One evening over the Christmas break, I found myself at the home of a friend and her partner, both of whom happen to be psychoanalysts. Over dinner, whilst attempting to steer the conversation away from work, we began discussing the role of storytelling in our lives; the social narratives we believe in, the stories we pass on to others and the ones that resonate at a personal level.
The conversation led us to conclude that whilst a good story will always have readers, a really powerful story, will inspire people to act. In the Fellowship department, we often discuss how to make this shift. When there is so much great material available, it can be difficult to know how to piece it all together and the power in a story can easily be lost.
At first glance, social change appears to lend itself well to narrative. For a start, there is natural beginning; if we are trying to solve a problem, first we have to understand it. The starting point has to be-
What exactly is happening here?
This is especially poignant when encountering subjects that people might be uncomfortable talking about. Rachel Clare FRSA is Assistant Director at the Campaign Against Living Miserably (CALM) which deals with the issue of male suicide. According to recent government statistics on mortality rates, suicide is a bigger cause of death in young men than HIV, traffic accidents and assault combined, with 77% of all cases of suicide in the UK every year being male. CALM was born from a simple need to generate greater awareness of the problem.
Once a problem is defined, we have to figure out the best way to solve it – how do we improve the world around us?
Monday night’s Fellows event RSA Engage demonstrated that within the Fellowship there is a wealth of ideas about how we can transition from the beginning to the middle; problem to potential solution. Amongst the seven Fellows who pitched their project at the event, was Richard Blissett FRSA. Richard was recommended for Fellowship by a previous Catalyst winner and in turn decided to apply for funding for his own project. Through RSA Catalyst, his digital tool Edukit is well on the way to helping teachers find the appropriate resources to support disadvantaged students, quickly and easily. For Richard, the how lies in getting the right tools to the right people.
However, for a modest enterprise like Edukit to earn a place in the grander narrative of social change, it must also create a story around itself. Tools will not reach people if it’s not clear why they’re relevant, so creating a strong, individual narrative is critical – it is not enough to be heard, you have to be understood.
New RSA Fellow Emily Farnworth founded her social business Counter Culture on precisely the understanding that powerful stories are the key to changing indiviual behaviour, yet when tackling complex issues such as poverty or climate change, a simple beginning, middle and end doesn’t always cut it.
Emily believes that ‘the only way to solve the world’s biggest problems in a meaningful way is to see all sides of an argument.’ Counter Culture was established to help businesses and charities reach their audiences through a more agile form of storytelling that incorporates multiple and differing perspectives.
This can be achieved in many different ways. Even if you don’t recognise it immediately, brands, charities and individuals are communicating with us all the time without ever needing to put pen to paper. New Fellow David Pope, filmmaker, consultant and member of the British Council’s Creative Economy Pool of Experts, is interested in the storytelling possibilities offered by new technologies because this evolution is creating opportunities for a more diverse range of voices and stories to reach wider audiences.
New mediums can transform the way an issue is presented and the type of people who can tell the story. An example -
In December, Mark Leruste FRSA joined the Fellowship. As well as being an ICF Certified Professional Co-Active Coach (CPCC), he is a Country Manager for Movember, the infamous worldwide men’s health charity that invites men around the world to grow a moustache for 30 days in November to raise awareness and funds for men’s health. This in itself proves that a serious message can be communicated through the power of a moustache.
A story can still carry weight even if the chronology is disjointed or the medium unconventional.
Movember shows that a life-threatening disease affecting a particular demographic can gather mass support using humour and facial hair. If that isn’t re-writing the story, I don’t know what is.
If you would like to find out more about any of the projects or Fellows mentioned above, or would like to know more about joining the Fellowship please contact email@example.com
Alexandra Barker is a Fellowship Development Coordinator at the RSA
This blog has been written by Jennifer Barnes, intern with 2020 Public Services team
Today, the Healthcare Insurance Marketplace is going live. Its feels like a distant memory now, but in June of this year, Democratic Senator Wendy Davis stood up in her pink trainers and delivered an incredible 11 hour filibuster in the Texas Senate against a bill that would take us back decades (to before the landmark Roe V. Wade decision) in our fight for women’s health. After all of the media attention, the twitter support, and the hundreds of confiscated tampons, we seem to have forgotten about the impact the passing of this legislation will have on the lives of Texas women.
As a Texan woman currently on an internship with the RSA, I wanted to share insight into the Texan example of how policy making can result in perverse incentives and unintended consequences. I hope that this post is enough to pique your interest in the current happenings in Texas as well as the wider healthcare debate in America.
House Bill 2 disregards the challenges that women face when it comes to affordable health care by:
- banning abortions after 20 weeks
- requiring clinics providing abortions to raise to the surgical standards of outpatient surgeries (read about procedures in other states that are performed in both licensed and unlicensed clinics)
- requiring that a doctor be present when a woman takes drugs to induce an abortion (although there is no evidence or history of danger)
- requiring doctors practicing abortions to have surgical rights at a hospital within a 30-mile radius of the clinic
While Texas has become the 13th state to pass legislation banning abortions after the widely debated 20 week mark, it is arguably the latter three requirements that are most cause for concern. Presented in the rhetoric of raising standards, these stipulations instead eradicate options. The passing of this bill is predicted to close dozens of clinics across the state (with the highest closure estimates predicting all but 5 of the state’s 42 abortion providing clinics), most notably those in disadvantaged, rural areas where alternative healthcare options are limited.
“Governor Perry and other state leaders have now taken sides and chosen narrow partisan special interests over mothers, daughters, sisters and every Texan who puts the health of their family, the well-being of their neighbors, and the future of Texas ahead of politics and personal ambitions.”- Wendy Davis
To understand the likely impact of the changes that House Bill 2 will bring it is important to understand how medical services for women in Texas, and elsewhere in the US, are funded.
Contrary to popular perception, pregnancy terminations form a very small part of what the major women’s clinics actually do. For Planned Parenthood, for example, the organisation that runs the majority of abortion providing clinics, abortions are only 3% of the medical services provided. But they are financially crucial. 30-50% of Planned Parenthood’s surpluses are generated from termination services. What this means is that as the system currently stands, many of the cancer screening, sex-education, STD, pre-natal care and pregnancy prevention services that are accessible to low income women will potentially become more difficult to fund if the legislation succeeds in driving down the number of abortions.
Alternatively, if clinics are required to invest in expensive unnecessary upgrades to surgical standards to perform abortions, they will have to choose between closing or stopping their abortion provisions entirely. Planned Parenthood gets about half of its funding from government, but there are strict limitations on how it can be used. Title X funds are the only federal funds devoted to family planning and by law these funds cannot be used for abortions. If the state increases funding for family planning provisions outside of abortions, the clinics will likely survive, but will no longer offer terminations.
This funding atmosphere has created a complicated and unbalanced relationship between terminations and other women’s wellness provisions, and wrongfully reduces this conversation to one of economics, not value read more on ThinkProgress.
Pretend for a minute that you’re Cathy, a sexually active 16 year old girl in Texas living in a conservative town where everyone knows everyone and you all go to church together on Sundays. Your church and your high school teach abstinence-only and therefore your sexual education is lacking, but you become sexually active anyway.
If this is your reality, then the likelihood that you would be willing to buy condoms from the local pharmacy (where the pharmacist is friends with your father) is slim to none. It’s quite unlikely that you’ll go to the clinic for birth control and free condoms. If your closest clinic is up to two hours’ drive away, it becomes vanishingly unlikely. If you become pregnant and have spent the first few months working up the courage to face what’s happening, the 20 week mark will significantly limit your options even if you do make the drive.
This isn’t an unlikely story in many areas of rural Texas. Here, a young girl is strongly deterred from accessing birth control and receiving an abortion due to logistics and circumstances over which she is powerless. Here, the passing of House Bill 2 achieves the pro-life agenda and significantly reduces access to abortion.
Regardless of your thoughts on the morality of early termination, an alternate scenario is enlightening:
Now consider that you’re Julia, a single mother, working two jobs to pay your bills. You work part-time jobs without health insurance and you can only just afford the premiums even after the Affordable Health Plan takes effect. While you are eligible for the Texas Women’s Health programme, the doctors taking part in it have taken their quota of Medicaid patients so this option becomes almost worthless to you. Even if you have a health insurance plan, your deductible (the amount of money you must spend before the insurance company begins to pay for your health services) is enormous, leaving clinics like Planned Parenthood the only places you can go for affordable reproductive health needs and screenings.
The local clinic shuts down and you don’t have the time or energy to drive to the city for an exam when you start noticing mild symptoms. The gas money to get there is too much and the childrens’ schedules are too busy on top of your multiple shifts…so you ignore the symptoms. When the pain becomes too much to bear you hire a babysitter that you can’t afford and go to the closest clinic, 100 miles away. By then, it’s clear that you have advanced cervical cancer.
Supporters of this legislation ignore the reality that for many women, clinics like Planned Parenthood are one of their only affordable options for reproductive care. In many geographic areas, for those who earn too much for government Medicaid assistance but lack private insurance, Planned Parenthood truly is one of their only options. The story isn’t that Planned Parenthood supports pre-marital sex and abortions, the story is that Planned Parenthood supports women and their freedom over their bodies.
The passing of this bill limits women’s freedoms: freedom of choice is nonexistent when there are no options.
The Centre for Citizenship and Community, a new collaboration between the RSA, the University of Central Lancashire and the Royal Society for Public Health, was formally launched at the RSA House yesterday. Grounding academic and social research in community practice, the Centre will bring together researchers and practitioners from universities, public bodies, voluntary organisations and business to implement community projects and guide social policy using a Connected Communities approach to social and community networks. The launch consisted of key-note speeches from the Centre’s associates followed by a series of discussion groups held by delegates from numerous professional backgrounds to debate the policy implications of the Centre’s early perspectives.
Co-production: a connected communities approach to social policy
In a plenary speech David Morris, Professor of mental health, inclusion and community at the University of Central Lancashire (UCLan) and the Centre for Citizenship and Community, spoke about how the Centre will promote a vision of the ‘social value of empowered communities’ being integrated into public policy, with a culture of co-production emerging in public services. He stressed the need for policy makers to recognise the complexity and potential that lies within communities, to build innovations around shared community assets, and to use Connected Communities-inspired research to inform the production of community owned, networked social interventions.
Afterwards, RSA Connected Communities director of research Steve Broome criticised what he described as the standard ‘deficit model’ of viewing communities, which focuses exclusively on their problems rather than their assets and potential. In contrast he demonstrated how social networks approaches help us to understand communities using an ‘attribute model’ which reveals which assets in a community help people interact and support one another. He emphasised the prominent role that public services play in supplying or supporting these community assets, and went on to highlight the danger that ill-considered spending cuts present to social networks when community assets are not mapped or recognised. A forthcoming RSA report will develop these themes further, focusing on the viability of community assets and social networks in the context of government austerity.
Theory into co-produced practice: Murton ‘mams’ and ways to wellbeing
Examples of such projects were presented by Mandy Chivers of Mersey Care NHS Care Trust and Lyndsey Wood of the East Durham Trust. Both organisations are working in partnership with the RSA and UCLan to implement co-produced, network-based community projects based on findings from Connected Communities research. In Liverpool, Mersey Care is training volunteers from the BAME community in the principles of the New Economic Foundation’s ‘five ways to wellbeing’, while in Murton, a former mining town, the East Durham Trust has helped set up a new social group for single mothers called ‘Murton Mams’, in which the activities and programme are led by the members of the group themselves to help combat the widespread isolation among this group that the Connected Communities findings revealed.
Challenges ahead: austerity, tolerated harshness, and championing social networks
Following the introductory talks, attendees split into discussion groups to debate the implications of the presentations for public policy and community practice, and to begin to think about what the Centre can contribute to such debates in the future. Some key points that emerged from these discussions included:
i) The need for the Centre to promote and build the status of social networks in a context in which the very existence of ‘communities’ often seems to be doubted. The evidence base for a networked approach to public and community policy must be vigorously argued.
ii) The need to be conscious of the risk of ‘making a contrivance out of ordinary connection’. Co-production, in other words, must avoid the pitfalls of regularising informal, reciprocal relationships, or exposing what David Halpern has called the ‘hidden wealth’ of communities to overly harsh light where they would be better preserved by remaining hidden. An example given was the ‘spontaneous expression of citizenship’ of a train ticket saleswoman who enjoys smiling at her customers and once decided to give Easter eggs to her regulars; if a statutory system of formalised gift-giving on public transport was initiated, the spontaneity and charm of the exchange would doubtless be compromised.
Other challenges were also discussed. Morris and Broome both highlighted the dangers posed to sometimes fragile networks by austerity, growing inequality, and ‘externally enforced fragmentation’, while it was elsewhere noted that cultural norms are becoming less social, along the lines of what Hugo Young described as a growing ‘tolerated harshness’ in society. Other attendees urged that co-productive services must be genuinely co-produced with public services taking an active role, rather than simply deferring responsibility or ‘outsourcing by another name’.
The mood was on the whole optimistic, however, with numerous attendees stating that they welcomed the opportunity to network and debate issues in this way, and praising the new Centre as a valuable line of communication between community-oriented actors from the academic, public, private, and third sectors.
Based in the School of Social Work at UCLan and the King’s Fund offices in London, the Centre for Citizenship and Community will meet regularly over the coming months and offers organisations dedicated support for community engagement through:
- Strategies and integrated programmes for social and community- based commissioning
- Service development and redesign, based on economic modelling and cost-benefit analysis, organisational, leadership and workforce development
This is backed up by:
- Bespoke programmes of accredited learning and professional development
- Programme evaluation and research evidence.
Its associates will be posting regular updates from varied perspectives on the RSA’s blogging platform; in the meantime, more information on the Centre including contact details can be found on the RSA website. If you would like to be notified when the forthcoming RSA report on the impact of austerity on communities is published, or to be kept informed of the work of the Centre for Citizenship and Community, email firstname.lastname@example.org and request to be added the the RSA Action and Research Centre mail list.
A trained psychologist myself, I took great interest in today’s call of the British Psychological Society for a departure of the biomedical model of mental illness. And, to my delight, so did other colleagues – read a great blog post from Social Brain’s Emma Lindley here, where she writes that we might be right now witnessing a bona fide revolution that may change mental health services so radically, ‘they will be unrecognisable to the children of my generation.’ As Emma points out, the debate is as much driven by differing concepts of human nature as it is by politics, and the struggle for professional relevance and power. It is the latter aspect that I want to focus on in this blog post.
The RSA has long taken an interest in professions and their future (including this project in the early 2000s), and is currently managing an independent review of the Police Federation. Further international projects with other professions may follow soon.
Interestingly, even though Psychiatry is the younger term, it is the arguably the older science, and literally means ‘the medical treatment of the soul’, whereas Psychology means ‘study of the soul’. Psychology and, specifically, its subdomain Clinical Psychology, have always had a hard time standing up to their medical cousin. Part of the reason for that one can find in the etymology; isn’t medical treatment is just so much more tangible than mere study? Thus, in more than one hospital of the world (including one I interned in a long, long time ago), Psychologists have not been much more than overeducated sidekicks to doctors. This may change soon.
The main reason for this is that over the last decade, and particularly since 2008, Psychology has arrived in the scientific establishment. It did so by using a strategy applied by underdogs since the advent of mankind: collaboration. (And, of course, the emergence of discipline rockstars like Steven Pinker has helped.)
Not having enough leverage itself, Psychology entered functional marriages with up and coming disciplines like neuroscience and traditional ones like economics, a process that led to the creation of new interdisciplinary fields like behavioural science. A prominent victim of this process was homo economicus – the notion that humans are wholly rational and narrowly self-interested. Homo biomedicus (not an official term, my inadequate creation), the similarly reductionist paradigm underlying present day psychiatry that acknowledges only the physical side of human existence, but leaves aside the social and psychological aspects, may very well be next.
There are two reasons to be concerned about the potential revolution of mental health services given that professional battle lines are drawn:
Firstly, while for Psychology there was the possibility of a non-threatening complementary relationship in the mutual interest with economics or neuroscience, with Psychiatry it is different. Here the question is ‘who runs the show?’, or, if you will, one of professional hegemony. Still, one hopes that the critical voices on both sides steer the process away from the zero-sum-game it is in danger to become, which certainly would leave everyone worse off.
Secondly, the homo biomedicus model is not entirely wrong, just as the homo economicus model is not completely off the mark. The concept has its merit and adequate areas of application, and it will need to be taken into account when designing future services based on a richer, more complex understanding of man as Homo biopsychosocialis that is embedded in a capabilities-based approach. Throwing out the baby with the bath water would be just as wrong.
Josef Lentsch is Director of RSA International – follow him at @joseflentsch
‘The best ideas are simple ideas.’ This was the assertion of a friend I met up with earlier this week for a pie and a pint, with a side order of his own-recipe barstool wisdom.
I found his stance difficult to agree with at first – it reminded me too much of my terrifying old English teacher gesturing at my waffly essays and barking, ‘What’s your argument? If you can’t explain it in ten seconds then you don’t have one!’ Yet over the course of this week I have come to see that he has a point. While we must always be mindful of the complexity of the problems we face as a society, if an idea cannot be expressed or enacted in a way that is meaningful to others then it is of very limited value.
Last Tuesday’s launch event for the new ‘Science, Medicine & Society Network’ at University College London served as a lesson in this principle. The Network is a new international academic partnership bringing together experts in health from a range of disciplines, and I had been worried that I would understand little of what the distinguished panel of medical clinicians, political scientists, lawyers and anthropologists would be discussing. Refreshingly though, the central, easy to comprehend message of the event was that although the challenges to global public health are complex and varied, the solutions must be grounded in simplicity, attainability, and relevance to the communities they affect.
For example, Lord Nigel Crisp, the former NHS senior manager and author of Turning the world upside down: The search for global health in the 21st century, spoke about his discussions with public health officials around the world on the question of how to reduce maternal mortality. An Indian government minister had presented a complicated series of rubrics and metrics, lofty policies and programmes, and a confusing mishmash of approaches that Lord Crisp struggled to follow let alone imagine being implemented. In contrast, an official at BRAC, the hugely successful Bangladeshi NGO, responded to Lord Crisp’s question simply: ‘Empower the women’. In recent years, this radically simple approach has contributed to a dramatic fall in Bangladesh’s maternal mortality figures.
Another speaker at the event offered a different example. Professor Cyril Chantler shared a story that he likes to tell his UCL first year medical students. When he was a consultant to Guy’s Hospital in the 1970s, a young boy was brought to see him with rectal bleeding apparently caused by a small cut on his skin – a straightforward diagnosis, one might think. However, Prof. Chantler suspected that the underlying cause was more complicated than this, so he began to investigate further. Why did he have this cut? Because he was constipated. Why was he constipated? It transpired that the boy’s family, who lived in a poor neighbourhood, did not have an indoor toilet and instead shared a communal lavatory with other households in the street. The roof above this communal toilet leaked, and the little boy didn’t like getting his head wet, so he stopped going to the toilet. Prof. Chantler said that he likes to challenge his students to suggest a solution to this problem: many say that the family needs an indoor toilet. This may be correct, but Prof. Chandler is not a plumber. The more politically-minded students might suggest that the socioeconomic situation is the problem, and that the boy’s family should not have to be so poor that they share an outdoor toilet with other people in their street. This also has the ring of truth, but again it is beyond Prof. Chandler’s capacity to change this from his clinical consulting room. So what did Prof. Chandler do? He gave the boy an umbrella. The boy no longer had to get wet when he needed the loo, he stopped getting constipated, and the bleeding went away.
I was again alerted to the potential for apparently simple ideas to help solve complex problems when the RSA, in partnership with Kingfisher PLC, hosted a seminar this week on the subject of building ‘sustainable, stronger communities’. Luminaries from business, the public sector, think-tanks, and charities discussed the potential for businesses to help promote community cohesion and social change through initiatives such as those pioneered by Kingfisher, including the online local networking website StreetClub. Much of the debate centred on whether initiatives like these should be high-concept, ambitious attempts to organise society and ‘create new cultural norms’, or whether a simpler, lighter touch was called for, striving to ‘do one thing very well’. Personally, I found the latter option more compelling. StreetClub’s core strength in encouraging neighbours to share tools is reminiscent of that other simple idea I blogged on recently, the Big Lunch. Both of these schemes harness the latent potential for communities to become more connected around a simple excuse to get together; to borrow a ladder or to share a lunch. As one attendee at our seminar sagely observed, successful initiatives like this ‘don’t change communities; they create the platform for change’.
Simple ideas which create the platform for change are what the RSA’s Connected Communities programme is all about. Our research found that some older people in South East London have low wellbeing because they are isolated and don’t have any way of transporting themselves away from their homes; we’re developing a project that will provide them with a social environment and a free lift in a minibus to help them get out and about. We found that people’s mental wellbeing can suffer when there is a lack of social support; we’re going to identify key members of local social networks and train them as peer support counsellors.
Complex problems: simple solutions. My friend in the pub swears by this equation, and so, presumably, did the little boy who trotted down the street with an umbrella every day. It’s an equation I’m coming around to too.
Here is an interesting Guardian piece on a transnational YouGov-Cambridge study. The research compared attitudes towards responsibilities of the state versus those of individuals in the UK, US, France and Germany.
To summarise, when it comes to the role of the state on issues like ‘a decent minimum income for all’ or ‘helping poor children get ahead’, British views are significantly more continental than atlantic. With the exception of company pay – on inequity of salaries, Britons are more liberal than Germans and French, if not as liberal as Americans – the results put the US on the individualist side, and UK, Germany and France broadly on the statist side; which highlights once again that the conversation on public services in the US is a very different one to this side of the pond.
What is just as interesting as the results, however, is the way the study is structured. It takes a classic two-dimensional approach: state versus individuals.
What about views on the responsibility of, and for, communities?
They are a pillar of social power just as much as the other two dimensions. And given fiscal pressures on both sides of the Atlantic, an increasing amount of challenges will need to be dealt with via this ‘third dimension’ (e.g., as my colleague Matthew Parsfield pointed out recently, in Mental Health, or as our CEO Matthew Taylor has argued, in Care).
But as so often, communities get left out of the equation – what statisticians would call an omitted variable. Arguably, without taking this third dimension into account, there is a lack of depth in the insights generated.
My hunch is that we would see a picture emerge that is more complex and informative than the binary US/Europe divide. But perhaps there is already some comparative data out there, maybe even longitudinal – might a reader point me in the right direction?
The RSA is well positioned to work across all three dimensions internationally, as we have strong Fellowships in all four countries (altogether we have Fellowships in 101 countries, the US being the largest one with almost 800 Fellows), as well as Fellow- and staff-led projects in the US and Germany. I will elaborate on these in my next blog posts.
Also, I am looking forward to the upcoming RSA Lecture with Tim Smit, CEO and Founder of the Eden Project, who asks the very question: ‘Where does responsibility for community lie’?
Mental health is a globally pressing issue. Conservative estimates suggest that 400 million people worldwide suffer from various mental illnesses, while the World Health Organisation predicts that by 2030 depression will be the world’s leading cause of the burden of disease, with mental health problems already exacting a greater toll than tuberculosis, cancer, or heart disease.
Yet look at this global picture more closely, and to some observers it appears as though this burden might not be spread evenly around the world. With recovery rates for schizophrenia and depression in the USA, UK, and other wealthy countries worse than those in Nigeria, India, and other developing nations, it looks as though the poor world is outperforming the rich when it comes to dealing with some mental disorders.
Theories as to why this may be abound. These range from the perhaps outdated and stereotypical idea that there is a greater tradition of family and community solidarity in economically developing nations, to the social anthropologist Tanya Luhrmann’s theory that a combination of greater stigma and “disgraceful” normative care practices in the West often mean that sufferers of devastating mental disorders like schizophrenia concurrently experience a range of other afflictions – ostracism, homelessness, poverty, substance addiction and a set of humiliating interpersonal experiences that she calls ‘social defeat’.
Last night, in his RSA lecture entitled ‘The Global Mental Health Crisis: What the rich world can learn from the poor’, Professor Vikram Patel of the London School of Hygiene and Tropical Medicine offered a slightly different perspective. Focussing on access to care, he gave examples of the relative ingenuity of mental health care practices in countries like India, where he has done extensive work.
There is, he said, no shortage of psychiatric professionals in wealthy Western nations; for example California alone has more psychiatrists than the whole of South Asia. Despite this, some 60% of people with mental illness symptoms in the USA do not access any form of psychiatric care. The UK, even with its free-of-charge National Health Service, only performs slightly better, with 40% of sufferers not seeking or receiving treatment. As explanations for this he pointed to the sometimes alienating, over-complicated professional culture of DSM-influenced approaches to mental illnesses in the West, and the remoteness of psychiatric practitioners to their patients in both lifestyle and outlook as reasons for people not knowing about or feeling they can access services.
By contrast, he presented a model of public health in India that, with limited resources in the form of professionals or pharmaceuticals, utilises lay community health workers to provide collaborative, locally appropriate community-based care. Specially trained lay workers operate under the direction of psychiatric professionals to provide outreach services, ‘psychiatric first aid’, and social interventions based in the home, in a Wellcome Trust-funded controlled trial, documented in a series of documentaries available online.
Back in the UK, the RSA is looking to draw upon a similar approach as part of its Connected Communities project, which seeks to explore ways of building resilient communities in which people’s wellbeing and life satisfaction benefit from social connections with their peers. Working with Nicky Forsythe of Positive Therapy, we shall shortly be launching an innovative Talk For Health peer support programme which will train key members of community networks as lay counsellors, giving them the confidence and knowledge to take the therapists’ skills of empathy, non-judgemental listening, and conversational support out of the doctors’ surgery and into the hands of the community. In Bristol, we’ve just launched an innovative tablet computer app called Social Mirror, which volunteer health champions will use to help people map their social networks and, where necessary, receive suggested social prescriptions. Simultaneously, we are working with Talk To Me London to launch an exciting pilot project in New Cross that seeks to encourage Londoners to engage in conversations with strangers, with participants identified by their ‘Talk To Me’ badges which show that they are friendly and willing to chat. The designers of the project promise that it will “be the most innovative, culture-changing campaign of our times”, so stay tuned for more on that.
With ever-increasing strains on public health and social care budgets, and worrying research that demonstrates links between social isolation and the risk of mental illness and death, it is hoped that we can learn much from Professor Patel and others in the ‘poor world’ who are demonstrating that innovative, ingenious social interventions can help manage the burden of mental illness by supporting connected communities. Keep checking this blog, follow #RSAConnected and @SocialMirrorApp on Twitter, or email email@example.com and ask to join the relevant email lists to keep updated with how this work progresses.
Today marks the beginning of the end of Disability Living Allowance. As of now, new applicants in the North East and North West will be assessed for the coalition government’s replacement for the non-means tested benefit, the Personal Independence Payment (PIP). Anyone whose award is up for review will go through the PIP assessment process, and the plan is that by 2018, more than 400,000 people who currently get DLA will not get PIP. This means that around 20% of people who currently receive DLA will lose the benefit all together.
The narratives attached to the need for welfare reform and benefits cuts are powerful, and the government has done a reasonably good job of convincing the nation that it is essential to reduce spending on welfare if our economy is to recover. The particular focus on disabled people, and DLA especially plays into our distaste at the idea of anyone languishing on a ‘lifetime’ benefit with no checks to see if they continue to be disabled ‘enough’ to deserve it.
DLA is also ripe for being framed as unpalatable because of the fact that it isn’t means-tested. It makes no difference if you are a banker, barrister or a barista, your right to claim DLA remains the same. This was designed to reflect the fact that being disabled is expensive, whether you have a visible, physical disability like multiple sclerosis, an invisible, chronic condition like lupus, or an intermittent, unpredictable illness like schizophrenia. In any of these cases, and regardless of a person’s income, DLA can make the difference between being able to work or not, eat properly or not, get around or not.
It makes no difference if you are a banker, barrister or a barista, your right to claim DLA remains the same.
This excellent personal account shows how DLA has made it possible for Mark Harper to continue working and illustrates the many small ways in which it enables him to have a better quality of life in spite of living with a painful neurological condition. As Mark points out, the obsession with employment as the panacea for all our nation’s economic ills is actually undermined by removing the sorts of benefits that make it possible for some people with disabilities to work at all.
DLA certainly wasn’t perfect, and the one-size-fits-all approach to assessing disability has always been ludicrously inflexible. For example, one of the measures of disability the distance a person can walk. Under the old DLA structure, 50 metres was the crucial distance that determined whether or not a person was eligible for the higher rate of mobility allowance. The PIP framework is more than halving this to 20 metres, and there’s plenty to say about the arbitrariness of this heavy handed and unfair change, but to focus on that would overlook the ridiculousness of using the ability to walk a certain distance as a key way of assessing a person’s mobility.
There are many serious physical disabilities which don’t affect one’s ability to walk. There are many disabilities which threaten people’s mobility even though they might be assessed as being physically the same as a non-disabled person. For someone with a learning disability, for example, being able to get around the world safely is not necessarily about moving one leg in front of the other so much as understanding dangers posed by traffic, navigating confusing routes through cities, and social vulnerability. What about a person with agoraphobia or extreme depression?
The transition from DLA to PIP is happening in phases, so those who were once promised ‘lifetime’ DLA support, or who are in the middle of a fixed term award have another couple of year’s grace before the major changes kick in, unless they experience a change in their disability. But the process has begun, there is no stopping it, and hundreds of thousands of disabled people are fearful for their futures because of it.
Matthew Taylor has recently written several blog posts about the need to reconsider care. His suggestion that secondary school pupils should be required to do 100 hours of caring as part of a compulsory work experience programme seems like a good one for lots of reasons.
Acquiring the skills of caring early in life can only be an advantage, and raising the profile and status of care are important likely benefits of such a scheme. In general I think working with young people in schools is a valid way to try to achieve cultural shifts across a generation.
Shouldn’t offering care be something that we all do, in some form, and continue to do throughout our lives?
But I also think that it can be an effective strategy for sidestepping our own responsibility to contribute in areas that we recognise as important, but might not want to engage with directly. For those of us who left school years ago and are busy working full time, developing our careers, or in Matthew Taylor’s case, running the RSA, the idea of doing a bit of hands-on care as well might seem unfeasible, not to mention unappealing.
If we are in broad agreement with Matthew’s arguments, shouldn’t offering care be something that we all do, in some form, and continue to do throughout our lives? It occurs to me that there might be scope for companies and organisations to set up schemes in which employees are encouraged to offer their time as voluntary carers during work hours.
There is at least one precedent in which a company has decided to donate employees’ time to charities. The housing association, First Ark Group, has recently made the decision to donate 500 days of staff time to volunteer in local good causes. In the Guardian’s report, published on Monday, First Ark explain that they see their responsibility to the community as extending beyond doing their ‘bread and butter’ work in the best way possible. Being a force for good and building genuine connections with the community are also key priorities and donating staff days is one way of making these things happen.
There is plenty of evidence to indicate that volunteering is good for us. It’s not just good for our communities and for the organisations, individuals and groups who receive voluntary help, it’s also good for the volunteer. In addition to the fact that volunteering brings the opportunity to learn new skills and build different kinds of relationships, it’s also good for our overall wellbeing. It has the feel good factor.
So, if an organisation were to introduce a caring scheme, what would it mean for the workplace? I suspect it would be likely to increase morale amongst staff, raise pride in the employer, develop a reputation for being a socially responsible organisation. If staff throughout organisations, from chief executives to managers to cleaners were all expected to participate, it would give the entire workforce a shared experience and sense of solidarity.
What about the likely costs? How could any company afford to donate staff time to offering care? What would the impact be on individuals’ time management and workload? According to First Ark, these problems are easily ironed out quickly, and all it takes is a bit of adjustment. Tot up the amount of time staff waste at the water cooler, and we already know that being present at work 100% of the time doesn’t amount to 100% productivity.
It will be interesting to see how First Ark’s scheme works out, and whether they continue with it beyond this year. It seems to me that if we really care about care, we should be prepared to demonstrate that by actually getting involved ourselves. The way working life is structured makes it a tall order to expect people to volunteer to care in their spare time, but I wonder how prepared we would be to do it if it became part of our working lives.
Fancy losing weight, looking younger, living longer, fending off Alzheimer’s, Parkinson’s and even cancer, whilst eating whatever you want? This is only some of what the 5:2 fasting diet claims to offer, and the only catch is that you have to fast twice a week. The ‘fast’ days do not require complete starvation, but instead involve heavily restricted calories – 500 for a woman and 600 for a man. It’s up to the individual how to make up the calories, but the suggestion is that you eat breakfast and one other meal, either lunch or dinner.
The evidence is strong that it’s a very effective way to lose weight. But there’s more to it than that – much has been made of the link between this pattern of eating and increased longevity. Research conducted by the Baltimore National Institute on Aging indicates that levels of the hormone insulin-like growth factor 1 (IGF-1) are lowered by twice-weekly fasting. Controlling levels of IGF-1 can promote longevity as well as offering protection against a range of diseases.
High levels of IGF-1 are thought to increase the cell divisions associated with cancer, hence the possibility that reducing it may offer defence against it. Although this evidence is encouraging, the sceptical scientific community still feel that more extensive research needs to be conducted before conclusions can be drawn. Some critics have suggested that the extremes involved might result in the development of eating disorder, although there is no hard evidence for this either.
Could it be that eating hardly anything twice a week is doable because of the fact that, for the rest of the time, one is at liberty to enjoy whatever one fancies, be it cake, steak, or booze?
Since the BBC broadcast a documentary about it last year, the diet has grown hugely in popularity, with celebrity support coming from the likes of Hugh Fearnley-Whittingstall. Is there something different about this approach to reducing the amount we eat, or is it just another boom and bust fad diet like Atkins or Dukan? According to those who champion it, this approach to reducing calorific intake is much easier to sustain because of the fact that five days out of seven are unrestricted.
Could it be that eating hardly anything twice a week is doable because of the fact that, for the rest of the time, one is at liberty to enjoy whatever one fancies, be it cake, steak, or booze? However hungry you might get on the fast day, is the knowledge that you could have a full English breakfast the next day enough to get you through?
It seems to me that this particular approach to eating might not only be easier to stick to than others, but could also encourage deeper consideration of one’s relationship with food. Having not tried this diet myself, I can’t comment from first-hand experience, but I suspect that on fast days, you are more acutely aware of your body’s need for food than on days when you’re eating whatever you want. By deliberately depriving yourself of the ‘usual’ amount of food, you are choosing to make yourself somewhat uncomfortable which much have psychological and maybe spiritual effects as well as physical ones.
The Islamic month of Ramadan uses fasting as a way of teaching Muslims self-discipline, self-restraint and generosity, as well as encouraging reflection on the suffering of the poor, who may be forced to fast through poverty. Being hungry is used as a vehicle for nurturing the skills needed to maintain self-control – acting as a tool for sustaining mindfulness. Perhaps some of these benefits can be gained through regular intermittent fasting as well.
Advocates of the 5:2 diet talk about quite enjoying the feeling of hunger (knowing that it will be short-lived) and of feeling exhilarated on the fast days and liberated on the days when no restrictions are in place. From the various accounts I’ve read of doing the diet, I have not seen explicit mention of spiritual or psychological benefits, but I have a suspicion that impacts on these domains may go some way towards explaining its popularity.