Mosaic Clubhouse in Brixton has been a lifeline for Lambeth residents suffering from mental health problems since 1994. Funded by Lambeth Council and the borough’s Clinical Commissioning Group, it provides education and employment opportunities, housing and benefits advice, advocacy, a supportive community and a safe space in the evenings for those in crisis.
According to the South London and Maudsley NHS Foundation Trust (SLAM), Lambeth experiences five times the national average for psychosis – in fact, it has one of the highest incidences in the world. Over the last year I’ve spent time at the Clubhouse getting to know staff and members. I spoke to Chief Executive Maresa Ness and Employment, Information and Training Coordinator Lee Elliott about the work they do, and how they’ve seen central Government cuts impact both Mosaic’s members and mental health services generally…
What brings people to the clubhouse?
Lee: A real mixture of reasons – but social isolation is usually a big factor. Mental health is a massive church, so we’ll have some people with pretty profound diagnoses and others with anxiety and depression, which are also very serious but may not haunt their whole lives.
Maresa: When you get your first diagnosis, quite often things have been going wrong for years but no-one’s put their finger on it. And in that time you’ve lost your friends, your education’s been terminated, you’ve never had a job, you may have lost your housing, you’re in debt, you may have started taking substances… it’s a real spiral, unless someone catches you quickly. Quite often, people end up coming into hospital for the first time with the police because things have gotten so bad.
So how do you help people?
Maresa: Lee coined the term “opportunity centre” and I think that’s what we are. When people come to us they’ve often been rejected by family and friends. They’re isolated, lonely, self-stigmatising – and I think the first thing that strikes you when you come here is the sense of community. It’s a place that accepts you for who you are, for where you are on your journey, and believes you can do whatever you want to do.
How have you seen austerity impact your members?
Lee: I think the biggest impact we’ve seen has come from changes to benefits, especially when they introduced sanctions. People with multiple problems, who perhaps have anxiety and depression, who might also be dyslexic, and at the point at which their anxiety and depression is at its worst get a threatening letter from the DWP (Department for Work and Pensions). Well, that’s going to raise their anxiety even more. They get sanctioned and debt starts to build up. And once Universal Credit kicks in it’s going to get worse.
Lee: Because people are being encouraged, by default, to use digital applications to apply. Even today a lot of people don’t have access to the equipment or don’t know how to use it – let alone wade through the minefield of an application form.
And no-one checks whether people are filling these forms out correctly. Just today I was talking to someone who’d been given no points on their ESA (Employment and Support Allowance) application, and yet they’re so clearly in desperate need. We can help them, but what happens to all the people who aren’t picked up by us or by other organisations? They’re pushed off ESA just because they filled the form in wrong, and they’re not even told what to do next. People only find out when they come here that they’re supposed to apply for JSA (Jobseeker’s Allowance).
You can present as clearly not ready to work, but if you try to be positive and say you’re ok, or that you’re keen to start working again, they’ll give you no points and mark you as fit for work. You’ve just made their job easier.
People can be functioning quite well, but a raft of bad things happen in quick succession and things fall apart. The system is not kind to people who ask for help themselves. It’s ok if I phone up on behalf of somebody, as a professional – they talk to me in a very different way. But if I was made homeless tomorrow and tried to sort it out for myself they would treat me very differently.
Maresa: I don’t know if some it, in terms of anti-depressants, is that GPs are now so overwhelmed by people coming through their doors with social problems that it’s quicker to write a prescription for anti-depressants – although maybe I’m being mean to GPs. I think it is hard for them when people walk in with depression or other mental health problems, because they can’t cure them in five minutes.
Lee: There is also a sense that if it’s not as stigmatised then you’re more likely to declare a mental health problem. But at the same time, I think we live in a much more violent world now than when I was a kid. And a world which lends itself more to paranoia because we are being watched a lot more closely.
Maresa: And we’ve just come out of a recession where there was a lot of anxiety about whether people would keep their jobs and be able to feed their children. And all that student debt, my God! That must be terrifying. And such high youth unemployment.
Nationally, how do you think the mental health sector has been affected by cuts?
Maresa: Well, there hasn’t been any investment, has there? For all those pronouncements, as far as I’m aware nothing has actually filtered through. All I’m hearing is that trusts are in worse financial states than they’ve ever been before. I’m now hearing that the foundation trusts, the ones that were awash with money for years, they’re all now in deficit. And it’s all because of a tidal wave of demand and chronic underinvestment.
All this stuff about parity for mental health and physical health, it’s never actually happened. All this stuff about extra money for CAMHs (Child and Adolescent Mental Health Services), as far as I’m aware it’s never happened. There’s never any new money. Any money that is promised [by Government], [the NHS trusts] have to find by cutting something else.
Where are the biggest gaps in provision?
Maresa: It’s got to be children. If you get it right with children, you don’t get depressed adults. You know all those Sure Start programmes we used to have? They were an amazing idea. But they’ve been cut back [as reported last year]. If you could get to all those kids who aren’t being parented properly, you would stop so much of this happening in 20 years’ time. [Mental health problems are estimated to cost the economy £105 billion a year – roughly the cost of the entire NHS, as Paul Farmer and Jacqui Dyer highlighted in their report last year.]
Lee: I guess learning disability is quite a gap as well.
What’s missing there?
Lee: Everything. We get so many attempted referrals from people whose primary diagnosis is learning difficulties rather than mental health, and it’s because there’s nothing available for them. There used to be the day centres, at least, and a few other services as well. But there’s virtually nothing now.
Something I’ve heard from other frontline organisations like yours is that there’s a lack of compassion from some of the statutory services – the NHS, social services – that people are just too overworked to care any more.
Maresa: Yes, it’s burn out. Actually, the most common thing we hear is that no-one answers the phone at all.
Lee: The number of times we’re concerned about one of our members and so try to contact their care co-ordinator, and it’s an absolute nightmare trying to get through to them. One of the questions we ask people when they use our information service is how they heard about us. Very often we get the response that they tried various other services but no-one ever answered the phone.
Maresa: And that’s really scary. Imagine that you’re going through a crisis. You’re terrified and on your own. You’ve got no-one to talk to and when you finally seek help, no-one picks up the phone.
What needs to happen? Is it just about money?
Maresa: No, it isn’t just money, although money is part of it, obviously. I think there’s a compassion deficit at the top. Nobody cares.
Lee: Nationally there just seems to be a real imbalance in society, and it’s a problem in Lambeth as well. The gulf between the haves and the have nots is growing exponentially. And yet the people who are being vilified are the people at the bottom. The rhetoric is toxic, and it has an impact on people’s mental health.
Maresa: It feels like the people in power, in central Government, just have no clue how people here are living. It’s so easy for people to spiral downwards, and we see it all the time. It can happen incredibly quickly – people don’t realise. One significant life event and bang, your whole life can implode. But until it happens to you, it’s someone else’s problem.