Changing UK mental health systems for the better: Learning #3

blog | Words Nick Webb | 19 Jun 2023

Read our previous blog

In this fourth blog in a four-part series, Innovation Unit is delighted to share our learning about how to change the UK’s mental health systems for the better, based on our experience of supporting four sites throughout the groundbreaking Living Well UK programme.

[Read the Learning Report]

The central theme of our learning is the urgent need to evolve a new response to mental health. It is not a difficult task to find evidence of the mechanistic dominance (find out more here) and its failures. Stories of lived experience, like those in our Living Well publication Waiting for Something Better, shine a clarifying light on this reality; demonstrating deep failures in the timeliness, effectiveness, and indeed equality and fairness of support. 

In our previous blogs, we argued that in order to evolve a new response to mental health:

• We must create the context in which we can truly acknowledge the limiting nature of our current dominant mechanistic response 
• We must nurture local collaborative system leadership capacity that can hold the dynamic tensions at the heart of our systems in order to evolve more relational responses.

In the last of this blog series, we turn to our third key learning: we must guide our systems towards the possibilities of an enlarged response to mental health.

A narrow and limiting perspective

The mechanistic response reflects and embodies stigmatisation of mental ill health such as: 

• dominance of the medical view of the causes and treatments for mental health
• separation of mind and body, and; 
• failure to engage with the evidence of the impact of our social, cultural and structural contexts on our mental health.

Perhaps most damagingly, the mechanistic response binds us to an almost obsessive focus on the role of formal services in responding to the UK’s mental health challenges, failing to unlock the abundant potential of families, friends, neighbours, communities and community organisations.

An enlarged perspective on what impacts our mental health

Our Living Well sites revealed the possibility of evolving relational systems. They have started to shift the dominance of the idea that people’s mental health is not just a function of brain chemistry. It is also the result of a complex interplay of social, economic and environmental influences and conditions, including power, agency, identity, wealth and inequality. 

Our sites’ multidisciplinary teams are starting to work effectively with organisations including housing, welfare rights, employment, education and training. This work is in its infancy, but it demonstrates an alternative future possibility where our conception of a mental health system is expanded and resourced to support people to live well. This means helping people to have good housing, safe neighbourhoods, meaningful work, access to green space, to connect with and support others. All of this means stepping out of the current narrow focus on health.

An enlarged perspective on what a mental health system is

Living Well points to a future that shifts us away from the idea of mental health systems as arrangements of teams, services and pathways that deliver treatments for limited conditions. In this future world support happens in informal and incidental spaces through networks of relationships in informal and formal spaces: pubs, hairdressers, barbershops, cafes, supermarkets as well as in more organised initiatives such as support groups and food banks. All are equally valid and trusted.

In a genuinely relational future system, people and communities will exercise control and agency over how mental health is understood and how help is organised. Easy to access support will be everywhere – talking to a friend, a life coach, going to a peer support group, creating art, enjoying a mindful garden, going to your GP, and, yes, getting help from a mental health service. 

Many mental health practitioners would like to embrace and work with this wider view. But the mechanistic tools, protocols and mental models they are required to deploy don’t allow it:

I would love to develop a rich formulation of a person’s life story, but I don’t have time and I am expected to complete a clinically based checklist assessment form. 

As our 2020 research highlighted, what people often want is simple, practical help with everyday problems, compassionate conversations or words of encouragement and emotional support from friends and loved ones. Systems that help people in communities feel more confident and able to care for themselves and others, with a more distributed holding of distress, will help reduce the burden of care on the mental health workforce and so create more sustainable formal provision. This kind of preventative system will be better able to manage demand and cost within available budgets.

Final thoughts

Our sites have had to spend time and energy holding back the expectations of the mechanistic demands being placed on them in order to build new foundations for their visions of more relational ways of working. These foundations are promising, hopeful and already impactful. 

We must accept the depth of transformation they are undertaking takes time. The dominance of our mechanistic systems is entrenched in the structures and cultures of mental health.  But our Living Well sites have shown that with the courage to come together to collaborate, that the possibilities of a more relational approach are very real, very urgent and quite possible. Our Living Well sites, and other pioneering places like Lambeth and Trieste, have shown that a radically collaborative response to mental health is both possible and impactful. To delve further into what this takes, download the Living Well Handbook.

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From 2018-2022, Living Well UK supported ambitious places to radically transform how they operate as a whole mental health system, bringing together the voluntary, statutory, health and social care sectors, and centering lived experience – thanks to £3.4million of funding from The National Lottery Community Fund.

The programme is hosted and supported by Innovation Unit. If you would like to find out more about Living Well systems, and the kinds of support we can offer, please contact Nick Webb.

Join the conversation on Twitter with #LivingWell and tag @Innovation_Unit