Transforming adult community mental health services and support

A great example of this work is our Living Well UK programme (2018-22), which successfully helped four pioneering places overcome the failure of the UK’s mental health systems to respond effectively to need. Funded by The National Lottery Community Fund, the programme has created new relational systems of community mental health support in Edinburgh, Luton, Salford, and Tameside & Glossop, inspired by a model developed in Lambeth, South London. 

Our Living Well teams are now helping local systems to more effectively tackle health inequalities and unmet needs for 10,000s of adults with mental health difficulties.

The programme was a direct response to the fact that across the UK, too many working age adults with poor mental health don’t get the help they need at the right time. They ‘bounce around’ mental health systems because they are seen as ‘too complex’ for primary care and ‘not unwell enough’ for secondary care. Many face long waiting lists, or receive treatment that helps mask symptoms but fails to address the underlying reasons for their distress.

Living Well systems put people’s strengths and lived experience at the centre and help people recover and stay well as part of their community. No thresholds, no eligibility criteria, no long waiting lists. Instead, quick access to holistic, person centred care that sees the whole person.

Since 2018 the movement has grown, and so far Innovation Unit has supported Joined Up Care Derbyshire, Greater Manchester Integrated Care Partnership and York’s Connecting our City Partnership to adapt and adopt Living Well systems. 

What we did

Innovation Unit’s mission is to grow and scale the boldest and best innovations that deliver long-term impact for people, address persistent inequalities, and transform the systems that surround them. To achieve these goals, we applied our innovation and impact formula to help our sites generate insights about people’s lives, then use this new knowledge to co-design and test new multidisciplinary teams, implement them successfully, and, finally, scale (extend and grow) them across whole places. 

Using adopt and adapt methodology we helped sites to adopt the critical success factors and key features of Lambeth’s original approach, while allowing adaptation to respond as required to fit with local context.

We helped to build the right environment for collaborative system leadership, initially through the establishment of Living Well Collaboratives, Design Teams and Prototyping Teams, and later via Living Well Governance groups. Collaboratives are non-hierarchical spaces where people with lived experience, carers, staff, managers and leaders (from NHS, local authority and the voluntary sector) come together to co-produce a bold vision for change, build a sense of shared purpose, craft person-centred outcomes, and overcome shared challenges with openness, trust and honesty.

Building a pathway
to a better future

Living Well has helped our sites move towards more relational systems, where practitioners see themselves in relationship to the whole system (not just their own organisation) and seek to embrace the full complexity of people’s lives (not just their clinical diagnosis), including how their personal, social and economic circumstances affect their mental health.

Living Well has demonstrated the potential of bringing people together, in order to begin to see themselves as a mental health system, and to foster collaborative relationships at every level. 

Reduced waiting times

• In Living Well systems average waiting times to get help are 14-25 days (nationally nearly a quarter of people wait more than 12 weeks to start treatment with standard services).

Progress towards life goals 

• Living Well systems help people to recover, and empowers them to make improvements in their lives – such as returning to work, or improving their housing situation. On average, Living Well participants make progress towards 3 – 3.5 life goals they set for themselves.
• There is evidence that people feel more connected and have positive relationships. In Tameside and Glossop, evaluators found a statistically significant increase in people reporting that they have a close friend (from 66% up to 81%) while the share of people participating in leisure or community activities nearly doubled from 26% to 48%.

Improved quality of life 

• The evaluation shows how 60% of people experienced meaningful improvement in their health and quality of life.

A cost-effective service

• The financial cost of achieving this improvement is well below the recommended cost ceiling NICE uses to judge cost effectiveness of interventions.

• Living Well has helped save money in other parts of local systems: in Edinburgh, of the 300 people the team initially worked with, just six were referred to formal therapy.

The multidisciplinary teams that our sites have created 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 by helping them to have good housing, safe neighbourhoods, meaningful work, access to green space, to connect with and support others.

Building a credible pathway to preventative public services for the future – that help families to thrive, help people to stay well, or stay out of prison, or remain in their own home – is hard. It requires cultural and structural change on many fronts: from what is measured, to how decisions are made and to where money goes. 

To learn more about our approach – and to talk to our partners about what working with us is really like – please get in touch with Nick Webb

We’d be delighted to connect you to the people we have helped to make a difference.

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