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constant realities and changing ideas

This article is an extract from the WIAMH Annual Review for 2013, published this week.


It seems inevitable that every few years voluntary organisations must reinvent themselves, supposedly to adjust to changing circumstances.  This is odd, because in our case at least, the circumstances which change are not our main focus.  Individuals’ states of health or illness may come and go, but the existence of mental illness, like other states of health, has been a constant factor since people started living long enough to avoid being someone else’s dinner.

What changes is organisational fashion and legal context, and for these reasons, WIAMH is now at the end of its third incarnation, as a charitable company, and the committee are now decided that we should reform as a Scottish Charitable Incorporated Organisation (SCIO).  This is not entirely a new idea – indeed, questions about the advantages of Company status have been around since our incorporation.  You’d be forgiven for thinking that the only constant factor in our history has been working out the next change.  But I say again:  The real constant factor is the states of ill health we seek to alleviate.

This doesn’t just affect voluntary organisations.  How statutory health and social care should be delivered is also a matter of interminable debate, and we hear that years of trying to provide services with “joined-up thinking” between necessarily disjointed agencies may be coming to an end.  Full integration will be the new theme.

It is important to remember, so I’ll say it a third time:  The core needs of the recipients of health and social care are constant.  Bar a few demographic shifts relating to increasing lifespan in the population (a trend with, sadly, greater effect in people with no significant mental illnesses earlier in life), this is institutional; the disjointed approach inherited from multiple Nineteenth-Century boards has lost inertia, and clearer ideas about single commissioning authorities have come to the foreground.

There is much to look forward to in administrative simplicity from the prospect of a single authority; one management structure for service provision; but we should recall that if it were that simple, there would be no argument for having a voluntary sector either.  A unitary approach also brings the risk that if you’re only doing one thing, you cannot afford to get that wrong.  Whereas, if one out of two or three things are wrong, you may still be able to provide something effective.  The phrase “eggs in one basket” should be enough to remind us of the things that can go wrong if, as a society, we’re not funding a variety of services through a variety of routes.

On the topic of variety – thanks in large part to Del’s grasp of the web of possibilities which to some of us seems like a confusing and fearsome trap, we continue to succeed in attracting a range of funding to keep our doors open.  Nevertheless, the main part of our funds comes from statutory agencies.  We sometimes get the impression that it’s difficult for everyone to keep clear which part of which agency is supposed to be funding what.

If the change to a single commissioning authority occurs, it may become clearer to the commissioners exactly what range of services they are, collectively, aiming to provide.  It may become easier to work out which services achieve the most efficient outcomes.  I would like to think that this could lead to an improvement in the robustness of our contractual agreements.  I say this because – for all that we are rather used to having to negotiate our way through the funding webs – the efficiency of any organisation, voluntary, statutory or other, is not improved by having to devote extra time to it.  A consistent funding base goes a long way to permitting the consistent needs of our clients to be addressed.

This does not mean that we would ever stop looking for additional funding sources; but ideally these should be funds for new or experimental services, and, again ideally, long term stable funding would be always be provided for successful services, rather than withdrawn once they are established enough to be no longer thought innovative.  We would prefer to use independent funding to explore ways of addressing needs which – though they be ancient – have never previously been met.

These are not issues which solely affect charity funding.  This is a time of radical change to the social security system – a safety net which some of us experience increasingly as a sticky trap.  There may be new ways of helping people out of poverty and benefit-system traps; but ideally we would not have to find them, because the systems should still be safety nets, and would have an enabling function.  This is not what we would prefer to spend time seeking funds to address.

So it is a peculiar situation we are in.  While it is true that we have more detailed knowledge of neurobiology and the genetics underlying different illnesses than at any time in the past, and are gaining more by the day, there have been very few significant changes in recent decades in actual treatments for mental illness, and (this is your final reminder) the illnesses themselves have not changed since the dawn of humanity.  How then is it that we are so persistently confusable about the need for support to alleviate the most consistent of the worst consequences: poverty, and all that comes with it?

An answer might fall outside the scope of this report, so I'll leave it as an exercise for the reader.  But WIAMH will continue to address the issues, in partnership with whomever wants to work with us.


Niall Shaw