Essay

Introduction

This is a case study of Stamford Volunteer Bureau and a project that offers volunteer opportunities to people with mental health needs. I have worked as the Manager of Stamford Volunteer Bureau (VB) since it opened in 1992.  The project has been an important part of the development of the Bureau, both in services available to volunteers and as a ‘partner’ with statutory organisations.  It is also close to my heart as the ‘model’ is unique and my creation.  Notwithstanding the inevitable difficulties with objectivity, the study offers an opportunity for me to look critically at where the Volunteer Bureau sits in its relationship to the state.  The impact of ‘partnership’ with a changing mental health service, and future funding uncertainties, is explored in relation to the project, the autonomy of the Bureau and volunteers with mental health needs. 

Perspective and Rationale

I first became involved with the Volunteer Bureau after taking redundancy from a full-time job with a multi-national life assurance and investment company.  Although I had little experience of volunteering and even less of voluntary organisations, I felt I could use my skills to get this project off the ground.  I had always taken an active interest in issues of social justice and the 6 hours per week suited my domestic arrangements - I had recently given birth to my second child.  Eight years later the role has grown into a full-time post and my knowledge, understanding and commitment to volunteering and voluntary groups has grown with it.  Particularly since I started the Diploma in Youth and Community Development three years ago. 

My own beliefs about volunteering reflect those of the National Association of Volunteer Bureau (see appendix).  I have a commitment to promoting volunteer opportunities to everyone; particularly people who find themselves isolated through poverty, disability and other political and social barriers.  The development of a scheme to support people with mental health needs was possible because of extra funding from the National Lottery Charities Board.  This funding was to expand the capacity of the Bureau to deliver core VB services, in a county where the voluntary sector infrastructure is fragmented and poorly funded.  There is no Council for Voluntary Service or other Local Development Agency in this area.  The increase in the number of available paid hours enabled us to work with Stamford Resource Centre. This is a hospital-centred unit providing in-patient care and day services for mental health patients.  It is the base for clinicians and social services professionals and was opened in response to the Community Care Act (1990).  We are now in our final year of a 3-year grant from National Lottery Charities Board and the future of Stamford Volunteer Bureau is far from secure.   Although it may be possible to find short-term funding for this particular aspect of the VB work, a more lasting solution is likely if we can link up effectively with mental health services.

In January 2001 I am to give a presentation and help facilitate a workshop looking at a model of inter-agency work, which aims to address social isolation and is potentially empowering people with mental health needs. The local Primary Care Group is hosting the event; a review of the ‘model’ is one objective of the Health Improvement Plan for this area.  Senior managers from the steering committee for the new integrated mental health trust will join service users, carers and practitioners.  I need to be prepared for the meeting.  Effective dialogue is more likely if I have an understanding of the current issues in mental health and a clear view of how Volunteer Bureaux might be involved as a partner.  As knowledge is power, it should help redress the power differential at the meeting.  I will be the only person (woman) from a voluntary organisation that may be viewed by others at the meeting as amateur.  Invitations to the event have been targeted at those in a position to endorse and, if appropriate, purchase this project.  My networking does not usually extend to these ‘men in suits’ and they will not be familiar with the Volunteer Bureau.  Nevertheless, by sharing my practice knowledge it may be possible to influence them in the direction of a more anti-oppressive way of working.  (Collinson, D.  1994).  I may only get the one opportunity to engage at this level to promote the model and the views of service users that I obtained from my evaluation.

I hope to move this project forward from a ‘pilot’ scheme into a more formal collaboration with the new integrated mental health service in south-west Lincolnshire.  It is important that I make considered judgements in relation to the development of the project and not get swept along in the euphoria of success. 

Information for the study will be taken primarily from documentation - VB Annual Report and Accounts, VB grant applications and reports to funders, project protocols and evaluation, for example.  I will use telephone interviews with key people at National Association of Volunteer Bureau, the Community Mental Health Trust and the local Health Improvement Facilitator and, of course, my own knowledge of the VB and this project.

Learning Objectives

1. To consider the impact of partnership and funding arrangements on a ‘voluntary sector’ organisation.

2. To gain an understanding of some of the current issues affecting mental health service provision in south west Lincolnshire, as they relate to this project.

3. How the Volunteer Bureau has acted as a catalyst for promoting anti-oppressive practice in mental health services.

Origins, Aims and Objectives

Stamford Volunteer Bureau was established in 1991 and, as a member of the National Association of Volunteer Bureaux, its core work is outlined in the Statement of Common Purpose for Volunteer Bureaux.  The NHS and Social Services have a history of involvement with volunteers and voluntary groups.  Both the Seebohm Report (1969) and the Aves Report (1969) acknowledged the need to integrate voluntary and community services with health and social services, in order to support increasing demands on the welfare state.  (Sheard, J 1992).  Aves was impressed with the work being done by a small number of volunteer bureaux and recommended that the network be extended throughout the country, funded by the local authority, whilst maintaining a high level of autonomy. 

Since the beginning of the 1990s, debates about citizenship have been taken up by Government.  One of Labour’s central social policy themes is that of social inclusion and the commitment to build ‘healthy, active communities’. (Boateng, P Home Office Minister 1999).  Volunteering is a key indicator, seen as an important expression of (active) citizenship and a critical factor in creating social capital.  The National Centre for Volunteering also sees it as essential to democracy.  (National Centre for Volunteering Policy Briefing 2.2 , 1999)  Volunteering is a two-way process where an individual makes a gift of time, skills and energy in return for fulfilling their own motivation, needs and wants.  Niyazi (1996) and Wilson (1998) have identified the potential benefits of volunteering for disabled people, including the opportunities it offers to build confidence and self-esteem and make friendships that are not based on dependency.

Hand in hand with this enthusiasm for volunteering, the Government has a vision for a more joined up and holistic approach to health: healthy living centres, healthy schools, healthy workplaces and healthy neighbourhoods.  The importance of social factors as determinants of health and the inequalities in health have been acknowledged in the Acheson Report (1998).  The Government’s mental health strategy also addresses social exclusion and the social factors that affect our mental health.  In order to improve services, the Government has stressed the need to work with service users, different agencies and the local community as ‘partners’.  (Department of Health, 1998).

Despite a low level of funding from Lincolnshire County Council Social Services Department, the VB has looked to engage with local statutory agencies and to try and give a ‘voluntary sector’ perspective in relation to Government initiatives, such as New Deal.  However, the Bureau has always resisted the temptation to take on additional work in response to these initiatives, participating on ‘consultative’ committees where appropriate but refusing to generate new schemes in order to meet funding criteria.  The ethos of the Management Committee has been to focus on the VB as a referral agency for volunteers and to facilitate the development of new schemes to meet an identified need, provided that there is congruence with the values and aims.  Rather than being involved in the direct provision of services, these are ‘floated off’ as separate entities.  In other words the VB acts as a facilitator and enabler, offering practical support, information and advice.  This approach is the antithesis of empire building by managing volunteer projects in-house.  At the same time the VB has been pro-active in promoting volunteering opportunities.  There has been a concerted effort to work in a way that is anti-oppressive and involve groups and individuals who often find themselves excluded from living an ‘ordinary’ life and making connections.  This is reflected in the culture of the organisation, which is fairly cohesive and task-oriented.  Both paid and volunteer staff participate in the development of VB operations and service delivery. (Handy, C.  1988).

In 1998 I gave a presentation to clinicians and the Consultant Psychiatrist about volunteering opportunities for people with mental health needs.  Then, building on a relationship established with two Community Support Workers, I formalised an arrangement to support volunteers into a set of protocols for working together (see appendix). The aim of the project was to enable people with mental health needs (and severe mental illness) to access volunteering.  It was ‘volunteer’ focused and not about ‘rehabilitation’ or a care programme.  Establishing a partnership with the Community Support Workers enabled us to resolve the VB problem with resources (i.e. no specialist support worker).  We were able to promote better communication and co-ordination between clinicians, social services and the Bureau whilst ensuring that service users/volunteers wishes were central.  We were offering information, advice and choice.  This was potentially empowering, enabling people with mental health needs to gain greater control over their lives.  (Thompson, N.  1998).  It represented a significantly different approach to the oppressive medical perspective at the Resource Centre. (Illich, I 1977 in Thompson, N.  1997). 

This ‘model’ was piloted for a year, after which time I conducted an evaluation using an action research approach and interviews with volunteers, charitable agencies and Social Services.  (Bellairs, C.  2000).  The paper was copied to my ‘partners’ and the volunteers.  After taking four months out on field practice placement, I returned to the Bureau and discovered that the model had been incorporated into the Health Improvement Plan (HImP).  The local Health Improvement Facilitator was unable to establish how this had come to be – the specific objective had been included in the overall plan for Lincolnshire.  Potentially, this project could now develop and be ‘floated off’ or run within the VB as an extension of core service.  The current developments in funding and mental health in relation to this project will now be considered.

Funding and Current Developments

Stamford Volunteer Bureau is a registered charity.  The main source of income has been a small grant from Lincolnshire County Council, Social Services Directorate - £6963 this year.  There is no Service Level Agreement or other contract.  Services to ‘customers’ are provided free of charge.  The largest item of expenditure is salaries and this increased last year, after a review of the Managers salary to reflect the role and responsibilities of the post.  The County Council’s Grant Application Form outlines the objectives for Social Services and the areas of work they are looking to support.  Applicants are warned that the Directorate is looking to cut its expenditure and that applications falling outside their remit will not succeed.   However, it appears to be the Council’s practice to take little notice of the applications, as the amount awarded is always the same as the year before, plus a percentage rise for inflation.  The Bureau is delivering services (including this particular scheme) that would appear to fit well with the funding criteria.  There has never been any recognition of the growth of the Bureau or the development of its policy and practice – despite being acknowledged as ‘one of the best VBx in the county’.

Whelan argues that, not unreasonably, the State will want to pay for something that ‘fits’ their agenda, but that in doing so it is the State that is defining ‘voluntary’ action.  Voluntary organisations that take money from the State must expect State influence on activities.  In order to remain innovative and independent, he urges voluntary bodies not to become ‘sub-contractors on the cheap’. (Whelan, R 1999).  Lincolnshire County Council’s tardy approach to monitoring its funding has not stifled the VB ability to work in a way that is innovative but neither has it recognised and supported the project.  There have been a few occasions when the VB has been able to attract small amounts of funding from business and commerce but making links with the private sector presents at least as many tensions as those made with the State.  Whilst the VB has encouraged ‘employee volunteering’ and the opportunities for charities to benefit from specific skills, companies will also have there own agendas.  These may not always be about the development of their key staff.

In 1997, the Bureau was awarded a three-year grant from the National Lottery Charities Board (NLCB) of £13235 pa.  Although these monies are from the sale of Lottery tickets and not taxation, it is not a public donation.  The NLCB distributes grants in accordance with its aims and objectives, which are linked to Government strategies as well as regionally identified needs. It could be argued that Lottery funding is State funding in disguise. (National Lottery Charities Board, 2000).  Recently, a consortium of Lincolnshire Volunteer Bureaux, Lincolnshire Voluntary Sector Network and Community Council of Lincolnshire was awarded over £300,000 from NLCB for a three year project to develop five Local Development Agencies.  This could have a bearing on Stamford Volunteer Bureau.  There are currently eight independent VBx spread throughout the county.  In the future some of these may have to look at the possibility of a merger.  This is about to happen in Leicester, with the merger of Leicester Volunteer Centre and Voluntary Action Leicester.  The merger is expedient since it will protect the VB from funding cuts and the organisations can work together from one building.  The Manager of the Volunteer Centre confirmed that the public does not view the organisations as separate entities and often confuses them.  As outlined in a Guardian article on 15 November 2000, the voluntary sector is disparate but this can have the effect of diluting the impact of organisations with similar aims. They may also be competing with one another for funds.  (Brindle, D.  2000). However, mergers could mean that disadvantaged or minority groups become sidelined as statutory agencies seek only one or two voluntary groups (or a large umbrella agency) to work with or to ‘consult’.   Mergers may also make it difficult for local and individual concerns to be addressed adequately as organisations become more distant and the structures more bureaucratic. 

The VB is working hard to maintain its autonomy and although almost all its funds come directly or indirectly from the State, it is managing to use or manipulate broader policy objectives to meet the needs of volunteers and volunteer-using groups.  It is not a profit making organisation, is self-governing and is often working in a way that is at odds with health and social services.  The skill and creativity involved in this is sophisticated and the inter-agency environment adds to the complexity.  Changes in the way that mental health services are to be delivered will present new challenges.  The VB would like to respond to these but without realistic funding this project could fold.  It would certainly be affected if key staff left because of low pay or redundancy.  Establishing a local ‘compact’ with the local authority and the NHS Trust may be one way forward, but could also threaten the independence of the VB if we have to meet quantitative outcomes rather than qualitative performance indicators.

Current Developments in Mental Health

The NHS Plan (2000) and the Health Act (1999) allow for the divisions between Social Services and NHS to be broken down.  In Lincolnshire the plan is for integrated provision of mental health services, where the local authority and the health authority merge to deliver a one-stop package and consistency of approach throughout the county.  Two healthcare trusts are to be dissolved into a new Lincolnshire Healthcare NHS Trust by April 2001.  This organisation will have responsibility for secondary health care and will commission and provide services for mental health, learning disabilities, day services, counselling, psychotherapy and community psychiatric nursing.  The integration of Social Services is subject to further consultation and agreement, but is a medium term goal of the NHS Trust.  The consultation document expresses a commitment to build upon existing relationships with the community and voluntary sector to ‘improve joint working and the overall provision of support to users and carers’.  (South Lincolnshire Healthcare NHS Trust 2000 p19).  In addition to this change, two local Primary Care Groups propose to merge next April to become Lincolnshire SW Primary Care Trust (PCT).  This organisation will be accountable to the NHS Trust and will also commission and provide services.  Some ‘community’ services will move from the NHS trust to the PCT.  The Primary Care Groups have already acknowledged their commitment to working with voluntary agencies and this is implicit in the Health Improvement Programme. The role of service user involvement and evaluation is not mentioned by either agency.

The National Framework for Mental Health (Department of Health 1999) focuses on the mental health needs of working age adults. The framework does not include quality of life indicators.  Performance is to be measured against reducing suicide rates and the National Psychiatric Morbidity Survey. It acknowledges the social isolation and discrimination experienced by people with a mental illness.  Although implied, it is not explicit about people with mental health needs being encompassed within the Government’s Social Inclusion strategy.  This reflects the Government’s discourse around citizenship, where social exclusion is related to (paid) work, personal responsibility and a moral underclass identified by pathology, dependency and culture-induced poverty and depravity.  (Levitas, R 1998).  A spokesperson for the NAVB said that in discussions with the Home Office, new initiatives around ‘active citizenship’ were targeted at ‘easy’ groups: older people, young people.  People with disabilities or mental health problems were not mentioned.  The government policy in relation to mental health and social inclusion would seem to be muddled.  Future collaboration between the VB and the integrated mental health service will depend upon their willingness to give the service user more involvement and choice and allow the VB to work in a flexible way, across the boundaries in health and social care.

Conclusion

Though it can been seen that the VB is not enterprising in the commercial sense, there has been a lot of time spent in building networks and relationships which have been used to create opportunities for some innovative work.  The development of the model to encourage people with severe mental health needs to volunteer was driven by the VB – not the statutory sector.  In this sense, the VB acted as a social entrepreneur.  (Leadbeater, C. 1997).  The inter-agency mental health project has come from a bottom-up approach but is also integrated with the core work of the VB.  It is not offering specialist help, but attempts to make it easier for people with mental health needs to engage with a generic service.  In a new integrated mental health service it may be that the VB can use its trust relationships, informal partnerships and networking to facilitate better dialogue between Social Services and NHS personnel, similar to the work done by The Bromley by Bow Centre.  (The Sainsbury Centre for Mental Health 2000).  The NHS Trust may be interested in purchasing the project and duplicating the work around Lincolnshire.  Such a contract would offer more long-term security to the project, but anti-oppressive practice would be compromised if the Trust were interested only in outputs.  Nevertheless, it seems clear that for the present, the statutory sector needs us as much as we need them.

Self Assessment

My learning objectives were designed to help me prepare for a high-profile presentation and consider how I might continue to champion anti-oppressive work within the constraints of the integrated mental health service. I think I have met this aim and I have clear ideas about the content and emphasis of my contribution to the event.  Despite a number of requests to the PR Manager at the Community Mental Health Trust and the Health Improvement Facilitator, I have been unable to obtain information about the structure of the integrated mental health service in SW Lincolnshire (see appendix).  Neither have I been able to establish how the VB work was included in the HImP.

I was surprised to find that I have been working in a way that, in many respects, meets Leadbeater's definition of a social entrepreneur.  In my examination of the funding issues, I learned that a merger of local volunteer bureaux is a real possibility.  I would like to have looked in more depth at the role of Government and NLCB funding strategies that could bring this about and the dilemmas for local agencies and anti-oppressive practice.

I struggled with objectivity and keeping focused, partly because I have almost too much knowledge about the volunteer bureau and the ‘current developments’ impacting upon our work.  I used my module colleague to ask me some critical questions about the project and act as an interviewer in order to redress this.  The experience has demonstrated the value of obtaining an external evaluation of the VB work – something we have not done before. 

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References & Recommended Reading

Acheson, D (1998) Independent Inquiry into Inequalities in Health. Report.  London.  The Stationery Office.

Aves, G M  (1969) The Voluntary Worker in the Social Services.  London.  Allen & Unwin.

Bellairs, C (2000)  Mental Health: Client Inclusion and Volunteering Guidelines.  Evaluation Report available from Stamford Volunteer Bureau, Stamford, Lincolnshire.

Boateng, Paul (1999) Shared Visions in The Guardian Society Extra 2 June 1999. London. 

Brindle, David (2000) Mutual Friends article in The Guardian Society i5 November 2000.  London

Collinson, D (1994)  Strategies of Resistance: Power, Knowledge and Subjectivity in the Workplace cited in Thompson, N (1998)

Department of Health (1998) Modernising Mental Health Services: safe, sound and supportive.  London.  Department of Health.

Department of Health (1999) A National Service Framework for Mental Health  Executive Summary. London. Department of Health.

Handy, C (1988)  Understanding Voluntary Organisations.  London.  Penguin.

Hedley, R & Smith J D (1992) Volunteering and Society: Principles and Practice. London.  NCVO.

Leadbeater, C (1997) The Rise of the Social Entrepreneur.  London. Demos.

Levitas, R (1998) The Inclusive Society?  Social Exclusion and New Labour.  London.  Macmillan.

MIND  (1999)  Creating Accepting Communities: Report of the MIND Enquiry into Social Exclusion.  London. MIND. 

National Centre for Volunteering (1999) Volunteering and Social Exclusion: making the connections.  Policy Briefing 2.2 May 1999.  London.  National Centre for Volunteering.

National Lottery Charities Board (2000) Annual Report 1999-2000  London. National Lottery Charities Board.

Niyazi, F (1996)  A Route to Opportunity: Volunteering by People with Disabilities.  London.  National Centre for Volunteering.

Sainsbury Centre for Mental Health (2000)  Taking Your Partners.  London.  The Sainsbury Centre for Mental Health.

Scott, D, Alcock, P, Russell, L and Macmillan, R  (2000) Critical Issues for Voluntary Action online http://www.jrf.org.uk/ accessed on 13/11/2000  

Sheard, J (1992)  Volunteering and Society 1960-1990 in Hedley, R & Smith, J D (1992)

Stamford Volunteer Bureau Annual Report and Accounts 1999/2000 available from Stamford Volunteer Bureau, Stamford, Lincolnshire.

Thompson, N (1997)  Anti-Discriminatory Practice.  Basingstoke.  Macmillan.

Thompson, N (1998)  Promoting Equality.  Basingstoke.  Macmillan.

Trevillion, S  (1999)  Networking and Community Partnership.  Aldershot. Ashgate. 

Whelan, R (1999)  Involuntary Action.  London.  Institute of Economic Affairs.

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