The fresh, light, airy and vibrant environment that we now have is in total contrast to how things were. A day centre was originally set up in the area in 1976 by the local Mind Association, when a group of volunteers gathered in a church hall and provided diversionary activities to people with longer-term mental ill health, many of whom lived in local residential care homes.

The service gradually developed, attracting funding to employ staff, rent larger premises, expand facilities and provides meals, transport and more recreational activity. There was a brief period when the centre was homeless in 1995, before another building was secured three months later and the service resumed with people settling back in to a familiar timetabled routine of collection by minibus, drinks, meals, recreation and outings.

Five years later, following a best value review by East Sussex County Council, a recommendation was made to re-tender the service in order to allow it to develop further. Together was awarded the contract and assumed responsibility for managing the service in July 2000.

Operating without a building base

This initial change of identity was soon followed by a more unsettling change that meant we had to leave our base again, at short notice. For a second time we were to lose a building, our central meeting place and the facility to provide meals and transport. During the three months prior to moving, the situation was discussed at great length among staff and service users and considerable time was spent planning contact and support for when we moved.

The staff team acquired an office base in a local community centre and set about finding spaces in different venues where contact, meetings and activities could take place. Many of the people using the service were unused to travelling independently. We therefore explored options for getting to different places and helped people to apply for concessionary passes for public transport. We met in church halls and community centres, venues provided by the local college, cafés and pubs, and on an allotment. As an alternative to providing meals, we introduced cookery groups and planned shopping trips to supermarkets.

We noticed how difficult it was for people who had been attending for years to get used to meeting for just an hour or two and in different locations. The dispersion meant that we were occupying spaces not designated solely for our use. We had to share with other groups and mix with other people (asylum seekers, over 60s club, mother and toddler groups, groups and classes run by local college tutors).
We were very conscious that different groups were being exposed to each other. IT was also very inconvenient, both for staff and service users, but we could see no alternative.

Adapting and learning

However, over the following 20 months of homelessness, we noticed that people were adapting and it became obvious that we had under-estimated our users’ resources and capacity to do things differently. People were managing to travel on public transport, and nobody reported going hungry.

It was at this point that we realised we had previously been caught up in a system that had been set up to contain, maintain and entertain people, and a service based on routine and convenience. The rigid framework, subsidised meals and transport may have seemed justifiable at the time, but had also acted as disincentives.

We noticed some changes within the service. During this period we observed that the service was attracting people who would not previously have engaged with us – this seemed to be an indication that the service was less stigmatising.

Among staff and service users there was evidence of a redefining of roles, relationships and expectations. For staff this led to a change in attitude and performance: they became more enablers than containers. For service users it led to a greater inclination to access other services and opportunities.

The staff adapted their approach to give greater consideration to the whole range of life domains and to helping people to develop a belief in themselves, a sense of being part of what was going on ‘out there’ and of being entitled to be part of it.

We also noticed that we were able to adopt a different language and began replacing psychiatric terminology with a vocabulary of well-being, growth, learning and opportunity. We began to recognise and emphasise the importance of areas of life other than mental health and, most importantly, the value of instilling hope and a belief in the capacity for recovery.

We gave more consideration to the obstacles that prevent people from engaging with their wider communities and occupying different spaces. We also adopted a more collaborative working process, with more sharing of responsibility.

Carisbrooke House

After 20 months a new building to house the day support service was secured and refurbished. Despite having looked forward and waited patiently for this to happen, as the time approached fro us to move in, we began to have some doubts and reservations and wondered if this would take the service back to how it was. Would the building become exclusive again? Would it be identified with mental illness and be stigmatised? Would people who had got used to being part of other communities slowly begin to retreat back into a ‘safer space’?

It was evident that from the outset we would need to make it as clear as possible that the building was a community space, acquired with funds intended to benefit the local community. We felt it would be important to designate spaces within it that were available to other community groups.

We began to plan with this in mind, consciously choosing to continue using other community spaces, inviting other groups and agencies into our building, and encouraging people not formally diagnosed to participate in our programmed activities. A plan was devised to recruit a centre co-ordinator to help further promote Carisbrooke House as a community resource.

Unfortunately this was hindered by another event that meant the loss of a substantial portion of funding. Our funders, the county council, decided to make some savings from their adult social care budget. The day service budget was cut by £60,000 – equivalent to a third of its funding.

This unsettling event appeared to undermine the value of the service and the people who used it for support. Despite opposition and resistance, the cuts went ahead and the team and the service were reduced.

At a time when the service was developing, gaining momentum and increased credibility, a major restructuring was required. The task, once again, was to re-organise and re-focus resources and to undertake a further re-assessment of how support could be provided.

Working differently

This resulted in the project staff finding ways of working with other agencies and becoming even better informed about existing community resources. More time and energy was now being devoted to linking service users with community activities and in developing a closer working relationship with the Community Bridge Builder services. As many of the supportive activities could no longer be provided by core staff, there has been a greater willingness and inclination for people who use the service to support each other and to take on more pro-active roles within the project (leading activities like healthy walks, swimming, art group and other groups).

Crises as catalysts

Although the interruptions described were unwelcome at this time, in retrospect they have served as useful catalysts for change when there were few incentives to do things differently. Service users had not requested a change in service except, maybe, more of the same. Nobody had complained or expressed dissatisfaction with the service as it was, and there was no directive to modernise.

The initial changes all took place at a time when the service was still measured quantitatively, by occupancy. It seemed at the time that a cost-effective service was one that contained a lot of very obviously sick people. Had we said then that we wanted to focus on peoples’ strengths, abilities and aspirations, we might have been judged as a non-essential service.

In our case changes were not imposed by those responsible for managing and providing the service but from other sources. This meant that staff and service users were required to adapt and respond collectively. This is an important point, because it prompted us to take some control and work more proactively.

After the initial shock of having to consider change, there was a willingness among the staff to evaluate their roles and contributions, and to consider what parts of the service made a difference to the quality of life of the people being offered support. It was, we believe, the positive attitude of the staff that helped to inspire people being supported to take part in and take ownership of the change process – making it a shared response.

We can now see the value of having reconstructed the service. The move out from building-based support to a more fragmented and dispersed service has resulted in the erosion of many barriers to recovery.

Modernisation may have been propelled by external factors – the growing influence of the service user voice/movement, research into the social exclusion of disadvantaged groups, shifting power structures since the introduction of community care – but, in our case, it was also propelled by a series of unfortunate events and a willingness to reflect and see crisis as an opportunity.

Lessons learnt

We learned many lessons, some of which may seem obvious, but the experience reminded us of how very real these issues are.

• Often we set needlessly low expectations of ourselves and others. It is easy to forget that people are essentially adaptable, and this disinclines us to do things differently.
• We have learned that a de-valued social identity can be maintained or changed by the things we do, the places we go and the people we spend time with.
• The wider community can be a source of valuable opportunities and can be more accommodating than we think.
• IT is important to be well informed, to know what is available, to make links and appreciate the value of developing and extending social networks.
• There has to be a good and justifiable reason for change, but adversity can be worked through positively and constructively. It can also provide the best opportunity for change. Importantly, a staff group needs to believe in what it is doing, as staff attitudes can be the main obstacle to change, as well as the main agent of change.
• Organising a service around convenience and routine is often non-therapeutic and can stifle a person’s growth and potential.

One of the most important things we have learned is that surviving or withstanding the process of change and adversity can, in itself, be curative and promote growth and development, and can give confidence and hope.

The need for refuge

Since the move to Carisbrooke House, among the many differences we have observed, we have noticed a tendency in some service users to want to claim space for their exclusive use. We sometimes encounter the desire to create and maintain a discrete and comfortable setting. We have to keep reminding people that we inhabit a community space. It seems that, in the absence of a social network, people still have a need to connect and belong to something, even if it means maintaining a de-valued identity, because this is preferable to not belonging or having very limited social connections.

That some people choose to retreat and not face the world may say something about the wider community (lack of tolerance, acceptance, understanding), or the way support systems are set up (not comprehensive enough, not fully thought through, or not genuinely person-centred). But maybe, it is a choice that an individual makes.

While accepting that it is not what everyone wants or needs, we can acknowledge refuge as a valid choice for some. The task is to create a setting and to find a careful balance between offering a refuge or resting place and inviting and creating opportunities to re-emerge into a wider world. Maybe in the past the emphasis was on refuge, without hope or opportunities. The challenge is to offer both options at the same time.

A point worth emphasising again is how those individuals who have travelled along with the service over the last few years have withstood and survived the various transitions. In fact, we have noticed the most significant changes in this group, which is very encouraging. There appears to have been a shift in how they use the service – from daily attendance and dependence, they now enjoy a wider range of social activities, peer support, extended networks, increased resilience and belief in themselves.

Next steps

The next stage is to work towards transformation within the local community. There are questions that we still need to address. How do people who do not use the service view it? To what extent can it be of value to people not formally diagnosed with mental health problems? What more can we do to erode some of the barriers in attitudes, perception, image, identity and willingness to consider one’s own mental well-being?
It may be that we can respond to some of these issues by inviting more people from the local community into this space, and offering them an opportunity to gain an appreciation of their own well-being and mental health needs.

In conclusion

Change is sometimes equated with loss and it can take time to dispel this initial fear and recognise that change and transformation offer an opportunity to reflect on what we do, and that they allow for growth and development.

Our thinking has evolved in response to what we have observed. It has encouraged us to pursue the idea of ‘citizenship’ more vigorously. Building on our belief in people’s capacity for recovery, we are determined to work towards promoting more valued social roles and identities, and generating opportunities to get involved in the wider community and do things for others, as these are, in our view, a measure of recovery.

Reproduced from:
A life in the day Volume 11 Issue 4 November 2007
© Pavilion Journals (Brighton) Ltd 1