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Living Well UK has been working to transform systems of community mental health in places across the UK including Edinburgh, Salford and Tameside & Glossop. So far the programme has supported some 2,500 people who might not otherwise have been helped and generated over five million pounds of additional investment in local mental health systems.

Transforming a system is not an easy task. We know from our years of experience with Living Well sites - starting with our partnership with Lambeth in south London 10 years ago - that this is not a technical challenge, but instead a very complex, messy human one. When the ambition is to move towards radically different ways of understanding and supporting people’s mental health, we reveal the often invisible power of our imagination.

Our work with sites has aimed to both acknowledge the power of imagination and create the right conditions where it can be mobilised and focused towards revealing and building different systems of support for people’s mental health. With our pioneering places across the UK, we have deepened our learning about the impact and importance of our imagination.

“We cannot solve our problems with the same thinking we used when we created them.” Albert Einstein.

The influence our imagination has over how we both conceive our current and possible future mental health systems is well evidenced in both theory and practice; from psychotherapy, to sociology and to systems theory. Here are the key learnings we have taken into our approach to transformation. Our imagination is what we use to maintain how things are, as much as what we use to create new futures

The 20th century psychoanalyst Cornelius Castoriadis, recognised how our imagination is what we draw on it to “explain the world to ourselves”. We do this by creating mental models - what Castoriadis termed social imaginaries. These are social and collective models that we begin to learn and embed from an early age. We can understand these as short-cuts we use to navigate the vast complexity of the world. They help categorise and organise what we experience, helping us to quickly make sense of what we see so that we don’t feel constantly overwhelmed. Increasing evidence from neuroscience suggests that these mental models become hard-wired; our brains develop stronger and quicker neural pathways and links so that we can quickly make meaning of experiences. As well as being really helpful, these mental models also blinker us from seeing things we are trying to change.

Imagination is not just something personal to each of us, but something social and collective

According to leading academics, our imagination is “deeply cultural (1)” and specific to our community and context. This is because “the contents of our imagination utilise cultural resources”; imagination draws on existing ways in which a society understands itself - its images, stories, ideas and importantly its language.

Acknowledging this is really important, as it allows us to recognise how these shared cultural resources might be invisibly influencing the way we think about the future. We best make these cultural resources visible when we bring diverse people together in collaborative processes to both reflect on the existing system and design new systems. Our local collaboratives have been the key platform for us to do this; fostering the trust required to truly reflect collectively on the ways we imagine mental health and creating the safe spaces to explore alternatives. For example, in Salford we worked together to share personal stories that revealed common themes about how people understood their mental health and in Tameside & Glossop we used drawing processes to do the same.

One of the most powerful resources we can use to reveal our imagination is stories of lived experience. Listening to the stories of people with varied needs have helped our sites to acknowledge the limiting effect of seeing someone solely through a lens of their diagnosis, their ‘deficits’, or as a user that requires treatment or a service. Instead, these stories have helped reveal the untapped possibilities when we see those with poor mental health as a ‘person’ who exists in relationships with others and in a specific context. Revealing these mental models has enabled our sites to imagine and develop ways of organising support within and through ‘community’ and ‘place’, rather than solely inside the walls of a hospital or service.

We captured people’s stories of lived experience in our ‘Waiting for Something Better’ storybook - and we also captured professional’s responses to these stories in our second storybook 'Working for Something Better’.

Reflecting on how stories changed her perspective, Katie, a senior manager for a mental health trust said: “I particularly remember two staying with me. They were powerful. I was sceptical by the ethnographic stories … about romanticising mental health needs, I wanted to ensure they were focusing on serious needs … but I was bowled over. They really challenged what we thought was going on.”

The language we use is powerful in both maintaining the way we imagine mental health now and in helping us to imagine it differently

From ‘lunatic’, to ‘inmate’, to ‘patient’; the language of mental health systems has both shaped and been shaped by the ways in which we perceive mental health as a society. This is because our language activates those mental models that we collectively hold. We are unlikely to have a human and collaborative relationship with those people whose mental health we are supporting, if, for example, we continue to use the language of ‘front-line services’ (front-line coming from those soldiers closest to the enemy and service deriving from the Latin ‘Servitium’ meaning slave) and the mental model that it activates.

As simple as it might seem, creating a new shared language that represents our aspirations for mental health is transformational for systems. Acknowledging how current language maintains a deficit view of people with poor mental health as consumers of services, has helped our sites reveal the possibilities when we see them as co-producers who hold an abundance of potential for improving theirs and others’ mental health.

We have seen new language emerging in our sites to reflect this shift: sites now ‘introduce people’, rather than ‘refer a case’; they have ‘conversations’, rather than carry out ‘assessments’; they focus on ‘aspirations’, rather than solely on ‘needs’. Furthermore, it has led to places like Tameside & Glossop moving away from seeing specialist support as a destination to be referred to and instead seeing it as a resource to draw up and into communities. This has helped them to begin to reimagine the ways in which important specialist expertise in their system is differently distributed to ensure that it can be most effectively used.

When we acknowledge the hold our collective and dominant mental models have over what can be imagined and reach out to explore others, we expand our potential. Seeking out perspectives and ideas from the margins of our systems is the fuel to an imaginative power that has no limits.


(1) Imagination in Societal Development, Zittoun and Gillespie, LSE 2016.

A long read version of this blog where we further explore the power of imagination and delve deeper into the history of how our language in mental health has shaped our ability to imagine radically different ways of understanding and supporting mental health.

If you’d like to talk to us about Living Well, including developing a programme in your area, then please email and we’d be delighted to start a conversation. Living Well UK Programme is funded by The National Lottery Community Fund, the largest funder of community activity in the UK.

Over the past four years, we’ve been creating new systems of community mental health in Living Well sites across the UK including Edinburgh, Salford and Tameside and Glossop. So far the programme has supported some 2,500 people who might not otherwise have been helped and generated over five million pounds of additional investment in local mental health systems.

Inspired by a model developed by the Innovation Unit in partnership with Lambeth, South London, Living Well sites have been designing, testing and learning new ways to build different and better systems of support, thanks to funding from The National Lottery Community Fund, the largest funder of community activity in the UK.

Living Well supports people whose needs are too complex to be met in primary care (GP support) but are unlikely to be accepted for secondary care due to thresholds set in place to manage demand. Often these people fall through the gaps between various services.

Living Well sites offer people ‘a front door’ to multidisciplinary teams in easily accessed places so that people can move between different kinds of support.

Key to the approach is the development of caring communities around the person - family and friends, faith groups and other peer groups as well as local businesses which promote the well-being of residents.

What have we learned?

Living Well delivers four main areas of impact:

  • for citizens, particularly around realising self-set goals and improving quality of life

  • for professionals

  • for organisations

  • for systems

In this blog, we’ll be focusing on the benefits to citizens based on data from interim evaluations carried out by the Living Well evaluation partner, Cordis Bright.

Progress towards self-set goals

Living Well teams emphasise placing people in control of their support. After an introduction to a Living Well offer and an initial conversation to understand a person's needs, strengths and priorities, the person seeking support is encouraged to set their own recovery goals - for example around managing anxiety, improving self-esteem, more independent living, taking part in positive activities, etc.

In Edinburgh, 97% of people** who worked with the Living Well team during the interim evaluation period* made progress on at least one self-set recovery goal, and 66% made progress towards at least two goals. This is similar in Tameside and Glossop, where 90% of people had made progress on at least one personal goal, and 66% had made progress on at least two goals.

Quality of life

Most Living Well teams use ReQoL to measure improvements in quality of life for people with different mental health conditions. ReQol is an outcome measure co-produced with people with lived experience by the University of Sheffield based on a questionnaire covering such aspects of life as meaningful activity, belonging and relationships, choice, control and autonomy, hope, self-perception, well-being and physical health.

Broadly, an improvement in a ReQoL score indicates an improvement in mental health and life quality.

The majority of people accessing support from Living Well teams experience a sufficiently large increase in their ReQoL scores to indicate a meaningful improvement in their recovery and quality of life. According to available data:

  • 59% of people accessing Living Well support in Salford showed improvement

  • 55% of people in Edinburgh

  • 53% of people in Tameside and Glossop

Most Living Well teams also measure improvements in satisfaction across key life areas. Data shows a statistically significant increase in personal safety and satisfaction with relationships and family / number and quality of friendships among people who received support from the Living Well teams in Edinburgh, Tameside & Glossop and Salford. People also experienced a statistically significant increase in satisfaction with jobs/studies/meaningful occupation in Edinburgh and Tameside and Glossop.

We also know the difference that the Living Well support is making to people on the ground from the stories they share.

One of the people who accessed support from the Living Well team in Edinburgh said:

“I came to you a broken woman, very afraid to share my troubles with anyone, but with great help from my worker I was able to express myself… [it] has given me hope that this phase of my life has passed.”

How were these results achieved?

Understandably many elements contribute to the impact that Living Well achieves, but we think two are essential - and both place people at the heart of the change.

Innovation methodology that puts people at the centre

It was paramount from the start that we placed the people who we’re designing for at the heart of this transformation. We’ve involved people with lived experience in the design teams as well as in the collaborative leadership spaces, so that each place’s vision and service model has been meaningful and locally owned.

To this end, collecting and sharing stories of people with lived experience of poor mental health has been intrinsic to our innovation methodology. Stories helped us understand cohorts’ needs as well as highlighting strengths and resources of individuals and communities.

Some of the stories can be found in our first Story Book ‘Waiting for Something Better’.

Stories also helped colleagues from a variety of organisations and backgrounds to connect to the reason why we embarked on this transformation. This built a shared sense of purpose as well as helping to overcome differences of perspective.

Some of these stories can be found in our second Story Book ‘Working for Something Better’.

Finally, stories and direct feedback from people accessing the offers have been central to learning and evaluating the model and practice in the emerging Living Well teams.

As a result of this intense focus on people across all the phases of the Living Well project, those working in the new system are in touch with their values and better able to overcome institutional barriers to collaboration and culture change. The Living Well teams see the person rather than a patient and ensure that people are given choice and control over their recovery.

Holistic approach to mental health practice

Key to Living Well is an understanding that mental health cannot be addressed in isolation. Many of the stories of lived experience we heard emphasised the importance of social determinants of mental health, like secure housing, stable financial situation and meaningful occupation.

When accessing a Living Well offer, a person seeking support benefits from a multidisciplinary team including representatives from the voluntary sector who work together using a shared practice model. The person will most often be connected to a key worker who would draw in the expertise of the rest of the team as needed. This might entail psychosocial support from a mental health practitioner, housing support from a support worker or emotional support and exploration of relevant community assets with a peer worker.

Indeed many recovery goals that people set for themselves when they work with a Living Well team revolve around practical improvements to their life.

This holistic approach wouldn't be possible without the collaborative culture that underpins shared practice. Throughout the transformation, we paid special attention to power and to the creation of meaningful relationships all the way from leadership to the multidisciplinary teams themselves.

Challenges in impact measurement in a pandemic

What we’ve also learned is that impact measurement is not easy. For one, data collection mechanisms on the ground are hard to implement and require sustained attention; it takes time to collect, analyse and act on data. Poor data system alignment and a lack of savvy collection solutions mean practitioners are the primary data gatherers, which, despite best efforts, often leads to incomplete data sets. There are also cultural barriers to data collection, not least because of its connection to power dynamics, which can bring up some difficult emotions.

Additionally, COVID-19 has had a significant impact. As well as moving community based interventions to remote delivery it has also diminished opportunities for data collection, with heavy reliance on email communication, telephone and even post!

Finally, the pandemic, subsequent social distancing and lockdowns has affected people's perception of their quality of life as well as the breadth of interventions that could be offered. This has been compounded by staff shortages across the metal health systems. When combined, these factors have detracted from the positive impact of Living Well and the data on its impact.

What happens next?

We’re proud of our success so far and, as the Living Well systems mature, scale and develop, we will continue to return to these places to monitor impact, with plans for a full report next year.

We have opportunities to grow and scale our bold innovation since the Living Well model overlaps significantly with the ambitious NHSE framework for community mental health for adults and older adults.

As a result, we’re working with places in the UK, such as Derbyshire and Greater Manchester, to adopt and adapt Living Well as part of their local community mental health transformation.


If you’d like to talk to us about Living Well, including developing a programme in your area, then please email and we’d be delighted to start a conversation.

** of the people for whom we have collected data

*Data is not available for all people who have accessed Living Well offer. All impact data presented in this blog is based on interim evaluations by Cordis Bright.

Living Well Systems UK is a programme from Innovation Unit whose 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.

Over the past four years, we’ve been creating new systems of community mental health in Living Well sites across the UK - and now we want to share our learning about how our partners have transformed systems for the benefit of thousands of people.

In a series of blogs we’ll bring to life what we’ve learned from Living Well UK so we can develop and extend a national dialogue around the UK’s mental health systems and what it might take to transform them.

In this, our first blog, we’ll highlight what you can look forward to reading over the next few months.

Our story is human, messy and complex.

Inspired by a model developed by the Innovation Unit in partnership with Lambeth, South London, Living Well sites have been designing, testing and learning new ways to build different and better systems of support, thanks to funding from The National Lottery Community Fund.

Together our partners in mental health trusts, voluntary and community services, local authorities and - most importantly - people with lived experience of mental health, have shared an ambition to transform systems, not simply improve them so they realise greater impact in people’s lives.

Our ambition is challenging. Why? Because mental health systems are complex. Unlike a complicated machine that is made up of predictable and visible parts that we can control and manipulate to increase the impact they produce, mental health systems are made up of people. It’s their relationships which create the impact.

Transforming such a complex system becomes a dynamic and fragile process, easily foiled. Yet change is both possible and rewarding. And so, as we enter our fourth year, we want to share the insight, unearthed by the people and places working to “unstick” systems and imagine new possibilities.

Our blog series will unpack the how of system transformation, grounded in stories of people making real change, people with lived experience of receiving and providing support for mental health; be they peer support workers, voluntary sector practitioners or commissioners. From imagination, to power, practice, outcomes, complex leadership, failure, and meaning making: the story we are telling is human, messy and complex.

What we’ll be sharing

  1. In our first blog of the series, we will examine some of the emerging impact that our pioneering Living Well sites are having on people’s lives and share analysis of what we have learnt about how this has happened.

  2. We will go on to explore imagination: what it is, how it is as much a resource for change as it is for maintaining things as they are, and how when collectively mobilised it can “unstick” inhibitive ways of thinking and doing.

  3. We go on to explore the human experience of transformation, recognising that systems are people and relationships, and change is hard.

  4. We will talk about co-production, and what it means to share power, reconfigure permission and autonomy, and democratise systems to hold them to account.

  5. We will explore why practice and prototyping is at the heart of Living Well systems. That innovation is a system that continues to test, learn and evolve to the needs of people.

  6. We will ask the question: how do we really know we are getting it right? We will explore outcomes, measurement and quality and who gets to decide how a system is performing

  7. We will unpack leadership and governance of complex change, and how to build capacity for adaptive leadership and greater distributed ownership

  8. We will examine failure; surfacing the dominant mindsets that lead to risk averse ways of working and exploring what it might mean to create cultures and processes that ensure we draw on failure as a resource for learning and development..

  9. In our final blog of the series, we explore public narrative, storytelling & meaning making; the why of the change. How might communities own the what and the how of transformation, and bring people together to make sense of what's going on?

This is a ‘living’ programme, where an increasing number of people and places across the UK are being inspired and influenced by Living Well ideas and ways of working. At Living Well UK, we are here to help support this growing movement. So, please follow this blog series and share the ideas, questions and challenges it raises in your local places and organisations. If they resonate with you, reach out and contact us to help you turn these conversations into action -

Watch this space for the chance to register your interest in joining our National Collaborative event in Spring 2022.


Living Well Systems UK is a programme from Innovation Unit whose 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.

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