It's never too late.

Just where do we start?

We should have been doing this nine years ago, when the government started to realise that there was a pretty big mental health problem out there that most NHS services aren't set up to deal with. An awful lot has happened in the last nine years, and this feels more like the end than the beginning. We're in such austere times, with limits on funding, with it feeling almost impossible to start anything new, and with many aspects of all our lives getting more harsh and severe. The national PD programme, which has done all sorts of things in the last nine years, is going to finish in March 2011 - and this blog, plus the website that goes with it, might be all that's left by April.

However, we're not going to get morose and glum here -  though we won't be putting a shiny corporate gloss on everything either. Most people in the PD movement will be experiencing at least some aspects of the national gloom at the moment, and we don't want to minimise that. Many good things that happened, and positive developments that are still happening. We hope that this blog, and the processes going on behind it, will help to link people up and build on the positive developments. Maybe a long shot - but we're going to try our best!

To get up to speed, let's do a good things/bad things list - about everything that has happened in this field since 'No Longer a Diagnosis of Exclusion' came out at the end of 2002.

Bad things

• Henderson Hospital and Main House closed: no NHS provider now has residential beds for adult non-forensic PD (what we call 'Tier 4 provision').
• The new government-funded pilot services (see below, good things) only cover 9% of the population.
• With so many NHS changes, nobody knows whether they are coming or going - and the general institutional response is harsher management control and less space for grass roots creativity.
• The new training (KUF - Knowledge and Understanding Framework) is very very difficult to get going in this environment, even with the decent funding from the government that it is getting.
• Recession and cuts, cuts, cuts. 
• For service users, considerable fear about being forced into work; for clinicians, a worry that the benefits system will fail to recognise their mental disorder, and so make them more unwell.

Good things 

• Eleven new pilot projects started in 2004 - and all of them are still going strong. The 'final clinical review' of them all will be the main preoccupation of this blog from now until March.
• Many others - number unknowable - have also started since then in the 'mainstream' NHS. We're going to start tracking them down and including them on the national website in April.
• Lots of other pilots and new ideas have also been developed in prisons and secure units (though they are not going to feature in this blog)
• Inspirational and attitude-changing training being set up across the country (KUF - but also see the down-side in 'bad things', above) 
• Useful NICE guidelines (BPD and ASPD) which aren't over-prescriptive, were published in January 2009
• Roadshows throughout the country to disseminate the 'Recognising Complexity' guidance for commissioners (mental health and others) were very well supported.
• Exceptional energy and enthusiasm has come from the PD service user (aka 'experts by experience') movement, represented by organisations such as Emergence (nationally) and STARS (in the Thames Valley). But probably many more around the country that we don't know about yet (So please respond to this blog if you are one of them!)
• A 'First National Congress' at the ICC in Birmingham in November 2009 to celebrate all the innovation and creativity: opened by Lord Victor Adebowale and hosted by the BBC's Mark Easton.

That's enough to start with.
Next posting expected when we're on the round-England journey, starting on Tuesday.
Here's the map of where we're off to:

PDB