Transforming adult community mental health

Partners

Salford CCG, Tameside & Glossop CCG, Edinburgh Health & Social Care Partnership & Luton CCG – funded by National Lottery Community Fund – through the Living Well UK Programme

Bolton CCG & partners, Oldham CCG & partners, Heywood, Middleton & Rochdale CCG & partners – funded by Greater Manchester Health & Social Care Partnership.

Derbyshire Healthcare NHS Foundation Trust & system partners – funded by Derby & Derbyshire CCG.

The need

Poor mental health affects millions of individuals and their families in many different ways: worse physical health, lost income, lower educational attainment, poor quality of life, poor access to other services and for many a much shorter life span.

Despite many brilliant practitioners working in adult community mental health in the UK, too many people don’t get help when and where they need it.

Demand for community mental health services outstrips supply, and so entry has been restricted to only those with the most complex needs.

Services are often highly medicalised and not designed to deal with the whole person’s context, which can include money worries, caring for others, housing, work, adverse childhood experiences and social isolation.

‘Frontline’ professionals often spend more time assessing, referring and signposting than actually supporting people. Staff lack permission to practice in a way that unlocks their talent and creativity or that best meets people’s needs.

The aims

• Significantly improve mental health outcomes for people who need help, including those with severe mental illness.
• Widen access to holistic, preventative and person-centred care and support through new models of multidisciplinary team working.
• Develop system leadership and collaboration between different organisations by bringing leaders together to develop shared purpose.
• Give people confidence to take risks, imagine and test new possibilities by offering up new solutions with evidence of impact from elsewhere.
• Scale new solutions across the NHS, including to help transform care in England as described in the NHS Community Mental Health Framework for Adults and Older Adults.
• Create a national movement for new models of community-based mental health services that influences national policy and service provision by showcasing the work and sharing learning.

The approach

We bring deep learning and expertise in transforming community mental health from our work – starting in 2010/11 – with ambitious leaders in Lambeth, south London, who wanted to ‘turn the system on its head’ and start to redistribute resources away from reactive treatment in secondary care and towards prevention in primary care.

They co-designed the ‘Living Well Network Hub’, which acted as the “front door” to mental health services, delivered by a multidisciplinary team from primary and secondary care and the voluntary sector. The Hub was an open access offer, with no thresholds or eligibility criteria, to help people experiencing mental distress.

Through the Living Well UK programme (2018-2022), funded by the National Lottery Community Fund, we have been able to support a growing number of local systems (ICSs in England, NHS Boards in Scotland) to adapt and adopt Lambeth’s approach to transformation. We support local leaders to co-design multidisciplinary, neighbourhood-based Living Well teams, alongside work to help them redesign integrated, specialist Community Mental Health Teams in secondary care. Our approach embraces:

• Co-design and co-production – ensuring that system change is built out of the voice of lived experience. We do this by facilitating Living Well Design Teams – groups that enable citizens and professionals to co-design new solutions.
• Story gathering and storytelling – reconnecting practitioners and leaders emotionally to why they work in mental health in the first place. We do this by providing training in ethnography, and by facilitating group storytelling and insight generation sessions.
• Prototyping (rather than ‘piloting’) – enabling fast-paced testing, learning and service development, and to avoid ‘right’ and ‘wrong’ thinking in complex systems where there is often no easy answer. We do this by facilitating ‘Prototyping Labs’.
• Developing and nurturing practice leadership – blending the best of clinical and social models and to recognise that real transformation happens in the work between professionals and between them and people using services. We do this by supporting Team Leaders to grow their practice leadership and by hosting Living Well Communities of Practice.
• Movement building – enabling citizens and professionals to work side by side and non-hierarchically. We do this by facilitating Living Well Collaboratives – non-hierarchical groups that enable citizens and professionals to work side by side to jointly craft visions for change and develop new ideas.
• Developing collaborative leadership across organisations and sectors – creating leadership communities based on dialogue and relationships. We do this through one to one leadership coaching, group leadership development and by facilitating cross-system leadership forums.

Impact

Through the Living Well UK programme:

• +£5M of new investment in mental health systems has been unlocked.
• +2,500 people have already been supported, many of whom would not have previously received help.
• The majority of service users report meaningful improvements in their mental wellbeing, recovery and quality of life (interim external evaluation data).