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Page 1
Mental Health Programme Report
he climate surrounding mental health service provision in 1993 -
when the City Parochial Foundation’s Mental Health Programme
was launched - was one of great change. Statutory purchasers and
providers had been increasingly focusing on the implementation of
care management guidelines in social services, and the care
programme approach in the health service. At the same time, a
number of high profile inquiries into individual examples of failures in
community care were associated with a great deal of negative media
coverage. Heightened public fear of the dangerousness of the
mentally ill - coupled with suspicion of the progressive policy of
transferring services from the large asylums into the community - were
reflected in the Secretary of State for Health’s response to the
Christopher Clunis Inquiry: ‘the pendulum has swung too far’.
Reprovision of psychiatric services into the community nevertheless
continued apace, as the Government increasingly endorsed a needs-led
service, responsive to market forces, and tempered by the involvement
of mental health service users in the monitoring and strategic planning
of the changing services.
The chequered history of community care
The shift towards community care had begun in the 1950s, with the
first large scale closures of the mental asylums in the early 1960s. In
1975 a discussion document, ‘Better Services for the Mentally Ill’
encouraged further moves away from large psychiatric hospitals whilst
at the same time recognising that there were insufficient services in the
community to support people with mental health problems.
The 1990 NHS and Community Care Act placed a requirement on local
social service and health authorities jointly to agree community care
plans for the local implementation of needs-based services for
long-term, severe and vulnerable psychiatric patients. Subsequent
DHSS Inspectorate guidance
defined the concept of ‘care
management’ - a change which marked the introduction of the
purchaser/provider division within social services, with the care
manager identified as a purchaser of services, as opposed to a
provider. In line with the Government’s free-market ethos, 85% of the
monies allocated to implement the Community Care Act, the Special
Transitional Grant, had to be spent in the private or voluntary sectors.
Department of Health and Social Security (1975) Better Services for the Mentally Ill. London: HMSO.
Department of Health and Social Services Inspectorate (1991) Care Management and Assessment.
ummary of Practice Guidance. London: HMSO.
page 1
Mental Health
Services in the

Page 2
Mental Health Programme Report
page 2
Alongside the 1990 Act, the Department of Health introduced the
‘Care Programme Approach’ (CPA)
. This was designed ‘to provide a
network of care in the community’ for mentally ill people, both to
ensure that they had adequate support and to minimise the risk of their
losing contact with services. The essential elements of the CPA were:
systematic arrangements for assessing the health and social
care needs of people accepted by the specialist psychiatric
formulation of a care plan which addressed the identified
health and social care needs
appointment of a key worker to keep in close touch with the
patient and monitor care
regular review, and if need be, agreed changes to the care
Problems arose as a result of there being two separate systems for
delivering mental health care, represented on the ground by the social
services care manager, designed to be a resource manager, and the
health services key-worker, engaged in service provision. Subsequent
Government guidance
was intended to resolve the
difficulties, which were further complicated by the rise in GP
Public fears and the media
Community care had acquired an unpopular image with the public. A
1993 survey of media coverage of mental health issues by the Glasgow
University Media Group found that two-thirds of items related mental
distress to violence, whilst audience research by the same group
confirmed the belief that the strong link between mental health and
violence in the public mind was largely derived from the influence of
the media
At the end of 1992, three devastating incidents served to reinforce the
association of dangerousness with mental illness, and with a
perceived inadequacy of community care arrangements for the
mentally ill: Ben Silcock, a discharged psychiatric patient with a
Department of Health (1990). The Care Programme Approach for People with a Mental Illness.
London HC(90) 24/LASSL (90)11 DH.
Department of Health (1995). Building Bridges: a guide to arrangements for inter-agency
working for the care and protection of severely mentally ill people. London: DH.
Department of Health (1994). Guidance on the discharge of mentally disordered people and their
care in the community. London HSG(94)27/LASSL(94)4 DH.
Philo G, Secker J, Platt S, Henderson L, McLaughlin G and Burnside J (1994). The Impact of the
Mass Media on Public Images of Mental Illness: Media Content and Audience Belief. Health
Education Journal 53; 271-81.

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Mental Health Programme Report
page 3
diagnosis of schizophrenia who climbed into the lion’s den at London
zoo and was badly savaged; the killing of Jonathan Zito by discharged
psychiatric patient, Christopher Clunis; and the murder of 54-year-old
former policeman, Frederick Graver, by a former psychiatric patient.
These incidents and their reporting in the press influenced the
Government’s 10-point plan (August 1993), which included new
guidance on the discharge of mentally disordered people into the
community, the establishment of supervision registers for patients
deemed a risk to themselves or others, and a new power of
supervised discharge.
The rise of the voluntary sector
The introduction of managed markets, in the health service in
particular, had shifted the emphasis of the statutory services towards a
more needs-led approach, giving purchasers the power to divert funds
away from secondary service providers. And increasingly, Government
directives were specifying that local purchasers and providers should
consult with service users regarding overall improvement in local
services, as well as in their own care.
In the prevailing climate, the voluntary sector was uniquely placed in
several ways to provide much of the social support frequently
identified by service users as a key element of mental health care.
Voluntary services were at once competitive and relatively flexible in
their approach, making them attractive to purchasers and users alike.
And within the voluntary sector, the rise of the user movement - with
its emphasis on self-advocacy and empowerment - was a highly
significant and innovative development.
With its beginnings in the early 1970s in the anti-psychiatry movement,
the user movement had grown exponentially. Over 10 years since
1985, the number of user groups rose from less than a dozen to an
estimated 350 plus at local, regional and national levels
. The
movement played a leading role in the Government-appointed Mental
Campbell, P (1996) The history of the user movement in the United Kingdom. In: Heller T,
Reynolds J, Gomm R, Muston R, Pattison S (eds). Mental Health Matters. A Reader. London:

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Mental Health Programme Report
page 4
Health Task Force, set up in 1992 to facilitate the development of
better services in the community. At a local level, representatives from
user groups were becoming more involved in service planning,
evaluation and training, and in providing advocacy and support, as
well as a platform for the user voice. User groups both represented
and modelled radically new approaches to mental health services
based on the needs and wants of service users.
What did users want?
Broadly, users were calling for a decreased emphasis on illness and
greater recognition of their social needs. Decent housing, adequate
income and more opportunities for paid employment were high
priorities. Beyond this, acceptance was the key issue: to be listened to
and have their views taken seriously. To be recognised as equal
citizens, to be better informed about treatment and services, and to
have more opportunities to participate in the development and
management of services that reflected these values. Community-based
services, despite their shortcomings, were consistently preferred and
engaged with by service users over hospital care
The mid 1990s was an opportune time for creating a user-friendly
future to support those in mental distress. Hopefully projects such
as those outlined in the following pages will have helped to support
that future.
Audit Commission (1994). Finding a Place. London: Audit Commission.
Beeforth M, Conlan E, Field V, Hoser B and Sayce L (1990). Whose service is it anyway? London:
Research and Development for Psychiatry.
Rogers A, Pilgrim D and Lacey R (1993). Experiencing Psychiatry: Users’ Views of Services. London:
Rose D (1996). Living in the Community. London: The Sainsbury Centre for Mental Health.

Page 5
Why a Mental Health Programme?
ommunity care was a recurrent theme in the Report of the City
Parochial Foundation’s Policy for Grants 1992-1996. As part of its
five yearly policy review in 1991, the Foundation had commissioned a
policy paper on community care to provide background information
on the needs for care in the community in London, and recommenda-
tions as to funding. This paper identified six broad concerns:
carer relief, respite and support
physical access and transport to mainstream services
enabling voluntary sector representation on planning bodies
self-advocacy projects
mental health day-care services
support services for people in mental distress, particularly people
from the Afro-Caribbean and Asian communities, and training of
therapists from these communities.
Racism and the refugee situation were also highlighted as priorities for
the future.
Three deciding factors motivated the Foundation’s decision to fund a
broad-spectrum mental health programme. First, the Foundation had
received few grant applications in the mental health field in the recent
past. Second, there were growing concerns about the needs of clients
and their families in this area. And last, the statutory services for those
with mental health problems were in the process of radical rethinking
and re-structuring, with the potential for adverse effects on the
provision of services to those in great need, such as the homeless
mentally distressed.
Priorities and projects
Preparations for the Foundation’s Mental Health Programme began in
1993. Early in the year, a specially convened advisory panel of mental
health experts was invited to recommend priorities for grants within
the programme. Four particular concerns were identified.
Women experiencing mental health problems (of all ages).
Young people with mental health problems, particularly young
people from black and minority ethnic communities, including
refugee communities.
Accommodation projects concerned with providing specialist help
for homeless people with mental health problems, especially
those with continuous ongoing needs.
Self-advocacy schemes and groups that brought together
consumers of mental health services to say what they felt about
those services and the way they were operating, with a view to
bringing about improvements.
Mental Health Programme Report
page 5
The Mental

Page 6
These priority concerns were put to a public meeting of people
involved in mental health organisations in June 1993. A total of 120
people attended the meeting and endorsed the choice of priorities.
Wide publicity about the availability of funds (up to £500,000 a year
over three years) for new work within the priority areas of concern
resulted in 90 approaches for grants being received by the Foundation.
Over half fell outside the stated priorities. Of the remainder, 20
organisations were invited to meet Foundation staff and 17 of these
were invited to submit full applications. Nine organisations eventually
received grants. The Foundation received no applications from
organisations working with the homeless mentally ill, thus the funds
allocated all went to groups working within the remaining three
priority areas of concern. These were:
The Manic Depression Fellowship
Nafsiyat Intercultural Therapy Centre
Peter Bedford Housing Association
Mental Health Media
Croydon Mental Health User Group
Mind in Tower Hamlets
Horn of Africa Counselling and Social Support Centre
Brixton Sanctuary
Islington Women’s Counselling Project
With the exception of the Horn of Africa Counselling and Social
Support Centre, which received funding for a feasibility study only,
these organisations all received three-year grants from the City
Parochial Foundation for specific mental health projects. The Brixton
Sanctuary and the Islington Refugee Project of Women’s Counselling
projects both closed prematurely (further information on page 7). The
remaining six projects, the services they have provided with
Foundation funding, the project outcomes, and the problems encoun-
tered during the course of development, are described in the following
pages of this report.
Monitoring and reporting
The Foundation outlined a number of monitoring and reporting
systems, both to monitor the Mental Health Programme as a whole,
and to assess individual projects comprising the programme. These
included the following elements.
Group meetings of the all organisations funded at the end of the
first six to ten months of the programme, and thereafter twice
yearly, to discuss issues and problems and exchange
Visits to the individual projects by the Policy and Monitoring
Officer, Dr Maknun Gamaledin-Ashami, every six months to
assess progress.
page 6
Mental Health Programme Report

Page 7
Mental Health Programme Report
All projects to copy project-related documentation to the Policy
and Monitoring Officer on a regular basis - and to inform him of
any management changes.
A short questionnaire to be completed every year by the
managers and key workers in the individual projects, aimed at
assessing the effectiveness of the grant, its impact and lessons
Annual reports to be prepared specifically by the individual
projects for the City Parochial Foundation. These to include a
section detailing the profile of clients using the services.
The Policy and Monitoring Officer and the Field Officer
responsible for the programme to prepare an annual monitoring
report for submission to the Monitoring Sub-Committee and other
relevant City Parochial Foundation committees.
Projects that ended prematurely
Brixton Community Sanctuary applied for and received, in 1994, a
grant of £77,735 over three years to employ a community outreach
worker who would particularly work with women. This was an
important initiative as members of the Sanctuary felt at the time that
women were not well represented amongst their regular membership.
Sadly, the organisation suffered from the effects of one member of
staff’s ill health and difficulties with premises. As a result, the project
came to an end when the remaining worker moved to another job in
The Islington Women’s Counselling Project received a grant of £92,771
over three years to employ a refugee worker to work with younger
women. This exciting work began in June 1994, but unfortunately
significant staff changes led the project leaders reluctantly to decide in
September 1995 that they could no longer continue the work as
originally envisaged.
page 7

Page 8
This organisation received a grant for a feasibility study to examine the
extent of mental health problems amongst refugees from the Horn of
Africa, the appropriateness of existing statutory and non-statutory
provision, and the health and social care needs experienced by people
from the Horn of Africa suffering mental distress. The research,
completed in 1995, successfully identified the particular problems faced
by refugees from the Horn of Africa with mental ill-health. These have
subsequently been widely acknowledged and several agencies,
including the Mental Health Foundation, are working to relieve mental
health and social care difficulties faced by refugees, including those
from the Horn of Africa.
page 8
Mental Health Programme Report

Page 9
anic depression, also known as bi-polar affective disorder, is
characterised by swings in a person's mood from high to low -
euphoric to depressed.
In the manic phase, the person has excessive amounts of energy and
feels little need for sleep. At these times they may behave in ways
which can have serious consequences when the episode is past, for
example leaving their job, spending a lot of money, or giving away
their possessions. During a depressive episode, there is a feeling of
hopelessness and despair, of lethargy, broken sleep, overwhelming
negativity and difficulty in carrying on with the activities of day-to-day
These are, however, only episodes. People with a diagnosis of manic
depression can have long periods of time without experiencing these
problems, and many sufferers lead useful and productive lives. In
addition, user-run groups like MDF have been instrumental in helping
people with manic depression learn how to cope better with the
problems arising from it, through self-management techniques and
through the support and advice offered in MDF self-help groups.
The Need for an Expanded MDF London Network
Manic depression, according to World Health Organisation figures,
affects 1 in 100 of the general population at some time in their life.
Despite this, it is a condition about which there is considerable
ignorance among the general public. As a consequence, people with
manic depression can feel isolated and experience prejudice.
MDF supports an expanding network of self-help groups nation-wide.
However, its presence in London in the early 1990s was under-
developed, particularly in inner city areas. A total of only nine London
MDF groups existed at the start of the project in 1994. In such a large
centre of population, there was an obvious need for outreach to
people living with manic depression, by developing the network of
MDF self-help groups in the Greater London area.
Mental Health Programme Report
page 9
Expanding the
MDF Self-Help
Network in
Greater London

Page 10
Self-help can mean two things. It can refer to an individual’s efforts to
cope better with whatever is troubling them, by educating themselves
about the nature of their problem, for example, or by learning new
ways to handle its effects.
Self-help can also involve meeting together with a group of people who
have been through similar problems to offer each other mutual support
and understanding. Such groups are known as self-help groups or,
sometimes, support groups. Through sharing their experiences,
members of MDF self-help groups learn how to cope better with the
effects of manic depression. Collective self-help not only assists group
members with managing their condition, but also enhances their
social lives and encourages them to campaign to improve services.
People who attend a self-help group may find that it is the only space
where they can be honest about their symptoms or fears without being
thought of as odd by the people listening. These groups do a great deal
to lessen the sense of isolation for MDF sufferers and their families and
to reduce their fears about not being able to cope.
Self-management of manic depression describes the process of
understanding one’s mood swings, the effects they have, and at what
times and how often they are likely to occur. This helps individuals to
recognise signs of an approaching mood swing and take steps to cope
with it better, leading to improved stability and a greater sense of
The London Project
City Parochial Foundation made MDF a grant of £132,732 over three
years to expand their services in Greater London, by appointing a
director with special responsibility to:
raise awareness of MDF services in Greater London
provide advice, information and access to MDF self-help groups
in Greater London
expand the network of MDF self-help groups throughout the
Greater London area
develop links and services appropriate for black and minority
ethnic communities affected by manic depression
ensure continued funding for the project and the local groups at
the end of the three year City Parochial Foundation grant.
In a region that has a population of nearly seven million people, with
32 boroughs and 68 separate NHS Trusts, this represented a formidable
Mental Health Programme Report
Self-help and self-

Page 11
Expanding the MDF Group Network in Greater London
An MDF Director for Greater London was appointed in March 1995.
Selection of a part time administrative assistant followed in November
The Director was responsible for all MDF development work in
Greater London. This focused initially on the development of new
MDF groups in under-developed areas. A target of six new groups by
the end of year one was successfully reached.
Kingston MDF Group
launched May 1995
West London MDF Group
launched May 1995
Wandsworth MDF Group
launched September 1995
MDF Groups launched
September 1995
Ealing MDF Group
launched March 1996
Hackney MDF Group
launched March 1996
Four further groups were subsequently established.
Enfield MDF Group
launched May 1996
Hampstead MDF Group
launched October 1996
Twickenham MDF Group
launched March 1997
Brent MDF Group
launched March 1997
Development work has since continued in Haringey and Merton.
How the Project Worked
To begin an MDF group in a new area, the Project Director would start
by making contact with local people to assess the level of interest.
This would include both MDF members in the area and professionals,
in order to access users of the mental health services locally who might
not know about MDF. Directories of local mental health services,
including other voluntary organisations, were further sources of
potential group members.
After consultation and discussion, a preliminary meeting might be set
up, where people would be invited to find out about MDF, self-help
groups and self-management of manic depression. If a number of
people were interested enough to want to start a group in the area, the
Project Director would work with them to help them develop their
own systems for running the group and to sort out the practicalities.
She would then provide ongoing support for group facilitators as the
group grew. She would also offer opportunities to network with other
MDF groups and their facilitators through a monthly Greater London
MDF Bulletin and quarterly Network Days and Group Training Events
for the region.
Mental Health Programme Report
page 11

Page 12
What Made a Group Work?
The success of a group seemed to depend on a number of different
factors. For instance, if a group relied on one key individual to lead it,
the absence of that person for any length of time could lead to the
group’s dissolution. One way of preventing this was shared
leadership, with a number of people, at least two, taking turns to lead
the group. This arrangement also served to relieve stress for people
who were interested in becoming more involved but worried about
their ability to cope.
Having shared leadership, however, sometimes led to a clash of styles
or opinions as to what a group should be doing. The involvement of
the Project Director, as a neutral mediator, was of key importance in
enabling different views to be heard and consensus to be achieved.
For a group to be successful, members have to be sure that
confidentiality will be maintained, thus new groups were encouraged
to have a clear statement to this effect to which all members agreed to
Project Successes
The availability of part-time administrative support from an efficient
and reliable assistant was extremely valuable in allowing the Director
to concentrate on the development and training of MDF groups.
MDF’s Greater London membership increased by almost 50% since the
start of the project, from 820 to 1,196 members. This required a great
deal of networking and public relations work on the part of the
Director - travelling around, talking to people and distributing leaflets
about MDF.
page 12
Mental Health Programme Report
“The Ealing group is beginning to thrive. We have a core membership
of 12 to 18 people who attend on a regular basis. At our last meeting,
members were still chatting to each other at 9.30 p.m., half an hour
after the consultant psychiatrist who came to speak to us had gone
home. He gave a very interesting talk. Four new members joined that
evening and it would seem that regular talks from various agencies
will engender new interest from outside parties and encourage
additional membership.
It is the intention of the group to be as self-reliant as possible, and to
organise our own speakers and so on, but we also acknowledge the
superb back-up we receive from all the staff at Kingston-Upon-Thames.
Ideally we would like a few more female and ethnic minority
members but we are optimistic that this wish will come to fruition in
the near future”.
Co-ordinator, Ealing MDF self-help group
Case study

Page 13
Mental Health Programme Report
The Director was able to work with MDF members in local areas and
effectively act as a catalyst for setting up new groups. The profile of
MDF was considerably enhanced as a result: the Fellowship became
much better known within mental health circles in the boroughs where
new groups were formed.
The training days were both innovative and well received. They had
not happened previously on a regional basis. MDF members much
appreciated meeting with members from other groups
throughout the London region to discuss group issues and business.
Future Work
There are still large areas of London in which MDF does not have any
self-help groups - or even very many members. Future work will need
to concentrate on those areas to make the most impact and to raise the
profile of MDF. Ongoing effort is required to support existing groups
as well as to help set up new ones. This strategy seems to have
worked well so far.
page 13
“The West London MDF - self help group aims to supplement psychiatric
and community care. Contact with other sufferers and carers is
immensely helpful in avoiding unpleasant experiences. By supporting
each other we also assist the community psychiatric system and
hospitals by leaving professional services and valuable bed space
available to others. We all want to live outside institutions and this
group helps enormously.
Twenty to forty sufferers and carers meet at the local community
centre on the first Wednesday of every month. For most of us it is an
invaluable support network - a place where the intense isolation
resulting from this illness can be relieved. Most of us see the group as a
lifeline, something the psychiatric services can only offer very
expensively. We offer support in times of crisis, by either phoning or
visiting in hospital members who have had to resort to an increasingly
unhelpful and overworked system of health and community care. We
also meet on the third Saturday in the month.
At group meetings literature and personal help is readily available to
both sufferers and carers regarding drug treatment, the nature of the
illness and how everyone copes with it. This help and information is,
sadly, not available anywhere else! The opportunity to speak with
other sufferers and carers to gain more insight into manic depression
and how it affects others around us is unique. We often invite speakers
who are professionally involved in treating or helping manic
In just a year and half the West London self help group has achieved a
membership of 84 sufferers and carers”.
Co-ordinator, West London MDF self-help group
Case study

Page 14
Training events will need to continue to develop team working and
facilitation skills, the lack of which appeared to be the common root of
difficulties among the self-help groups.
Mental Health Programme Report
“When I first heard of MDF, I had just come out of a long bout of
depression lasting 18 months. My confidence and self-esteem were at a
low ebb. I hadn’t worked for two years and my social skills had become
redundant due to long periods of isolation. A lot of friends had
deserted me, and I them.
Going to the first meeting was a big step as I didn’t feel confident
amongst groups of strangers, but I was made to feel welcome and I
found for the first time that I was able to speak openly and frankly
about bi-polar episodes knowing that other people had been through
what I’d been through - different experiences, some funny, some tragic,
some downright horrendous. I did not want sympathy; just someone to
listen without prejudice.
The meeting took place in someone’s house around a big oval table
and was informal and friendly. Interesting and informative ideas
were being bandied about. I came away having made a few new
friends who I still keep in touch with, and with a positive vibe about
I am now group co-ordinator in Enfield and we have attracted new
members from within the borough and from a neighbouring area. I
have since been to workshops on the media and mental illness and on
coping with manic depression, and I’ve attended a supper evening at
the Royal College of Psychiatrists.
I am now attending College in Tottenham studying Humanities and
Social Services. I hope to sustain the members’ interest in the Enfield
group, to attract new members, and to obtain as much literature and
information on the subject as possible”.
Co-ordinator, Enfield MDF self-help group
One person’s

Page 15
Mental Health Programme Report
page 15
“I have really benefited from the support and companionship of
members of our self-help group. I cycle from mania through
depression twice a year and I have great difficulty keeping in touch
with reality. Three members of the group keep personal contact with
me and advise me on how my attitude - aggressiveness, moodiness and
withdrawal - appears to the world at large. They give me invaluable
help between visits to my psychiatrist. I have not even been close to
entering hospital since the group began.
To return the help extended to me I regularly help sufferers in crisis
and/or in hospital. Carers frequently need more help than the
sufferers, particularly when the latter has gone astray while suffering
mania. This is very time consuming but satisfying”.
Member, West London MDF self-help group
One person’s

Page 16
The Need for a Counselling Service for Young Refugees
s its reputation for intercultural therapeutic work grew, Nafsiyat
began receiving an increasing number of requests for help from
refugees. Lack of available resources at the time meant that these
requests could not be met. In 1992, research into the problems
experienced by young refugees, conducted by Nafsiyat together with
the Traumatic Stress Clinic, indicated that this group was particularly
likely to experience problems as a result of witnessing violence and
death, being separated from or losing members of their family, losing
their familiar culture, language and community, and being isolated at
school. Some young refugees were also thrust into the position of
being carers to other siblings, increasing their stress and worry. For
young refugees with families in this country, generational conflicts
resulting from the young person’s adaptation to English culture were
also a frequent problem.
Research into the availability of services indicated a widespread lack of
provision for meeting the emotional needs of young refugees, and
particularly an absence of counselling services in languages other than
English. Language needs were usually met through translation via
interpreters - an arrangement which could frequently be uncomfortable
as well as inconvenient. Little preventative work was happening.
Moreover, most young refugees in contact with services were already
displaying behavioural and emotional difficulties, often of a serious
In addition, young refugees were frequently facing stress resulting from
practical problems, such as higher than average rates of
unemployment; poorer access to training as a result of unmet language
needs; poor housing; and difficulties with their benefits claims and
legal status.
The Refugee Project
City Parochial Foundation made Nafsiyat a grant of £148,766 over three
years to establish a counselling project for young refugees. The aims
were threefold:
to provide direct psychotherapy, counselling and group work
services to young refugees
to develop support within refugee communities themselves by
training potential counsellors and therapists
to liaise with statutory and voluntary organisations to ensure that
the psychological and emotional needs of young refugees were
being met.
page 16
Work with
Young Refugees
Mental Health Programme Report

Page 17
Mental Health Programme Report
A therapist/counsellor was appointed as full-time Project Leader in
January 1995. The City Parochial Foundation grant covered her salary
and supervision costs, the salary of a part-time administrative assistant,
and contract payments for sessional therapists.
The project leader’s main roles were:
to co-ordinate the training and work of volunteer counsellors
to provide individual counselling/therapy and group work in
schools and colleges
to liaise with refugee community organisations and other
appropriate agencies.
How the Service Worked
The Project Leader began by building on Nafsiyat’s 1992 research, to
establish the needs of young refugees across London. Consultation
took place with diverse counselling agencies, black mental health
agencies, schools, colleges, youth clubs, and refugee forums and
community groups. The Refugee Project and its training opportunities
for potential therapists from refugee communities were publicised
through these networks.
From these beginnings, the project grew to provide a therapeutic
service taking into account the stresses faced by young people from
refugee communities, particularly the after-effects of trauma and loss.
Ongoing work with the wider refugee communities continued to
promote understanding and use of the service. Therapy was offered
in a manner that made it acceptable to young refugees; for example, it
would often not be referred to as therapy, and it might not take place
in a therapist's consulting room. Drama, art and play would
sometimes be used in addition to more conventional counselling
techniques. Clients were offered flexibility in choosing a therapist;
they were asked whether they wanted a man or a woman and whether
they would like to see someone who spoke their own language. Most
Eritrean and Ethiopian clients preferred to see counsellors who were
not from their own community, even though they might have found it
easier to talk in their own language, because of concerns over cultural
values, including issues of confidentiality.
page 17

Page 18
Group work, less intensive than individual therapy, was conducted in
two schools and a sixth form college. Groups were run separately for
boys and girls where appropriate, and were scheduled within school
hours to make it easy for children to attend and to demonstrate the
importance and value of the groups from the point of view of the
school authorities.
The recruitment and training of volunteer counsellors was a major
focus. Seven volunteers started training with Nafsiyat in September
1995, and most started seeing clients under supervision from January
1996. The one-year training course looked specifically at counselling
issues for young refugees. Volunteers were encouraged to see the
training as part of their career development. Nafsiyat is a United
Kingdom Council for Psychotherapy (UKCP) recognised training
centre, the volunteers received a certificate at the end of their training,
and there was an option to progress to more advanced counselling
In addition to the training programme, the Refugee Project ran training
and awareness raising sessions for outside agencies on the mental
health needs of refugees, particularly in the younger age groups.
There were more requests for this work than could be dealt with - the
majority coming from statutory mental health care agencies.
Almost all the work of the Refugee Project was focused on developing
skills within the refugee communities - in order for refugees
themselves to be able to provide services to their own communities in
their own language. Workers and volunteer counsellors were
involved in continuous evaluation of the project, whilst a refugee
advisory group fed back to ensure that the diverse perspectives of the
different refugee communities were represented.
page 18
Mental Health Programme Report
“The Project started being available for referrals from November 1995,
and we were been able to offer a range of services from January 1996,
when the volunteers had received an appropriate amount of
preparatory training. In total we reached 129 referrals to June 1997.
The central issue for many of our clients has been separation,
bereavement or loss. Almost all our clients have had family members
who have died, sometimes in violent incidents.”
Project Leader, Nafsiyat Refugee Project

Page 19
Mental Health Programme Report
Who Used the Service?
The Refugee Project offered counselling and therapy for 129 refugee
children and young adults aged 12-30, mainly from Ethiopia and Eritrea
(26%), Somalia (15%), Turkey and Kurdistan (9%), Iran (9%), Sudan
(5%), and Latin America (4%). The young people using the project
presented a wide range of needs: some were in distress and
displaying behavioural difficulties and sometimes physical symptoms;
others had more deep-seated emotional problems. Some clients
would be coping well with their day-to-day lives at school or college,
but experiencing emotional stress and problems to do with their status
as refugees; some of these young ones attended the centre, whilst
others went to groups at their place of education.
The project initially received more referrals of young women than
young men, but numbers subsequently roughly equalised.
page 19
“A 16-year-old client came to the Centre feeling very depressed, she had
left her parents in Africa and had come to England with a relative.
Once in England the relative was treating her like a servant, not
sending her to school and making her stay at home and look after his
children. The young woman's self confidence had been decimated by
this relative, and when she came to Nafsiyat she had a very low
opinion of herself. She also had a lot of anger towards everyone she
met, some of which was based on envy. She was described as having
behavioural difficulties. She saw an English-speaking therapist at
Nafsiyat on a weekly basis for 12 weeks, after which she was seen every
month until the counselling gradually ended. Throughout the
counselling she was able to talk about her pain and about the loss of
her whole family, and to see that she had a strong attachment to the
relative who was abusing her because he was the only link to her past,
and to the rest of her family back home. At the end of the counselling
this young woman became much more confident and is now living in
her own accommodation and attending college.”
“One referral was of an Turkish father and daughter, the young
woman's mother had died in Turkey, although the exact nature of the
circumstances are still unknown. The father and daughter were
having many conflicts about their roles. The father had culturally
specific expectations of how his daughter should behave, and she
compared her father to how she imagined white parents behaved
towards their daughters. The young women was considered to have
‘behavioural difficulties’. Both father and daughter were seen by a
Turkish-speaking counsellor on a weekly basis for 12 weeks. The
counselling helped them both to accept and mourn the death of their
mother/wife and to see how they were blaming each other for her
death. The loss of culture, language and social values was creating
conflicts for the family; once they began to see how these issues were
affecting them, they began to improve in their communication.”
Case study
Case study

Page 20
Project Successes
Nafsiyat has always had a high standard of clinical work with clients.
The new work was the outreach work and forming the team of
volunteer counsellors from the refugee communities. Training of the
volunteers was particularly successful. The project was able to find
very high quality volunteers; all but two out of the seven original
trainees decided to stay on after the training, and they made a very
solid team. Nafsiyat thus met its criteria for the training - the
development of skills within refugee communities.
The outreach also worked well. The clients using the service were
exactly those for whom initial research had identified gaps in existing
services. They came from three groups. First, unaccompanied young
people - the 14 to 18 year-olds coming to this country on their own.
Second, the 19 plus age group (79 in total); this group lack any
statutory support, and they have deeper emotional issues than the
younger age group. There were several recent suicides amongst
refugees in this age group in London. Third, there were those
refugees (74) who did not speak English. Being able to offer a service
in the person’s language was found to be very important.
page 20
Mental Health Programme Report
“One young Eritrean man we saw was 24 years old. He had joined
the army at the age of 12 and had come to this country at the age of
18. He was referred by his doctor as being depressed. The client had
been in the country for six years and felt that this time had been like a
dream for him. He had become preoccupied with imagining that he
had a life-threatening illness; the doctors could not identify any
illnesses and had put him on anti-psychotic medication. Now that he
had settled he was having panic attacks and feeling very depressed. He
thought these emotions were linked to his past experiences of witnessing
and being involved with extreme violence, both in the army and in his
His past history was one of being brave and coping with all events, and
as such he had found it very difficult to express his fear and sorrow
about the events that occurred in his life. This fear was now beginning
to take over and he felt afraid of everything, to the extent that he found
it difficult to work and live his life. He received therapy for over 6
months, and was subsequently considered for long-term treatment
after a psychiatric assessment at Nafsiyat. The counselling helped him
to talk about all his built-up pain, anger and most importantly fear.
He had witnessed people being killed from a very young age, but had
always had to be brave. In the counselling he was able to explore the
root of his fear, and address fear in his present life.”
Case study

Page 21
Mental Health Programme Report
Future Work
Throughout the project, Nafsiyat were asked to do a surprising amount
of training and supervision for other organisations. To mid-June 1997,
they ran 27 workshops, conferences and one-day training sessions
aimed at teachers, social workers and other counselling centres on
specific ways of working with refugees as well as providing
consultancy work. Nafsiyat found that teachers, for example, were
keen to help refugee children but they did not know what to do.
More training and workshop programmes are planned, as is continued
ongoing supervision with mental health professionals working with
refugees. If professionals learn how to cope with refugees hopefully
services will be more appropriate for refugee communities.
Nafsiyat would also like to train more people from refugee
communities. They will be running further training courses in future,
with the aim of providing more resources within the communities.
The hardest part of the work was establishing the project and getting
recognition. That done, Nafsiyat are now seen as somewhere to send
people. They have established trust - and that needs to continue.
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Page 22
eter Bedford HA has many years’ experience in running employ-
ment and training schemes for people living in its housing projects.
These schemes offer participants the opportunity to meet people, keep
busy during the day; earn money to supplement benefits; develop and
improve their skills; and subsequently move on to open employment
or training if they wish, with full support. The schemes are designed to
accommodate people whose reasons for wanting to work may be very
different. Many may just want the chance to be with others
during the day and do something interesting with their time. For
others, however, moving into open employment or earning decent
money are more important.
The Need for Women’s’ Employment and Training Schemes
In 1992, the Peter Bedford Trust set itself positive action targets to
increase the number of women living in Peter Bedford Housing. This
met with considerable success - and in the subsequent two years the
proportion of women residents increased from 21 to 30%. Once
established, however, the women began to demand a better range of
services more appropriate to their needs. In particular, they wanted
more and different work opportunities besides those already available
in canteen catering and in the carpentry and upholstery workshops.
The most frequent requests were for opportunities in administrative
work and sewing-related activities, which were viewed as offering the
most useful training to enable a return to open employment.
Consultation with other mental health agencies involved in developing
employment opportunities locally confirmed that there was heavy
demand from women both for training that would enable them to
move into administrative work and for work activities like sewing.
Lack of access to suitable training opportunities is a significant issue for
people with mental health problems - and together with stigma, acts as
a considerable barrier to their joining the job market One reason for
this lack is that training agencies and colleges are not geared up to
meet any additional needs for support that mental health service users
may have. A key feature of the Peter Bedford HA schemes was
therefore to offer women participants the opportunity to gain genuine
qualifications that were recognised on the open market.
page 22
Peter Bedford
and Training
for Women
Mental Health Programme Report

Page 23
Mental Health Programme Report
The Women’s Employment and Training Projects
To attract more women into the Peter Bedford HA work schemes
required new developments. The City Parochial Foundation made
Peter Bedford HA a grant of £159,066 over three years to set up
schemes offering employment and training for women in office
administration skills and soft furnishings production.
The grant was to cover the salary for a full-time trainer/assessor for the
Soft Furnishings Scheme, plus expenses for a part-time paid
community service volunteer for this scheme, running costs, materials
and equipment. On the administrative training side, funding
covered the running costs of the scheme, the salary of a full-time
receptionist and the costs of her training. Both new schemes were to
offer the option of NVQ qualifications for participants.
Both schemes became operational in late February 1995, with the
opening of the Peter Bedford HA new facility at Stamford Works in the
London Borough of Hackney.
The Soft Furnishings Work Scheme
Participants received training to produce a wide range of high quality
soft furnishing items, including curtains, cushions, covers, tablecloths,
napkins, quilts and bed linens. Skills training included:
design and pattern making
use of tools and machinery
cutting, machining and finishing items to a suitable standard
use of different textiles and fabrics
time keeping and reliability
working to instructions and deadlines.
Training was delivered on site, by the workshop supervisor and
volunteer assistant. The emphasis was very much on the production of
high quality goods that could compete with others on the retail market.
Positive feedback from sales was found to be very important in
maintaining morale as well as in planning production. Good planning
of retail outlets and opportunities was vital for this purpose as well as
for bringing revenue into the scheme.
page 23

Page 24
The scheme accommodated up to six participants a day, five days a
week. As part of the programme, the workshop supervisor became a
trained NVQ assessor, giving participants the opportunity to gain an
NVQ in Manufacturing Products from Textiles. Overall, around 20
people participated in the scheme, and by popular demand, three days
were designated ‘women only days’. The Soft Furnishings Scheme
proved popular beyond expectations: towards the end of the project
there were waiting lists to join the scheme on ‘women only days’.
page 24
Mental Health Programme Report
“We get very positive feedback from participants in the Soft Furnishings
Scheme. The training there is of a very high standard. Overall, it is
one of our most successful work schemes ever.”
Project Leader, Peter Bedford Women’s Employment and
Training Schemes
‘It’s therapeutic. I'm not working at the moment - coming here gives
me something to do and somewhere to go. You learn new skills.’
Christine, attending just over a year
‘My social worker recommended Peter Bedford to me... I think Soft
Furnishings is brilliant - otherwise I’d be stuck indoors looking at four
bare walls. Being stuck indoors is like looking at paint dry. Being a
single bloke, there's more chance to make friends. I've made friends
here - before I didn't know anybody. Since I've been working here I've
got more confidence.’
Derek, attending 3 months
I like meeting people; I like doing the things I do like sewing and
making cushions and bags and sheets.’
Pamela, attending nearly 2 years
‘Before I came to the Soft Furnishings Work Scheme I'd go to day
centres. It's been a change in my life coming to the work scheme; I’ve
quietened down a lot. Money I've never had - the work scheme wages
help me to save up.’
Marian, attending for over a year
‘I feel fine here… I can pay for my holidays. I learn sewing here
Hilary told me that she could help me to be trained in sewing and get a
Anne Marie, attending 6 months
Positive feedback
What the
users thought

Page 25
Mental Health Programme Report
The Administrative Training Work Scheme
The Administrative Training Scheme was set up to offer three
administrative training posts to women living in Peter Bedford
Housing. One was a full-time paid post based and managed within
the office administrative team at the Hackney site, and operated on a
one-year contract basis, such that each trainee could complete an NVQ
Level 2 in Business Administration during their term. Two further
part-time 'feeder' posts, based at Peter Bedford’s Legard Road site in
Islington, paid the post-holders allowances only as benefit
supplements. The feeder posts were designed to be less intensive,
offering women the experience to be able to make an informed choice
about whether they might want to take up the intensive post at the
Hackney site.
The full-time administrative worker had the support of Peter Bedford’s
employment worker who was also an NVQ assessor. The employment
worker provided individual on-the-job support and assistance with
applying for open employment to move on to when the one year
contract was coming to a close. Among the advantages of this post
was that it demonstrated the organisation’s ongoing commitment to full
participation by tenants in the running of the organisation, and
provided participants and enquirers with a first point of contact who
was particularly ‘user-friendly’ when they came to pay their rent or see
staff at the office.
The first post-holder successfully moved into open employment at the
end of her twelve-month contract. The second took up the post after
working on one of the ‘feeder posts’, and then completed eight months
of the one-year contract before moving on to paid employment outside
the organisation. The reception and administrative support services
they provided were of a high standard, and both gave very positive
feedback about their experience of the post.
Over the course of the scheme, the Peter Bedford HA office became a
City and Guilds accredited assessment centre for the delivery of the
Business Administration NVQ.
page 25

Page 26
Project Successes
The Administrative Training Scheme was successful both in terms of
providing administrative support at the Peter Bedford Association’s
new Hackney site, and in enabling participants to go out and get
follow-on jobs. Similarly, the introduction of the Soft Furnishings Work
Scheme substantially increased the overall usage of work schemes by
women at Peter Bedford HA. Over 30 women were involved in the
two new schemes since start-up in February 1995, representing a third
of all the women participants at Peter Bedford HA. Targets for ethnic
minority participation were maintained amongst the new women: 20%
were from black or other ethnic minority groups, and 14% were Irish.
There were notable changes in the atmosphere at Peter Bedford HA
with the increased involvement of women, according to the Project
Leader. Staff noticed a positive impact on the organisation’s culture as
the environment became more welcoming. The new Soft Furnishings
Scheme made Peter Bedford HA a much friendlier place for both
women and men to come to.
Future Options
The Soft Furnishings Scheme has gone from strength to strength both
in terms of participant satisfaction and demand for places, hence the
scheme is something Peter Bedford HA would like to develop further.
Continued implementation of the NVQ training is also planned in both
the Business Administration and Soft Furnishings Work Schemes to the
point where people are gaining these qualifications on a steady basis.
Peter Bedford HA is expecting to improve the marketing of the goods
produced in the Soft Furnishings Scheme by changing the location of
their retail outlet. Suitable shop-front premises have been identified
and secured on a busy local high road. The income generated is
hoped to offset some of the costs of the scheme.
Cutbacks in the Peter Bedford Association’s core funding in 1996
necessitated considerable restructuring and operational down-sizing to
enable the organisations basic services to remain open. Further funds
are required to maintain staffing and management of the women’s
training schemes, and to expand these services to meet the demand
from participants. Both increased management capacity and support
functions would be needed to achieve these aims.
page 26
Mental Health Programme Report

Page 27
Mental Health Programme Report
page 27
Janet had been living long-term on an acute psychiatric ward. She
liked life on the ward and was very institutionalised and reluctant to
move out. The only time she had been discharged to an independent
living flat she had been re-admitted 24 hours later with acute alcohol
poisoning, having drunk one and a half bottles of spirits. It was felt she
was too much at risk to be discharged into an unsupported setting
again. In spite of her preference for living in the hospital her key work-
er was seeking a community placement for her due to increasing pres-
sure on acute beds, but was reluctant to push her out feeling that this
would lead to guaranteed failure. However, he could not find her a
suitable placement. Peter Bedford was suggested to her, and she came
to visit and reluctantly agreed to start a trial period in the Soft
Furnishings Work Scheme. The ultimate aim was for her to move into
Peter Bedford housing.
Janet would come with her worker from the ward initially for a
morning a week, her history of extreme distress in new situations
indicated that she would need a great deal of support to attend the
project, so it was planned for the worker to be around if Janet became
distressed, but not to actually come into the workshop with her.
Initially Janet could not spend more than 10 minutes in the workshop -
her distress included physical symptoms such as vomiting. The
expectation was that Janet would at some point refuse to come, and
there was concern around allowing Janet to undergo an experience she
found so distressing. But after attending a few times, she actively
wanted to continue, and all concerned decided to support her in this.
Gradually, over a period of months, Janet was able to spend longer
periods in the workshop. Her level of distress became manageable, then
finally disappeared altogether. She began to learn the skills needed to
produce things in the workshop, actively take part and enjoy the work.
Her motivation to move out of the hospital increased as a result. She
willingly moved into Peter Bedford housing six months after starting
her placement in Soft Furnishings. She now lives in Peter Bedford
housing and continues to attend the Soft Furnishings Scheme regularly.
Case study

Page 28
page 28
Mental Health Programme Report
The Need to Improve Press Coverage of Mental Health Issues
y the early 1990s, service providers had begun to recognise that
users of mental health services were vital partners in developing
mental health provision to meet people’s needs. However, media atti-
tudes to those with mental health problems lagged far behind.
Emotive terms like ‘psycho’, ‘nutter’ or ‘lunatic’ were continuing to be
used by journalists on a daily basis in reporting on mental health
issues, feeding public ignorance and fear rather than encouraging
respect and understanding.
Even when journalists avoided sensationalism, the views of mental
health service users were largely ignored, or canvassed only to provide
personal testimony to add human interest to a story. Any serious
debate of mental health issues tended to be seen as a dialogue
between health professionals and politicians, ignoring the views of
service users both as experts in their own care needs - and as sources
of informed comment on the broader issues.
Lack of resources amongst mental health charities and user groups had
generally meant that they had no press officer or public
relations/media strategy - making it very difficult indeed to get the user
voice into newspapers running mental health stories. Since the media
had been shown to be a powerful influence on public attitudes to
mental health (see page 2), it was reasoned that funding targeted at
improving media coverage of the issues would be bound to improve
public attitudes somewhat towards those in mental distress.
Mental Health
Media Project:
Getting the
User Voice into
the Media
A new report, ‘Living in the Community’, on users’ experience of
community care, found that users thought the media was the single
most important source of stigma. Researcher Diana Rose said “mental
health organisations must work with the media, the most powerful
means of public education we have, to encourage more positive images
of mental health”.
Headlines, June 1996
Care-less community

Page 29
Mental Health Programme Report
The Headlines Project
The City Parochial Foundation granted MHM £101,776 over three years
to run a new initiative - the Headlines project.
The project brief was to redress the balance of press coverage of
mental health issues, by working closely with both journalists and user
led groups in the Greater London area. Funding covered the
appointment of a media relations officer with a specific remit to
promote users’ views and voices, and to develop a core group of
service users with good media skills to liaise with the press.
There were three key objectives:
to empower users through providing media-skills training and
back-up support to enable them to get their voice over in the
press; support elements to include the regular production of a
newsletter - ‘Headlines’ - reporting media successes and
campaigns and targeted at London-based user groups
to encourage responsible reporting of mental health issues, for
example by networking with professionals
to discourage irresponsible journalism, for example by
orchestrating co-ordinated campaigns of complaint.
The project commenced in August 1994, with the appointment of two
journalists job-sharing the media relations officer post. This
arrangement changed first in March 1996 when a new media relations
officer was appointed as sole post-holder, and again in December
1996, when the media relations officer left Headlines and a user
development worker was appointed for 3 days a week in his place.
For the final 8 months of the project, monies saved on the worker’s
salary were used to cover the costs of equipment and training involved
in starting to develop a user network on the Internet.
Empowering Users and Promoting the User View
The two media relations officers initially undertook considerable
development work, beginning with the recruitment of user groups to
participate in the project. Media skills training was developed, and a
system of ongoing support, advice and information exchange between
user groups and the Headlines workers was established.
page 29

Page 30
Basic media skills training was run as a one-day workshop, designed
to provide the skills and support for maximising positive local press
coverage. Elements of the training included:
background information on how the press works and how to
work with them for maximum impact
planning a media strategy
interview skills training
writing a press release.
About 35 user groups in the Greater London area participated in the
basic training - and Headlines ran advanced workshops for groups
already active in media work who wanted to further improve their
press skills, for example in learning how to deal with journalists when
it came to more controversial issues, such as combating so-called
NIMBY (not in my back yard) campaigns against proposed mental
health facilities.
Once user groups were involved in press work, the Headlines media
relations officer would remain available for advice on getting a story
into the press - providing information on press contacts for specific
stories for example, and looking at press releases to see if there was a
better angle worth pursuing.
Other support services included the production of a user-written
leaflet, ‘You, the press and mental health’, the compilation of an
information pack on facts and figures surrounding mental health and
violence, and regular updates on the work of Headlines and its
associated network of user groups via the Headlines newsletter,
produced bi-monthly.
page 30
Mental Health Programme Report
Two years ago when Headlines started there had been no formal
contact with local newspapers. A member of our group went on the
very first training day on writing press releases, and the skills learnt
there have been used ever since by the group. The training really
helped us focus on the importance of the media.
Most valuable has been the training in showing how to pitch a press
release. Whereas in the past we would have just picked up the ‘phone
to contact a newspaper, we now do a formal press release. It seems to
work, as the local paper does get back to us.
I think the media work with Headlines has helped the group to focus
on its image. Acquiring skills and confidence in dealing with the
media has affected the whole organisation. Members now know how
to send a formal press release, and nobody gives anything out to a
journalist on the ‘phone.
Group Leader, Bromley User Group
What the
users thought

Page 31
Mental Health Programme Report
Confronting Irresponsible Journalism
Headline’s brainchild, ‘Response’, was a letter writing campaign which
aimed to challenge negative reporting of mental health issues in the
press. Response had its first try-out in June 1995, when a letter to the
Independent sparked outrage in the mental health user movement. A
series of telephone calls galvanised user groups into rapid action. The
Independent received a flood of letters from psychiatrists, and groups
as diverse as Mind, the Manchester based Schizophrenia Media Agency
and local user groups. Several letters were published over the ensuing
few days - enough to keep the issue in the public eye.
In June 1996, the Press Complaints Commission (PCC) made its first
ever ruling against a newspaper for its use of offensive language in a
mental health story, following a barrage of complaints from service
users in the Response campaign. The press watchdog decided that the
Daily Star had broken Clause 15 of its code of practice by referring to
user, Paul Fahy, as a ‘raving nutter’ and a ‘loony’, after he kissed
Princess Di on the cheek on a visit to Liverpool. The reason for Fahy’s
mental distress, the death of his father, was buried in a tiny box at the
end of the five-page story.
Following the ruling, the Headlines’ Project Leader was fortunate
enough to be able to publicise the problem of press complaints and
mental health service users in an interview for Radio Four’s
programme, ‘Mediumwave’.
page 31
I have found Headlines’ advice and support to be excellent, and the
newsletter good and informative.
The work with Headlines has certainly flowed into other areas. For
example I learnt a great deal from the very first letter I did with [former
project leaders] Tim and Susannah, who altered the layout to make it
more effective. The culmination of this for me was the publication of a
recent letter of complaint I wrote as a member of Headlines’ Response
Group to the Daily Express over an article headed. ‘How years of
blunders have set free maniacs to butcher and rape the public’. My
letter to the Deputy Editor, Jean Carr, was used in its entirety.
Group Leader, The Consumer Forum, Hammersmith
What the
users thought

Page 32
Networking with Professionals
Bridge-building with sympathetic journalists was relatively slow to
progress, though there were some successes. Not surprisingly,
Headlines found links with the broad-sheet newspapers and more
left-wing social issues magazines easier to establish than with the
tabloids - and the strategy of pursuing the best-chance outlets paid off.
Some journalists even began to approach Headlines for leads on
mental health stories.
In another important step in encouraging responsible reporting, the
NUJ Ethics Committee gave their agreement for Headlines to produce
new guidelines for journalists on reporting mental health issues. The
relaunch of a mental health press officers’ forum also helped in the
exchange of information and ideas.
User groups reported a number of successes in promoting positive
press coverage by working with members of the press. A leading
member of the Bromley User Group, for example, said she managed to
persuade a BBC radio journalist to take a different line of
questioning, moving away from questions based on an exclusively
medical view of mental health, after she had talked about the issues
from a user perspective, following advice from Headlines.
page 32
Mental Health Programme Report
Media work is very important in mental health. We are in receipt of
such bad press the majority of the time that it is necessary to work
constantly to redress the balance and re-educate the public not to
think of all mental patients as murderers!
We have worked very positively with our local paper, the Croydon
Advertiser, for example in a campaign for single-sex locked wards at
our local hospital, and more recently over the dire Mental Health Act
Commission report received by Warlingham Park Hospital. The furore
created by the Advertiser’s report resulted in the appointment of more
qualified staff for the hospital, a Mental Health Act worker and ward
Problems remain in persuading the media to report positively on
mental health stories such as World Mental Health Day and the Defeat
Depression campaign. It is a question of keeping up the pressure.
We do hope this project continues and indeed expands to cover the
whole country. So many of us suffer mental health problems these days
that constant efforts must be made to do away with stigma thus
making it easier for community care to work. The community has to
be helped to care and the media is the foremost way to reach the
public at large.
Group Facilitator, Croydon Mental Health User Group
The experience of
one user group

Page 33
Mental Health Programme Report
page 33
Project Successes
The media skills training at Headlines significantly raised the skills
level of the user groups, so that they were much more confident in
dealing with the media and promoting the user view. Back-up
support from the Headlines Project was an important factor in their
In terms of combating irresponsible journalism, the PCC decision on
the Fahy case was of national significance. There were other notable
successes. The appearance of black user consultant Les Bailey, on
Channel Four’s late-night discussion show, ‘Weekly Planet’, was
extremely powerful. His reasoned approach meant that he came over
as an expert on mental health in his own right - in direct contradiction
to the conventional media representation of mental health service
users - particularly black users - as mad, bad and dangerous.
Future Options
In the light of the successes of the Headlines project, MHM are
proposing to develop the work of Headlines into a national project
countering stigma - for which three years’ funding has been secured
from the Department of Health. This would employ two workers.
The first would be a media relations officer whose brief would be to
produce a newsletter for national distribution, maintain and develop
links with journalists and run a national press liaison service. The
second would be a user development worker, responsible for building
national connections with user groups and running Headlines’ media
skills training days. The setting-up of a novel project linking user
groups across the country via an Internet web site and mailing list will
be a key part of their brief.
I found Headlines’ media skills training particularly useful in
understanding how journalists operate, as well as the pressures they
are under. It has also helped in dealing with calls from TV people, and
in understanding the tight deadlines they have to work to.
There has been a knock-on effect in terms of giving MDF members who
went on the course more confidence and support in dealing with the
press. It has been very empowering.
Group Leader, Manic Depression Fellowship, Greater London
The benefits
of training

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The Need for a Mental Health User Group in Croydon
n 1992, the London Borough of Croydon and Croydon Health
Commissioning Agency produced a strategy document outlining the
proposed development of mental health services locally
. The report
assessed the prevalence of mental health problems in the region,
suggesting that mental distress affected up to a third of people in the
local community, but that only around 10% were in touch with the
mental health services. Much larger numbers experiencing mental
health problems went undetected. The figures suggested were:
mental distress in the community
mental distress among GP attenders
mental disorders recognised by GPs
mental disorders treated by the mental health services 6,000
annual admission to hospital
The report also highlighted the need for user involvement in the
planning and evaluation of local mental health services, previously
called for nationally in the Health of the Nation White Paper and
Patient’s Charter.
The driving force behind CMHUG derived from the anger of a number
of service users at the way in which services were organised without
regard to users’ views. The evolution of the group began when the
local Mind association nominated one of its staff members responsible
for developing user involvement in planning. As early as January 1992,
there were meetings with service users to see how user involvement
and advocacy could be developed. The first Users’ Forum was
convened in May 1992 at Warlingham Park, the local psychiatric
hospital, from which a steering group emerged to take forward the
development of a Patients’ Council. From the Patients’ Council,
interest grew in other aspects of mental health services locally. The
linking of these different groups and individuals led to the formation of
CMHUG received its first funding from local Joint Finance, which
allowed it to set up it own office. Even then, much of the group’s time
was spent struggling for resources rather than on substantive work. It
was felt that the best way to address the need of enabling user
involvement in Croydon would be to consolidate and expand the
group, and that this would require further funds that were not available
London Borough of Croydon and Croydon Health Commissioning Agency (1992). Strategy for
mental health service development 1993/4-1996/7.
Croydon Mental
Health User
for Better
Mental Health
in Croydon

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The CMHUG Project
The City Parochial Foundation granted CMHUG £91,504 over three
years to open its office full time, with a paid administrator. This would
allow the group to respond more readily to calls for help and user
input. At CMHUG’s request, the grant money was to be paid to
Croydon Mind who would take on the role of employer for the
administrator, administer the finances and take part in the steering
The funding would allow CMHUG to:
develop and expand its involvement in shaping local mental
health services via membership of steering groups, working
parties, joint planning and strategy reviews, and participation in
staff recruitment
develop its campaigning work on mental health issues
continue to facilitate the Users’ Forum and Patients’ Council
provide ‘therapeutic earnings’ of up to £15 a week (as allowed by
social services) to volunteer workers who would otherwise be
purchase computer equipment and other office equipment
develop its publicity via leaflets, posters and a regular newsletter
‘Talking Treatment’
undertake public awareness-raising campaigns
expand its liaison work with other user groups
develop and enhance skills within the group, such as advocacy
and administration skills
provide training to mental health workers on user issues.
Vision and Values
CMHUG believed that users should be at the centre of mental health
services planning, and that anger about existing services should be
channelled constructively. When consulting or advising, CMHUG
never used a criticism-only approach, instead giving credit where it
was due, as well as offering positive ideas for change. CMHUG was
not separatist, but saw a need to work in partnership with health and
social services in order to effect change. The group’s efforts to make
allies paid off, ensuring that local senior management supported
CMHUG from the beginning.

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How CMHUG Worked
CMHUG was involved in almost every aspect of mental health services
in Croydon. For example, to ensure effective user participation in
planning services at least two or three CMHUG representatives
attended all planning meetings on mental health. Projects CMHUG
was involved with included:
The Croydon Mental Health Service Reprovision Programme
The Mental Health Policy Development Group for the Croydon
Community Care Plan
The Farleigh Unit Review at Warlingham Park Hospital
The Section 117 Aftercare Planning Group
The development of user groups in mental health resource
centres borough-wide
The development of Croydon Young People’s Centre
The Safe House Project Group
The Section 136 (Police Powers) Place of Safety Policy
Development Group
The Welfare Benefits Working Group.
CMHUG was also involved in monitoring both social services and
mental healthcare provision, commissioned by Croydon Social Services
and the Community Health Council, respectively.
CMHUG had a strong campaigning arm, which aimed to promote
mental health, public awareness of mental health issues, and
understanding of the user perspective amongst mental health service
workers. CMHUG ran stalls and floats on a number of public
occasions, including the Croydon Carnival and World Mental Health
Days. They were also involved in setting up a London-wide user
forum as a resource for mental health service user groups in the
capital, together with Good Practices in Mental Health, the UK
Advocacy Network (UKAN) and the UK Federation of Small Mental
Health Agencies.
CMHUG also provided a support and information service for individual
service users, which they saw as a key part of their work. They
received, on average, between one and three calls a day from people
in distress requiring support. There was considerable two-way traffic
between the CMHUG steering group and its wider membership, with
CMHUG being able to canvass views on the needs of mental health
service users via their members, and feed these back to the authorities
formally via reports, committees and working groups.

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Operating Style
Internally, CMHUG avoided hierarchies, and planned by consensus as
a team. They set formal objectives and worked to them until their
aims were achieved. They avoided long-term plans, sensing that these
could lead to a shift away from their consensus approach. In their
view, avoiding long-term plans also allowed them to be instantly
reactive to local circumstances.
The group was aware that its lack of formal structure could make it
difficult for others to understand how CMHUG worked and how they
could work with them. However, CMHUG was firmly of the view that
their lack of structure was not an issue for them, but only for others.
CMHUG's view was that hierarchy could be destructive in user groups,
and they felt that their achievements demonstrated the effectiveness of
their democratic approach.
The group’s paid administrator was employed by MIND. The rest of
the work was done on a voluntary basis by members, and all
information in the office was open to everyone. There was only one
written policy, on equal opportunities. However, group members
acknowledged that there were unwritten rules: members did not
disagree with each other in public, for example, and did not make
reference to personal experiences in planning meetings.
Project Successes
When the City Parochial Foundation awarded its grant in 1994,
CMHUG had six members and an office staffed by volunteers three
mornings a week. By December 1996, there were 235 members, two
adjoining offices staffed five days a week, two phones, two computers
and a part-time member of staff. The funding allowed CMHUG to
campaign effectively, put across the user viewpoint, and gain respect
for its work. At the same time, the funders always supported CMHUG
in the direction the group wanted to go, in particular, backing its
increasing emphasis on public awareness raising.
The volume of work undertaken by the group was tremendous, with
the result that CMHUG had a major impact on mental health services
locally. Some notable successes have included:
production of a video on young people’s mental health (a
second video, on self-harm, was begun)
production of a training pack on promoting young peoples’
mental health aimed at schools, colleges and youth clubs
reversion to single-sex wards at a local psychiatric hospital, after
an independent evaluation of mixed sex wards commissioned by
research into users’ needs for mental health crisis services (results
available 1997)

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provision of awareness training sessions for nurses, occupational
therapists and GPs
successfully campaigning, along with Mind in Croydon and the
Community Mental Health Council, for Croydon Health to
become part of the Bethlem and Maudsley Group Mental Health
assistance with the NHS clinical audit of mental health services in
open days held twice a year for members and prospective
public awareness raising work on World Mental Health Day and
for the Defeat Depression Campaign.
My three ‘holidays’ in Croydon's local psychiatric institution were as
enlightening as they were horrifying. I could not conceive that such
degradation and inhuman treatment were possible in what passes for a
civilised society.
I have to say I was treated very well, possibly because I am white,
middle-class, middle-aged and fairly articulate, but what I saw happen
around me made me determined to try for change. How psychiatry can
justify its existence when basically it has not changed much in 200
years beats me entirely. A Parliamentary Select Committee in 1815
advised that aggressive and depressive patients should not be mixed.
This still happens in 1996 so what have we learned?
I made three very good friends in my time at Warlingham Park
Hospital, and this saw the origins of the Croydon Mental Health Users'
Group, thanks to help and encouragement from Mind in Croydon. We
now have nearly 250 members and a reputation for a positive and
constructive contribution to the improvement of mental health services
Government has to realise its responsibility to persuade every citizen of
the benefits of good mental health. Life can be a nightmare these days,
especially for the young, and we need a national mental health
promotion campaign to address some of these difficult issues. Mental
health has to be dragged out of the closet and discussed. So my brain
works differently from yours, so what? Ninety per cent of the time I can
still make a useful contribution to the world at large!
Social psychiatry has definitely been kicked into touch by the experts so
let's have a bit of common sense in all this! The majority of us break
down for social reasons and need practical help to pick up the pieces.
CMHUG Founder Member
Case study

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Future Work
CMHUG would like to develop its outreach to people in mental
distress and continue its educational and mental health promotion
drives, particularly in schools. Though awareness raising work is
difficult to monitor, CMHUG has noted that people still feel very
uneasy talking about mental health issues. Hence members are also
keen to expand this area of work.
Given CMHUG’s notable achievements to date, it seems likely that the
group will continue to make the voice of service users heard both
locally and on a wider scale.
“The Users' Group not only focuses minds on the needs of people with
mental health problems, but also provides a type of occupational
therapy for those who join and support it”.
CMHUG member
“CMHUG provides support to many people, both friends and strangers.
This can lead to pressure, and times of difficulty, as well as success and
comradeship. It is a credit to the group's strength that it can both sup-
port and inform”.
CMHUG Support & Development Worker
Why user groups
are important

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The Need for a Somali Mental Health Project
n the early 1990s, the needs of the Somali community in Tower
Hamlets (an estimated 12,000 people) were acute. There were
exceptionally high rates of unemployment, illiteracy and poor housing.
Many Somalis were refugees who faced complex practical, legal and
psychological issues - including problems arising from language
barriers, immigration issues, and difficulties with benefits claims. Many
were also severely distressed as a result of the civil war in their
homeland and the traumas of being uprooted and separated from their
families and friends, as well as being isolated in Britain.
At the end of 1992, the Black and Ethnic Communities Advisory
Committee of Mind in Tower Hamlets commissioned the London
School of Economics Community and Health Research Group to carry
out a study of mental health needs amongst the main ethnic
communities in Tower Hamlets. Their report made a special plea on
behalf of the Somali community, and the main recommendations of
this report were incorporated into a funding proposal submitted to the
City Parochial Foundation.
The Project
The City Parochial Foundation granted Mind in Tower Hamlets
£175,118 over three years to set up a specialist Somali mental health
project, focusing on the 16-30 age group. The overall aim was to
improve the mental health of Somalis in the London Borough of Tower
Hamlets through early intervention and liaison.
The funding paid for the recruitment, training and employment of two
full-time Somali workers - a man and a woman, and provided a
development budget for the running of social drop-in sessions, outings
and other activities suggested by the users.
The initial targets for the project were:
to provide an information and advice service for users and mental
health workers
to offer intensive support and advocacy to individual clients
to set up a number of drop-in and living skills groups
to produce and distribute mental health information leaflets in
Somali and in English
to organise training workshops for workers on issues affecting
the mental health of the Somali community.
Maanka: Mind
in Tower
Hamlets’ Mental
Health Service
for the Somali

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How Daryeelka Maanka Worked
The Project commenced its operations in July 1994 with the
appointment of two workers to the preventative team funded by the
City Parochial Foundation. A third Somali worker, funded through
Mental Illness Specific Grant (MISG), focused on Somalis with
long-term mental health problems. All three workers were supervised
by Mind’s Support Services Manager, with advisory input from a
specially convened Somali mental health steering group.
Intensive support to individuals and advocacy took most of the
workers’ time. This ranged from help with practical issues raised by
language barriers, to complex immigration and benefits issues and
intensive emotional support. The outreach work also involved
providing support to Somali people in the local psychiatric hospital,
and street work with homeless people and persistent street drinkers in
the Whitechapel area.
The workers ran several group sessions for the Somali community: a
weekly all-day women’s therapy group, a women’s woodwork group,
a media skills group, and a luncheon group. The groups were
organised in such a way as to be congruent with Somali values and
experience and acceptable to people who were not used to using
mental health services. The women's group, for example, had health
and fitness sessions and Somali dancing, and provided both collective
and individual counselling opportunities. The groups were well
received by the local Somali community: members seemed to value
greatly the experience of having a safe and mutually supportive space
in which to express things that would traditionally be kept private.
The information and advisory service initially attracted an average of
160 phone calls a week, of which roughly 100 were from members of
the public and 60 were from professionals. The volume of calls
decreased somewhat in the third year of the project, since other Somali
workers had been employed to deal with legal issues and welfare
rights in the borough.
The project workers provided health awareness sessions to Somali
students, and training to health and social care professionals on Somali
mental health issues. In addition, representatives from the project
attended a number of planning groups working to develop local
services for the Somali community.

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Who Used the Service?
Two-thirds of Somalis who used Daryeelka Maanka were men: in
1995-96, for example, there were 145 men to 62 women. Over 50% of
those using the Project were under 30 years old. Over 40% were not
in stable accommodation, often living on a temporary basis with family
and friends, whilst over 30% lived alone.
The vast majority of the Project’s users (over 80%) had no previous
contact with the statutory mental health services. This was probably
indicative partly of the low awareness of professional mental health
services amongst members of the Somali community and partly of the
stigmatisation of mental health problems and hence mental health
services in Somali culture. The majority of the Project’s users found
out about Daryeelka Maanka through community networks; around
48% were self-referrals, some of whom may have originally been
referred by their families.
Project Successes
In terms of providing information and advice, Daryeelka Maanka
exceeded its targets. The original target was to provide for 500 people
per annum: in the first two years, the project received calls from an
average of 125 people per week. In addition to information sheets and
leaflets, the project produced a quarterly newsletter for the Somali
community from early 1996. In terms of intensive individual support, it
provided twice the original target amount. The group sessions were
likewise very popular and well attended, which was particularly
encouraging in the case of the women’s groups; Somali women on the
whole are traditionally much more difficult to engage with mental
health services.
One of the great successes of the project was that people from the
Somali community were increasingly willing to come forward and seek
help. Thus a need for raising awareness of mental health issues within
the community was met by the project, along with many of the mental
health needs of individuals. Daryeelka Maanka developed to a stage
where its staff were also working effectively with the statutory mental
health services, providing an essential bridge for the Somali
community. The support of the workers to community members with
severe mental health problems was provided in close liaison with the
community mental health teams and their statutory key workers.

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Future Work
Now that there are other Somali workers in Tower Hamlets, Daryeelka
Maanka will continue with two project workers instead of three. There
is scope to run more women’s groups, to develop the men’s work, and
to strengthen effective co-working with the statutory services and their
community mental health teams. Overall, Mind in Tower Hamlets feel
that it has evolved a good combination of services for the Somali
community with Daryeelka Maanka, and would like to continue with
the project in order to meet now identified mental health needs within
the community.
Magood is a women in her mid-thirties. She is married and has four
small children, the oldest being five years. She looks after the children
adequately when she is not too depressed. She is not known to the
locality CMHT (Community Mental Health Team) and rarely visits her
GP. She is, however, extremely depressed. She is confused and isolated,
does not read or write, and apparently does not want to improve her
situation through education.
Her husband chews khat, but he refuses any help. He causes Magood a
lot of problems. He hits her because she does not seem to be interested
in the world. He blames her for everything that goes wrong.
Magood first came to Daryeelka Maanka in March 1996 for help with
letters. She hardly discloses anything, even though she knows that the
project worker is a mental health worker and she brings her personal
letters to read. She now attends the woodwork group regularly and
sometimes comes to the lunch club. Her children come with her to
Open House and play with the toys in the creche; at home they have no
toys or television. Woodwork and the creche are quite important for
Magood’s survival. Some evenings she does not do any woodwork, but
just sits and listens to the other women.
Daryeelka Maanka are providing Magood with on-going support.
Case study

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Jama Osman came to Britain in 1989, suffering from severe injuries
from gunfire. During the civil war he had witnessed corruption,
looting, false imprisonment, soldiers raping women. He took part in an
uprising, and was caught and tortured, but escaped. In later
fighting he was hit in the back of the head by a bullet which came out
of his mouth, destroying his palate. He escaped to Britain for medical
attention, and had two major operations. When the treatment was
completed he was discharged and allocated a flat on the seventh floor
of a block. He spoke little English, was worried about relatives in
refugee camps and caught up in the civil war, and he was isolated. He
became lonely and frustrated. He began to want to go back to
Somalia, despite all its dangers.
He approached Daryeelka Maanka in February 1995. He was having
flashbacks of traumatic events, including scenes of family members
being killed in front of him. He had financial difficulties. He was
chewing khat six nights a week, leaving him lethargic and
demotivated each day. His large family, fifteen brothers and ten
sisters, were mostly spread around refugee camps in East Africa. Letters
from them asking for financial help added to his worries. As the only
member of the family living outside of East Africa, he was perceived as
being rich. Every letter he received to which he was unable to respond
added to his depression.
The Daryeelka Maanka project worker, Abdirashid, helped him to
obtain disability benefits. They were back-dated, so Jama Osman was
able to send some money to his family, which made him happier.
Abdirashid also helped him to obtain a travel permit.
Through this period Abdirashid was concerned about Jama Osman's
mental health, and was eventually able to accompany him to his GP,
who referred him to a consultant psychiatrist. The psychiatrist referred
him to the locality Community Mental Health Team. He was
diagnosed as suffering from post traumatic stress disorder. Through
the project Jama Osman is now getting computer training and
attending the Somali lunch club at Open House. Gradually he has
become more confident. Abdirashid is now trying to get him
Case study

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any valuable lessons were learnt during the course of the Mental
Health Programme, both by project workers and managers, and
by the funders. Since many of the themes that emerged recurred
across projects, they are documented collectively here, rather than in
the reports of individual projects. Key points that emerged can be
summarised as follows.
Management needs to be very flexible and supportive if small-
scale voluntary and user-run projects such as these are to
succeed. Both refugee and advocacy groups work in different
ways from professional health and social care services, and
professionals need to appreciate the differences.
Outreach to black and minority ethnic groups from largely white
organisations can be hampered by cultural and ethnic differences
and by racism, and tends to be most successful when efforts are
made to engage these groups on their terms.
Refugee mental health projects are a completely new area and, as
such, offer a particular challenge above and beyond the
development of a service.
In operating a mental health service for refugee communities,
flexibility is essential in terms of the type of services offered and
the way they are run if they are to engage members of the
community they are intended to reach. Counselling services in
particular often need to be complementary to providing practical
care. A holistic approach will be the norm rather than the
Appropriate counselling and mental health support skills exist
within refugee communities, and can be effectively engaged in
serving those communities if recruitment strategies are carefully
Countering the stigma associated with mental health problems is
a key part of the work of any voluntary agency. The importance
of awareness-raising work should not be underestimated in this
There is a vital role for funders and purchasers in supporting the
growth and development of small voluntary and user-led projects,
and thereby expanding choice for users and potential users of
services in their constituencies.
Consistency of staffing in advocacy and refugee projects such as
these is essential in order to enable the work to become
Funders need to allow adequate time for the development of new
projects, and funding contracts should not restrict this important
work. A five-year funding period may be more appropriate than
three years in allowing sufficient time for such projects to set up
and establish themselves.
Lessons for the

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Outreach to Black and Minority Ethnic Communities
A priority for the projects was to develop means of reaching out to
black and minority ethnic peoples in Greater London. For largely
white groups, there appear to be three key blocks to significant
progress in this work.
Racism and the oppression of labelling. There is substantial
evidence to indicate that most black users have negative
experiences of using mental health services. Research by Mind
and other bodies reveals extensive institutional racism within the
Lack of cultural accessibility. Cultural and language differences
can mean that fundamental concepts of mental illness -
symptoms, causes, forms of treatment - do not translate easily,
and that the Western medical model of mental illness alienates
people in some communities.
Stigma and community exclusivity. Mental illness in any form is
highly stigmatised and therefore mostly unacknowledged
amongst particular minority groups, for example, the Chinese,
and many African communities. Coupled with this is an
established trend for support groups to remain based within and
exclusive to particular communities.
Both the Manic Depression Fellowship (MDF) and Mental Health
Media experienced initial difficulties in making contact with black and
minority ethnic service users. In addition to the major obstacles
identified above, indicators from the MDF Greater London Project
suggested a particular reluctance amongst black people to
acknowledge or accept the label ‘manic depression’ in addition to that
of service user. Yet acceptance of the condition (‘ownership of’) is the
key motivation for self-help group participation. To find a way of
developing this work, MDF employed a black outreach worker to
conduct a piece of action research involving MDF contacts in Waltham
Forest and Hackney, two London boroughs with high ethnic minority
populations. A report of the findings is currently in preparation.
In the case of the Headlines project at Mental Health Media, initial
difficulties in establishing links with black user groups were felt to be
due in part to the fact that there are fewer user-led black groups in
operation. With persistence though, Headlines eventually made links
with three projects. This was achieved through contact with Tower
Hamlets Mind, during discussions about holding an event on the sub-
ject of black users and the media; through a new Forum for African-
Caribbean Users, supported by Good Practices in Mental Health, for
which Headlines helped to secure coverage in ‘The Voice’; and finally
through the Islington based ‘Lambo’ African and Caribbean Centre, in
training members and providing press support for World Mental Health

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Refugee Issues
Nafsiyat and Daryeelka Maanka, the Somali mental health project at
Mind in Tower Hamlets, highlighted a number of common issues that
are likely to arise in future mental health work with refugee
communities. These were as follows.
Concepts of mental health and illness are frequently alien to
these communities.
Mental illness is often highly stigmatised. This was a particular
problem amongst the Somali community in Tower Hamlets,
where signs of mental distress are seen as weakness.
The concept of counselling is often unfamiliar. In their home
country individuals are much more likely to talk to a friend or
relative, and the idea of discussing personal issues with a stranger
can seem very odd. Cultural barriers will also often discourage
people from accessing such a service. Counselling is unheard of
in the Somali culture: one is not supposed to express emotion,
thus many Somalis in distress tend to display physical symptoms
In light of these factors, Daryeelka Maanka had to be extremely
flexible in its approach, providing more than just a mental health
service. Groups, for example, were organised around fitness or skills
training, whilst one-to-one work was operated within very flexible
boundaries in order to gain the trust and confidence of members of the
community it was designed to serve. The drawback with this
approach was that the project workers could be very overstretched by
demand. However, it did demonstrate a need for better understanding
of mental health status in the Somali community.
The Nafsiyat refugee project encountered many of the same issues in
their work with children and young people. A number of observations
were made as to what was required for successful work with young
refugees. These were as follows.
Therapy services offered to a sibling along with a client or to a
small family group can improve take up of the service by young
Boundaries need to be defined in working within school and
college settings; agreements on what children are told as to the
limits of confidentiality should be made in advance with the
school and clearly stated to the children.
Evaluating group work with young children demands a different
approach from the usual; children aged 12 -14 have difficulty in
completing a written evaluation form - so to ensure that
evaluation takes place, a one-off evaluative discussion session is
recommended at the end of a group work series.

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A particularly encouraging finding from the Nafsiyat project was the
relative ease with which volunteer trainee counsellors were recruited.
The project co-ordinator was repeatedly told that it would be a difficult
undertaking to recruit sufficient volunteers with appropriate skills from
the refugee communities. In fact, there were more suitable applicants
than places available on the first training course, and all those recruited
had some background in counselling training prior to starting the
course. On the down side, it did take the project longer than
anticipated to recruit the volunteers. The message Nafsiyat would
wish to share is that health and social care agencies need to think
carefully about their recruitment strategies and whether they are
presenting information in places where members of refugee
communities are likely to see it and respond. A proactive approach is
Management Issues
All-round flexibility on the part of managers and purchasers is essential
in order to ensure the workability of small-scale voluntary and user-led
projects. Management can help to support the development of such
groups, but cannot and should not insist on their complying with the
standards of planning, assessment and presentation of well established
organisations as they develop.
Key management issues in the projects have included:
lack of monitoring and evaluation
difficulties in setting realistic or clear objectives
lack of a professional management structure and ethos, as well as
a lack of understanding of the organisational systems governing
the care network in which they operate.
Monitoring and evaluation
Lack of monitoring and evaluation was an issue for the majority of
projects, and is of particular concern since it can affect the ability of
such projects to secure continued funding. This is in some part due to
the frequently pragmatic and informal structure of small voluntary and
user-led advocacy projects, together with their emphasis on service
development rather than provision. The City Parochial Foundation
supported all groups in developing systems by setting up two joint
workshops on monitoring and evaluation, and by providing a
consultant who visited all the groups individually to help them develop
their own systems.

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Resistance to complying with provider requirements on monitoring can
also mean that such groups are unable to provide the materials
specified by funders as part of a funding agreement. The Croydon
Mental Health User Group, for example, operated a policy of not
asking any details about new members personal lives, a practice
developed in response to members’ previous experience in having to
relate the same information to mental health professionals repeatedly
as they were going through the system. Thus they were not able to
show who used their service in terms of mental illness diagnoses, a
common requirement now that health policy stresses the need for
targeting people with severe mental illness. CMHUG did not want to
operate in a way that resembled statutory services - and their strategy
was not to compromise on this issue. CMHUG would acknowledge
that they have been unusually lucky in their funders who have worked
with them in a way that has empowered them to create their own
Learning the system
Lack of understanding of the procedures, laws and unwritten rules
governing the system(s) in which they operated was problematic for
many projects. For MDF and CMHUG, establishing good links with
Health and Social Services providers helped to foster mutual
understanding and support the groups’ acceptance and development.
For Mental Health Media, providing training in media skills to advocacy
projects helped to promote understanding of how journalists operated
and the pressures they were under, and thus facilitate effective use of
the media by these groups.
For the refugee projects, the workers also needed to learn the systems
governing the communities which they were serving - and to act as a
bridge between these and the systems used by the mental health
professionals they came into contact with. Operation of the Somali
mental health project, in this regard, was associated with a raft of
cultural and management issues which required a great deal of
flexibility on the part of both management and workers to resolve. The
white professional ethos simply did not apply to the way the project
needed to be run, either in terms of working styles, time management,
or boundaries and confidentiality. There was also the issue that the
workers could become isolated, being managed by a white person in a
non-Somali organisation. Moreover, supervision and monitoring are
alien to Somali culture and have sometimes felt to the workers like a
lack of trust. Realising this, Mind offered external supervision by
Somali supervisors to project workers, and this was well taken up.
Regular supervision sessions and close yet flexible management led to
a growing appreciation of the difficulties on both sides.

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The working style of the Somali mental health project was markedly
different from that of statutory services in that the approach taken to
the mental health needs of Somalis by the project workers was a
holistic one. They did not operate boundaries between mental health
and practical problems, but would undertake advocacy and counselling
with an individual, as well as providing practical support with the tasks
of daily life and immigration applications. Their flexibility extended to
the hours project workers were available, the people they worked with
(they were not able to restrict their work to the 16-39 age group), and
where they worked. Needless to say, workers in the statutory services
could often find this approach baffling and fail to understand the
varied roles of the project workers. This necessitated a lot of
awareness-raising work amongst statutory and voluntary services
workers which was helpful in building bridges between the Somali
community and the professionals.
Objective setting
Setting realistic objectives was problematic for two of the projects in
different ways. First, MDF initially set an objective of three new
self-help groups in each of 33 London boroughs over three years.
Within the first eight months, however, this was recognised to be
unrealistic, and the targets were revised by agreement with the
Second, Peter Bedford HA severely underestimated the time needed to
set up as an NVQ assessment centre for both of its women’s
employment and training schemes. For the administrative training
scheme, where NVQ training was an integral part of the post, this had
an adverse effect on the project schedule. That this happened was not
entirely surprising: there are few mental health employment schemes
that offer participants the opportunity to gain NVQs, thus the Peter
Bedford Organisation did not have a body of knowledge and
experience to draw on in their planning. Implementation of NVQs is
a long process requiring provision of NVQ induction training for the
trainer/assessor, the development of policies, procedures and practices
in line with the standards, and the initial piloting of the NVQ training
scheme with one or two participants to enable the trainer to gain their
assessor qualification. A further issue is that for any NVQ training
centre, individual students have different needs. Peter Bedford HA
accordingly found that their trainees required considerably different
degrees of support and widely varying timetables for achieving
successive stages of their NVQ. These factors need to be taken into
account by agencies planning to implement NVQs for their users, since
they can mean that timetables and work schedules slip considerably
from those originally planned.

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Implementing NVQ training nevertheless had many benefits for the
Peter Bedford Housing Association, in terms of developing
management systems for a productive and competent workplace,
guiding the identification of training needs for individuals, and giving
participants the opportunity to gain a qualification. Based on their
experiences of setting up the NVQ in Business Administration, the
process ran much more smoothly second time around.
Countering stigma
Stigmatisation of mental illness remains an enduring problem, creating
a barrier to normal life in the community for mental health service
users, and forming a backdrop for all the mental health work of the
projects in this programme.
Different projects have had different approaches to dealing with
stigma. At Peter Bedford HA, the emphasis is on empowerment, and
involving the participants in every aspect of the work. MDF are very
open about their work, promoting a network of support groups to
create a sense of solidarity and lessen the isolation of sufferers. The
Somali refugee project chose to play down the mental health aspects of
their work in order to attract people to the project who might
otherwise not have felt able to attend. Mental Health Media and
CMHUG both took a direct approach to countering stigma and raising
public awareness about mental health issues.
Stigma for service users is closely linked to media coverage of mental
illness and mental health issues. The media consistently fail to reflect
the true facts that:
mental distress is a poor predictor of violent behaviour
the number of murders committed by people with mental illness
is very small - and has remained steady for approaching 40 years,
whilst the number committed by the rest of the population has
more than doubled
people with mental distress are far more likely to harm
themselves than other people.
In this climate, misleading reports of mental health issues are the norm,
rather than the exception. The Confidential Inquiry into Homicides
and Suicides by Mentally Ill People
found 34 cases of homicide
committed over a three-year period by people who had been in
Confidential Inquiry (1996). Report of the Confidential Inquiry into homicides and suicides by
mentally ill people, London, Royal College of Psychiatry.

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contact with psychiatric services within the previous year. Of the 22
cases which could be followed up in detail, the Inquiry found that only
two were random killings by strangers, only half had been in
psychiatric hospital at all that year, and none had been discharged
from a long-stay institution into the community. Nevertheless,
subsequent reports of this research in the press were fairly uniformly
inflammatory. ‘Sick and dangerous’, ran the headline in the Daily Mail;
‘Mad policy’, said the Daily Star; and ‘Free to Kill’, said the Sun. In
fact, only about six of this country’s 700 killings each year (less than
1%) are committed by people who have been in psychiatric hospital in
the previous year.
Mental Health Media have made good headway in supporting local
groups to counter the barrage of negative media coverage and
establish increasingly strong media profiles that were listened to by the
local press.
CMHUG likewise ran a number of awareness-raising events to reach
the public directly, and promote an alternative image of mental health
service users as capable individuals taking charge of their lives.
Small-scale voluntary and user-led projects offer the potential for
user-friendly, user-orientated services that are less formal and less
stigmatising than statutory mental health services, and can provide a
true alternative to the health and social care that is framed by the
traditional medical approach. Such projects often represent the
cutting-edge of a needs-led service and, as such, can give a lead to
service development on the ground, as well as providing a grass-roots
influence on statutory services planning.
Lack of resources, however, can make such alternative services
extremely vulnerable. Limited funding can often mean that they
depend on one or two key individuals whose input is crucial to their
continued success. Difficulties in acquiring ongoing funding can be
repeatedly encountered, particularly when groups are unfamiliar with
the language and operational procedures of potential funders. Flexible
and supportive management is required on the part of managers and
purchasers if such services are to survive as an integral part of the
network of community care.

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Self-Help Network in Greater London
Project leader: Karen Campbell
CPF grant: £132,732 over three years
Further information from: Karen Campbell, Greater London
Director, Manic Depression Fellowship, 8-10 High Street,
Kingston-upon-Thames, Surrey KT1 1EY. Tel: 0181 546 0323
NAFSIYAT: Therapeutic Work with Young Refugees
Project leader: Gita Patel
CPF grant: £148,766 over three years
Further information from: Gita Patel, Nafsiyat Intercultural
Therapy Centre, 278 Seven Sisters Road, Finsbury Park,
London N4 2HY. Tel: 0171 263 4130
Employment and Training Opportunities for Women
Project leader: Brian Dawn
CPF grant: £159,066 over three years
Further information from: Brian Dawn, Peter Bedford Housing
Association Limited, Legard Works, Legard Road,
London N5 1DE. Tel: 0171 226 6074
MENTAL HEALTH MEDIA: Headlines: Getting the User Voice into
the Media
Project manager:Radhika Bynon
CPF grant: £101,776 over three years
Further information from: Radhika Bynon, Mental Health Media,
The Resource Centre, 356 Holloway Road, London N7 6PA.
Tel: 0171 700 8131
Better Mental Health in Croydon
Project leader: Jane Field
CPF grant: £91,504 over three years
Further information from: Jane Field, Croydon Mental Health
User Group Steering Committee, Cornerstone House, 14 Willis
Road, Croydon CR0 2XX. Tel: 0181 665 0210
DARYEELKA MAANKA: A Mind-Led Mental Health Service for the
Somali Community in Tower Hamlets
Project leader: Val Ford
CPF grant: £175,118 over three years
Further information from: Val Ford, Support Services Manager,
Mind in Tower Hamlets, 13 Whitethorn Street, London E3 4DA.
Tel: 0171 537 7284
Project Details

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