"Mental health day centres in Manchester - we don't understand the changes"

About: Collective Voice: North West Standing Conference Patient Opinion

(as a service user),

I attended the Collective Voice event in Manchester last month. It was at Kings Church near Oxford Rd train station and there were lots of people there. I saw a presentation by Patient Opinion in the afternoon and thought I could share my opinion on day centres in Manchester.

I went to the adult social care fairer charging review on 25th August. It was to discuss the changes to the way we are being charged. The following questions were asked:

Question one: Do people understand the changes to the way they are charged?

Most people don't understand why it costs so much and don't understand why were are charged as these services are for our health and healthcare is free. Most people don't think it is right that some pay more than others. We also thought that many of the people who go to the day centres wouldn't understand the changes - was this capacity taken into account when implementing the new policy?

Question two: Do people understand why we changed the way they are charged?

No! A few people felt it was a way of taking their DLA away from them, which people use to keep them out of hospital. Apparently, there is £1.6billion extra money available - why do we need to pay?! We just havn't had enough information.

Question three: Do people think the way we charge them now is fairer?

No! Paying more for exactly the same service isn't fair. It's wrong to make people use benefits to pay for social care services. "We didn't choose to be ill". We should only pay for services in retrospect, not in advance and then wait for a rebate with no interest. Also, people who don't 'behave themselves' (e.g. by refusing medication) won't end up paying. Lots of other local authorities don't charge MH customers.

Other impacts of the Fairer Charging Policy:

Has a knock on effect to other parts of the trust. It is making people ill. No one had an impact assessment before the changes were made. It might encourage people to get more ill so that they can get the services for free (under section 117). The people who made this decision don't understand what it's like to survive on very little money every day. Mental health needs fluctuate, it's got to be more flexible.

We think that the NHS will end up paying for the 'damage done' by this decision because people won't be able to access the council services and will end up more unwell and potentially sectioned. Mental health care and physical health care should not be treated as seperately as they are. We want to know what would happen if we didn't pay, would the service be withdrawn?

We just all want good quality mental health care that is free, in the same way that if we had healthcare needs in general they would be met with no cost. It seems like mental health care is only free when you are really very ill and sectioned, until then it is difficult to support yourself and prevent hospital admission. The group are 100% against the decisions made in this charging reveiw and would like to see something done about it. No one understands why they have to pay to access help from mental health day centres. It feels like 'the system' wants us to end up in hospital instead of at home, supporting ourselves to live independently.

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Response from Mick McKeown, Principal Lecturer in Mental Health, University of Central Lancashire

Thank you for this very thought-provoking post. My name is Mick McKeown and I help to support Collective Voice.

Your reporting of what is happening on the issue of 'fairer charging' for adult social care servcies in your locality is really helpful for us at Collective Voice. And I'm sure this is also the case for vistors to the Patient Opinion site too. These issues are likely to be very important for Collective Voice, and the attempt to have more of a say at strategic level. The allocation of funding resources and the impact of different decisions on people's lives is central to any debate we might have about the future direction of mental health services. Also, unfortunately, in the midst of the current economic crisis, differences of opinion over how best to spend money and budgets are likely to be profound. It is very important that Collective Voice has something credible to say on this. We must also take care to ensure that as wide a possible network of people, service users and carers, have their voice heard. Ultimately, the decisions taken on funding for social care are big issues for local democracy. It is entirely relevant that as many service users and carers who can take part in debating these issues and bring forward their collective views to the relevant policy makers and local politicians.

For these reasons, I would very much like to encourage you and others who have views on these sort of funding and payment issues to continue to post your views on Patient Opinion, and flag them to Collective Voice. It would be great to start an on-line conversation on this that could help us put together collective responses.

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