(Belated) reflections on “complex needs” and an Australian adventure
Last week at a ceremony in Church House, I was presented with a Churchill medallion following my 2011 trip to Australia to identify new and innovative responses to people with complex needs. The Churchill Fellowships provide opportunities to travel abroad to learn from other countries and to bring back new ideas, knowledge and best practice to apply in the United Kingdom. The Churchill medallion was presented by Guest of Honour, Dame Mary Peters DBE, Olympic gold medal winning pentathlete and a 1972 Churchill Fellow herself.
The 113 Fellows receiving their medallions last week included many colleagues from the mental health and penal reform sector: Mark Bolt, from Devon and Cornwall Police who looked at models for police in dealing with mental health crisis (report here); Paula Reid, from Rethink, who looked at diverting offenders with mental illness from the criminal justice system (report here); Mark Walsh, from Hampshire Police, looking at peer courts for young people (report here); Marina Cantacuzino, founder of the Forgiveness Project, who looked at restorative justice approaches and the transformative power of the personal narrative (report here); and Damian Allain, from the Metropolitan Police, who looked at tackling gang crime (report here). I felt privileged to be part of this community.
Across Victoria and New South Wales I visited almost 30 services, attended two international conferences, and met with over one hundred policymakers, service managers, practitioners and academics. Among my reflections from my trip is the need for collective responsibility and strong leadership at both a national and regional level for integrating services and improving responses to this group. Where change had happened in Australia, such as in the Victorian Multiple and Complex Needs Initiative, it had had cross-government buy-in, reflected in both ongoing involvement in the strategic direction of the programme and financial commitment. The current government’s Social Justice strategy is an important step, but without clear drivers for change, accountability and flexible funding at a local level then it is hard to see how its intentions will be realised.
Another lesson was the need at both a strategic and operational level to be responsive to problems in a pragmatic manner. Allowing service user needs and desires to drive service responses seems almost tautological, however we know that all too often this is not realised. Instead, service users have to try and fit their needs into the (limited) menu of options that services provide. This is changing slowly, with the onset of personalisation and outcome-based commissioning, but we need to be comprehensive and creative in needs assessments, take identified need seriously, and be pragmatic in our responses. We can’t let politics, ideology or professional hegemony dictate the way. Good examples of this included, strategically, the Medically Supervised Injecting Centre in Sydney, and, operationally, the Police and Community Triage (PACT) project’s client-directed support for those likely to be in repeat contact with the police for any reason.
In contrast with Australia, I also reflected that insufficient attention has been given in the UK context to hidden disabilities such as acquired brain injury and learning disabilities and their implications for justice policy and practice. There is a need to introduce learning and evidence from neuroscience into debates around criminal justice responses; while being fully aware of the dangers that such discussions have historically posed in terms of fatalism about change, discrimination and ultimately eugenics.
Finally, the potential for technology to be used to coordinate responses to people with multiple problems remains underexplored. I was excited by the SupportLink programme which enabled police to make on the street referrals to support using iphones, as well as work undertaken by the PACT service to develop a case management system that could be accessed by multiple services.
However, my one regret about the trip was that I was not bolder. I chose to visit Australia as it shares similar systems, similar problems and has strived to find solutions. I wanted solutions that were ‘transferrable’ to the United Kingdom. But I was not aspirational enough. I met inspirational individuals and visited interesting projects – but all too often they languished in pilot phase, unable to make a significant and long-lasting impact on the mainstream. A sticking plaster on a broken system.
My overwhelming lesson from my trip was that ‘complexity’ is as much a product of the many systems that we have created and now inhabit, as it is of the individuals that we describe as ‘complex’. One cannot escape the irony of being told by services which do not communicate and which pass you from pillar to post in a never-ending and Kafkaesque scenario wherein there is always a reason why the support that you want is denied, that it is you, the individual, that has ‘multiple problems’.
Lisa Archibald, from New Horizons Borders, was another Churchill Fellow collecting her medallion last week, following her trip to New Zealand to look at addressing mental health stigma in rural communities. On reading her report, I was struck by the need to look beyond Western approaches and fundamentally rethink our approach to human wellbeing. She writes:
“Traditional Māori health acknowledges the link between the mind, the spirit, the human connection with whanau (family), and the physical world in a way that is seamless and uncontrived. Until the introduction of Western medicine there was no division between them. The Māori philosophy towards health is based on a wellness or holistic health model….they generally see “mental illness” as a pakeha (white European settlers) construct. They instead view mental well being as an equal contributory part of our health along with family (whanau), physical well being and spirituality.”
It is sometimes all too easy to forget that there are other ways of conceiving our experiences and challenges. Our way is not the only way and our responses are not the only ones possible, nor necessarily the best. I have emphasised the need to be pragmatic. But we also need to be brave.
The full report from the trip can be downloaded: here
Applications for the 2015 Churchill Fellowships are now open and categories include Medicine, Health and Patient Care and Prison and Penal Reform. More information is available on the: Winston Churchill Memorial Trust website
