Sunday, May 13, 2007

Michael Elvin's 1990 Mental Health Document "Shifting The Balance"

The late Michael Elvin in Birmingham, once a mental health patient, and Chair of the Birmingham And Solihull Mental Health Trust Patient & Public Involvement Forum in 2004 had in his possession an interesting 1990 document titled : "Shifting The Balance" intended to give more rights to Birmingham City Council mental health Service Users - or "Consumerees" as he called them.

He was rightly skeptical of such intentions by the mental health services in Birmingham and in this case the Birmingham City Council, to reform their approaches.

They never have really. In the opinion of UserWatch. Service Users are still under the yoke of bureaucracy in various disguises and its various cost cutting driven agendas.

Its striking over 10 years later in 2003 the Strategic Health Authorites also created a paper named "Shifting The Balance of Power" - which was something Michael Elvin was aware of . And skeptical of .

Intended to create a more robust sense of Patient Involvement in health with a future quality driver of patient choice shaping the State enabled purchase of treatments, the sense of "Shifting the balance" has become mangled within new service assimilated "User-bureacracy" (especially in Mental Health) and a lack of real choices, so that the status quo Health Bureacracies are still monolithically in the driving seat ..

Lets have a look back in time through Michael Elvins own words, rhetoric and views taken from his JARMI (Justice And Rights For The Mentally Ill) site that has outlasted his life :

"Our stand is for Justice, Rights, Democracy, and Fraternity

We start with a message about the attitude of Birmingham City Council, United Kingdom:

Birmingham Mental Health Pioneers operated on a shoestring and their friendships laced community care together ... ... shamefully untied by Birmingham City Council.

We are informing in part of our antecedent, so that you may understand our motives and intentions. JARMI evolved to be dedicated to the cause of justice and rights for people with a mental illness because of the numerous occasions people with mental health problems have been let down by society, government and statutory agencies. By "rights" we mean those that are legally enforceable and not wallpaper.

In 1990 Birmingham City Council produced a document with the title "Shifting the Balance" (Click here). It was described as "a strategic review of community-based mental health services in Birmingham. The foreword contains the following:

"This Review of Community Based Mental Health Services has been undertaken because the City Council wished to raise the profile of a large group of people who are seldom noticed, and who have a need to ensure their voice is more clearly heard. The work was conducted by the Strategic Policy and Planning Unit by Alan Coe, seconded from the Social Services Department and Ed Whitton from this Unit."

The key features of the strategy included::

- Participation of Service Users
- A multi-agency approach
- Creating uniformly high service standards
- Ensuring that the needs of under-represented and minority groups are met

Key conclusions pointed to the need for:

- increasing service users participation in the running and planning of services
- ensuring information about services is easily accessible to all
- reducing stigma and creating a positive image
- ensuring there is improved access to leisure, training, and employment opportunities achieved
- ensuring equal access to services for those presently under-represented as service users
- providing support for the development of more community services at weekends and Bank Holidays

The strategy led to:

- the development of a City-wide users movement
- increasing opportunities for user participation
- ensuring bids for new resources have the active support of service users

In the Introduction of "Shifting the Balance" it is stated:

"that the involvement of service users and providers was seen as particularly important if the cultural shift from provider-led to needs-led services was to be achieved."

Birmingham Mental Health Pioneers proved to be a highly successful for mental health service users who wished to be involved in the development of social and health care delivery. The outstanding success of the Pioneers was extensive city-wide networking which increased choice and opened doors for those who wished to grab opportunities and become involved. In 1993 Birmingham social services decided to withdraw funding. This was not a council decision but made by social worker employees. It is the view of JARMI that the reason was because the professionals resented the shift in the balance of power.

In addition, The Search Team was created in 1990 and the Pioneers played an active and successful part. Michael Elvin, in particular, completed original work on the accessing of social workers. Michael Elvin's research was accepted by at meeting of the highest level managerial team of social services attended by the Director and all his Assistant Directors. It is the view of JARMI that this success was resented by middle managers.


In 1991 The Search Team consisted of special interest groups of which mental health was one. The mental health special interest group was always active and well attended. A particular special interest groups was the Black Community Care Forum which was formed in the Autumn of 1991. In 1992 the Black Community Care Forum had over 60 members. In 2004 the 60 members had been reduced to about 6 members. The mental health special interest group had ceased to be active before 1996. The Black Community Care Forum amalgamated with the Elderly Special Interest Group.

An initiative proposed by Birmingham Mental Health Pioneers supported by The Search Team and led by Michael Elvin was for two service users to become Care Managers.

The following account was published in Summer 1998 edition of BMHP's newsletter, The Pioneer Voice :


Are we the enemy? They talk about user empowerment, but what does this fancy jargon really mean? Recent experience suggests that the words are false signposts, erected to lead us up the garden path.


The Pioneers are represented on the search Team which is a 'watchdog' for Community Care. A forum for users, carers and service providers. Search put forward the proposal that 2 service users should become Care Managers.

We accepted this proposal and negotiations resulted in an offer of 2 Pioneers to perform the role of Care Managers and participate in training. We were told to recruit 2 people. The project would be called 'Start-Up'.

Here was the opportunity for The Pioneers to embrace a real partnership with the professionals. Our policy is to work with them, so we pursued this partnership with enthusiasm and a belief in mutual trust and respect.


We were told that the project started at the beginning of September. We were told that Birmingham University have the job evaluating the project and were looking forward to service users being involved.

Two people with excellent qualities were recruited. The Pioneers have no doubts that these two people are as capable as the professionals for becoming Care Managers. We share with them the bitterness of disappointment when it became apparent that our partners, the professionals, were not consistent with their initial enthusiasm for the partnership.


The fact is that we didn't get the expected go-ahead, even though we had two superb people ready willing. Indeed, communications became difficult and we weren't informed about what was going on.

Eventually in October 1998 , we did attend a meeting expecting to negotiate the release of funds. But, THERE IS NOTHING TO NEGOTIATE, we were told. To add insult to injury a professional said:


This sick statement was thrown at us as if we were the scum of the earth. They had revealed their true intentions. The partnerships was dead.

Well, they can treat us with contempt. They can treat us like dogs. But, the professionals, even after a million years have past, will never understand the love and friendship that binds The Pioneers together.

Our cause is just and honourable. Together we shall march into the future with pride and dignity. Our time will come because we always have each other, united under The Pioneers banner.


We were offered another crack at Care Management last Spring. We were being set up for yet another put down. Do they want us to fail? Are they frightened of us? Perhaps they are drunk with power, arrogance and delusion! "

(Michael Elvin D. December 2006 )

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