates for more people-focused responses to social needs:

I want to firmly state my belief that it is a far from safe assumption that net benefits would automatically flow to consumers from doing just any form of work, in and of itself.

The so-called work ethic can be oppressive and work can be alienating just as easily as it can be enabling and fulfilling – with much depending on the design and context of the work, the likely benefits, the degree of control people have over their lives and destinies, how the project might improve people's quality of life and future prospects. Matters of social context, the scope for personal autonomy, values and beliefs of choice, and questions of meaning and purpose are of great importance too, and to overlook these factors can be very damaging to people.

It is important to understand how consumers in many settings often speak about how the experience of mental illness has led them to embrace other, alternative systems of personal meaning -- often based on ideas of friendship, community, spiritual expression, creativity and other less materialistic values -- and assert that consumers already DO contribute to the community in a myriad of ways, not the least of which is in supporting fellow consumers.

Work projects which do not sufficiently recognise these systems of alternative meaning – some would say enhanced meaning -- and make claims too much along the lines that “work will set you free” could be somewhat alienating to some consumers and limit the readiness of engagement and potential benefits of projects. Such factors related to an individual’s values and approaches to life, far from being abstractions they may first appear, are often fundamentally and centrally linked with the person’s experience of diagnosed mental illness, and related matters of psychiatric disabilities and social marginalisation.

Mental health consumers are often offended by the notion of "mutual obligation" as espoused by the Federal Government in debates around welfare changes. Consumer advocates often argue that the policy, as implemented, is another example of how a society governed according to economic rationalist policies tends to “devalue” people who are limited in their capacity to undertake paid employment, consume goods and services and pay taxes.

Many community activists and other critics of the Federal Government’s implementation the welfare changes have argued that ‘mutual obligation” policies are “one sided” and place demands and coercive sanctions on welfare recipients and provide little genuine help for people with disabilities to access employment and training, or provide any meaningful initiatives towards breaking down related social and economic barriers.

The McClure report is probably correct, up to a point, in arguing that increased access to paid employment would offer the best chances for mental health consumers to secure an economic future for themselves, (to the extent people can manage), and to avoid poverty and other social difficulties.

The central idea of the McClure Report of a more “active” welfare system, geared up to promote access to employment, education and training and to provide more opportunities for people with disabilities and people experiencing social disadvantages seem acceptable and constructive enough in principle -- with the proviso that if we are to have “mutual obligation” policies they should be implemented in positive, supportive and compassionate ways -- rather than in ways experienced as “blaming the victims” in society, leaving poverty and inequality largely unrestrained, and making the lives of already disadvantaged people even harder.

It would probably be a good strategy for community action coalitions to be formed, in regions and states, to make representations to policy makers and governments to advocate for employment services and a welfare system characterised by principles of social justice, equal opportunity and fairer distribution of social resources -- including provision of adequate levels of income support, equity, fair access to welfare, removal of punitive breaching regimes and “poverty traps,” and recognition the diverse range of people’s needs and social contribution.

Of course it would also be very desirable for community level research and development projects to happen, involving a wide range of stakeholders, and plans made and funding applied for or raised for developing new and localised responses to employment and prevocational needs for people with psychiatric disabilities.

In recognition of the fact that the needs of consumers are complex and multi faceted, and community problems virtually never reducible to simple “blanket” solutions, there could be a whole series of interlinked community development based awareness raising and advocacy campaigns on many urgent issues running parallel to consumer employment needs in the mental health field, such as:

• Proper funding for PDRS, employment programs and other community services to better reflect community needs, and allow further developments.

• Improvements to the service system are needed, with greater integration of services, to make mental health clinical “treatment in the community” more of an actuality.

• Long term strategies including urgent provision of increased numbers of acute care psychiatric inpatient unit beds.

• Action to end the shortage of housing and support places and urgent need to tackle homelessness problems;

• Increased resources for consumer participation in the running of PDRS and clinical services.

• Burgeoning needs for more and improved carer and consumer respite care;

• More information, education and participation for carers, across all mental health services.

• Need to foster development of consumer based peer support options.

• Improved access to general health services, GPs, and health education programs, to counteract “disastrous” burden of disease levels in the mental health consumer population.

• Free access for mental health consumers to proper dental services is needed.

• Smoking cessation programs, based on an understanding of the lived experiences of consumers, could seriously tackle tobacco related poverty and the under-addressed general health crisis among people with mental illness.

• Supportive assistance to parents with mental illness and their children.

• New and innovative programs to for young adults with mental health issues.

• Helping agencies develop more supportive approaches on drug and alcohol problems experienced by consumers.

• Continuing education of the community and media about mental health issues and attempting to reduce “stigma.”

• And many other important issues about community “entitlements.”
Psychiatric Disability Rehabilitation and Support services, in collaboration with Vicserv, consumers, and a range of community stakeholders could make a determined and increased contribution to such efforts, which would greatly benefit consumers and the wider community.

An afterword for service development:

Some consumer-based programmatic considerations on employment related programs, expressed in the mode of strategic questions:

• Could qualitative research be carried out of PDRS service consumers’ needs and

aspirations regarding employment -- not just for work or earnings in the short term, but for a working life path and opportunities for training, education and employment? Could this be a job that Consumer Consultants could be employed to do? Or an outside consultancy?

• What steps could be taken to assist participants in preparing for a real working future for participants? What support and assistance would participants get for widely exploring their future options? How exhaustive would these methods for locating opportunities for participants be, and how long lasting and far reaching would the follow up be?

• What specific methods and processes would be used to assist participants to branch out/ move on from any given project? How would this be resourced? How would networking and community development type work feed into the day to day work of the project?

• Would there be adequate scope within any given project for vocational counselling, skill identification and assessment of transferability of skills, and development of personal learning and achievement plans?

• Are staffing levels for programs or projects adequate for the range of roles responsibilities that would be required to also target the broader psychosocial rehabilitation and support needs of consumer participants? This would be important, in the face of external relationships, reporting, accountability, and monitoring requirements for funding bodies, promotion, community development and education and the wide range of skill bases required are considered?

• Would the learning component, in the specific employment types be strongly enough emphasised? Would there be a range of value-adding program elements for consumer participants? Would participants be able to gain recognised qualifications by formal study and traineeships? How readily could they make the transition to other work and study types without losing adequate levels of support?

• How will the agency manage external community linkages, for example with colleges of TAFE or specialist agencies? How will services deal with the likelihood that at least some of these agency relationships may be more "high maintenance" than anticipated.? Would this affect staffing levels and profiles?

• Through what specific structures and methods would consumers be able to receive effective, tailored, and flexible support in various education facilities and workplaces they may progress into from a program? How could this be delivered in a way that consumers wouldn’t raise complications about “disclosure” issues or worries about possible stigma?

• What would a dedicated program of education participation support for people with mental health issues look like? How could this be developed? What would it take to mobilise the political/ bureaucratic/ community agency/ education provider support to make this possible? What actions and resources would need to be mobilised?

• What are the positive and negative implications re Centrelink (ie, Social Security) benefits of clients who take on work options and how accessible and able to be maintained are such supplements as Pensioner Education Supplement and Training Allowance? What are the implications of “poverty traps” caused by pension deductions due to earnings? How can these be alleviated?

• What elements of consumer participation in project management and control could be built in? Could any given project be developed along the lines of community entrepreneurialism? Would it be possible for participants to take part in formal small business courses? Could employment programs include a progression for participants to go on to create and run their own businesses, individually or in small groups? What practical steps would be needed? What capital, information and mentorship resources would be needed for such ventures to succeed?

• How would the psychosocial support and developmental needs of participants be met? Discussion topic: The personal employment barriers (as distinct from external structural/ societal ones) experienced by many consumers can be very complex and go beyond whether a person has "work skills." In what ways? Discussion topic: Qualitative life experiences are important, and many solutions/ possibilities for future action can emerge from within the participant's own inner resources, if properly nurtured. How can such an idea be translated into a lived reality?

• Would the project include a number of options providing flexibility over the type and level of engagement with the program? What would be the methods and criteria of selection? How would services handle issues of participants’ ongoing job performance?
• What would be the opportunities for participants to have social outings, organised sport or recreation and some fun? How could participants and staff to celebrate together their progress and achievements?

• Would consumer employees receive a fair and equitable wage, comparable (when adjusted with Centrelink pensions etc) to Award rates?

There are quite a number of programs which have built in at least some of the consumer considerations and value-added features I have outlined in this article, and no doubt many wonderful and innovative features I may not have included here. There would also be many services earnestly working on programmatic issues in similar terms to those I have expressed here, and many interesting and worthwhile developments -- hopefully in good and committed partnerships with consumers and with strong understanding of the lived experiences and needs of consumers. I hope that my article will help stimulate and inform further constructive discussion about these important issues.

© Allan Pinches 2004.