The Future of SRV-Based Modelling
So what of the future of this style of thinking in stimulating models and gaining a better balance in overall services? The author believes many old models need refreshing to gain a better equilibrium.
Let us consider the perennial issues of people with serious mental illness (SMI) suffering preventable physical illness (mostly due to poor diet and lifestyle problems) and older people being isolated, as examples. A standard health response, which is partially successful, is to physically monitor people with SMI and refer to GPs whilst trying to encourage sports clubs and other activities. There is nothing wrong with these activities, but they are limited in effect. Just imagine being told you have an SMI in your youth and probably being signed off sick. Eighty-seven percent of people with SMI are unemployed and they are by far the most discriminated against group in the work arena. You might then be asked to attend a day hospital, and be given medications that stimulate your appetite and, sadly as a side effect, sometimes dull your motivation. You will not be allowed to drive and often, sadly, friendships and relationships may fracture too. With no real role and little hope, you may become more demotivated, without transport spending more time at home and possibly eating more take-away and convenience foods. It is a pattern many follow almost inevitably.
Now consider older people and isolation, depression and lack of supervision and activity. The biggest cause of admission to hospital with confusion, when audited before Home from Home, was dehydration. Again a standard response might be to refer the person to a voluntary agency for a lunch club or similar. Sadly, many of these social interventions have been subject to considerable reduction in the current austerity in public services. Even if available, is a free lunch what is needed? The elderly person may be grateful for something to relieve the isolation but may feel demeaned. Why would you give me charity? Am I worthy of that now? Can I do anything in return to preserve my pride and make me feel useful/needed?
The answer then may be completely non-traditional, if using SRV as the lens through which to look at these issues. Why not a community supermarket? Yes, a real supermarket selling all the things supermarkets do, but with a different emphasis. Where we all shop together, no food banks for the poor, or subsidised shops where only the poor or disadvantaged groups can be (ever stood in the free school dinners queue?). A supermarket where the profits from you and I are put back and subsidise people like those with SMI who have dietary problems, to help them gain healthy habits and use foods better. Where you can prescribe, as part of early interventions, a subsidised healthy diet and cooking skills. Better still, where older people at risk of isolation can come and share their best recipes with such young people and be engaged with helping them gain better understandings of diet. Those isolated people have then rightly earned a lunch and whilst we are here let's have a rollicking good sing-along too, you've earned it! Where the profits from the community's shopping are reinvested in the community and many other community functions take place, too, in a more social setting. And yes of course work, training, skills and education for vulnerable groups would be present too, but nobody would know who was who, who was subsidised and who was just passing through shopping. That, in a time of austerity particularly, when the message is clear that government doesn't wish to pay more for health, is the way to make services valuable to the public and remove the stigma of receiving them. It is the author's view that most people wouldn't mind paying more for health services. They just don't want to finance the huge and seemingly out-of-touch bureaucracy that creates all the stigma and separation in the first place.
So, thinking in terms of valued roles and really tackling problems, I do not wish my role to be a recipient of charity, or simply that of patient. I need to be more! Let's insist on the services that we offer to disadvantaged groups being what we might expect for a family member. Let's insist on the services being organised to offer people a sense of value, at very least not damaging what they already have.
Further, let's design things to consider how people as recipients will likely be seen by others. Victims? Of less importance? Harmless in need of charity? Potentially dangerous and in need of greater security? Unable to take any decisions for themselves?
Primum non nocere and let us have a revolution where the dimensions of spirit, pride, soul and the way people will be perceived by others are given a prominent place in all our designs of service, way beyond the dictates of simple functionality, or just a passing nod to aesthetic issues.