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Demands on our mental health system have been increasing for decades with people falling through the gap between primary and secondary care. Too many fail to find the support they need with their GPs only to discover that specialist secondary care is not available to them.

COVID has made the situation worse, shining a light on existing known failures - both for people wanting to access the system and for professionals delivering support.

Yet the pandemic has also shown us that when we have no choice but to meet people’s immediate and urgent needs, this can further drive our collective imagination to transform the ‘ways we’ve always done things’.

Importantly, for some practitioners, COVID has renewed their motivation for choosing mental health as a profession and galvanised them to radically reconsider what we need to keep, adapt, create and discard.

At Innovation Unit (IU), we know that long-lasting change requires time to think and design, try out and learn. We also know that people need to be at the heart of that change - both the people who benefit from mental health support and the people who design and deliver that support.

Through IU’s Living Well UK programme, funded by the National Lottery Community Fund, we’ve been co-producing new systems of mental health support with partners across the UK for the past four years. Inspired by the Living Well Collaborative in Lambeth, South London set up 10 years ago, we’ve been ‘adopting and adapting’ the Living Well model to meet the different needs of each new Living Well site.

Although each site is its own adaptation of Living Well, each is built around people’s lived experiences. From the start, staff and service users work in a supportive partnership to design and deliver services with the benefit and support of IU’s years of innovation knowledge and expertise.

We’ve captured these lived experiences in two storybooks, one focused on people who use mental health services, the other on practitioners.

Storybook One: Waiting for Something Better

Our first storybook: ‘Waiting for Something Better’ from October 2020, was co-authored with seven people experiencing trauma, sexual and physical abuse, poverty, homelessness, discrimination and other forms of adversity.

Although from a range of ages, family backgrounds and circumstances, the stories reveal common themes around the need to recognise and respond to each person’s interwoven experiences rather than diagnosing on single issues, and the need to offer support or treatment which matches each person’s ability to access what’s offered.

We heard time and again from people that, when seeking help, they rarely got to be truly heard. Instead they were expected to repeat their stories to different practitioners over several assessments which were then reduced to a disconnected list of problems.

We shared these lived experience stories with voluntary and public sector representatives from the Living Well sites at a learning event in May 2019. The impact was powerful. Hearing the voices of service users challenge the dominance of the professional voices helped our practitioners understand the importance of their efforts and reconnect them with why they’d chosen their profession.

As Judd, Commissioner in Salford told us:

“I think when the ethnographic stories started coming in ... I think that really started to make it very real, … we started to really see and hear not only the points in people's lives where there had been some sort of support intervention where things could have been different - but the strengths people have and the assets people have, and the lives they lead and the things they've dealt with that haven't derailed them!”


Storybook Two: Working for Something Better

Building on the power of connection, we’ve been listening and gathering stories of people designing, testing and leading Living Well systems in our soon-to-be-released storybook: ‘Working for Something Better’.

Created at a time of COVID, the storybook captures the humanity in mental health practitioners, reminding us - and them - that the people who work in the system have their own fears, hopes and dreams.

Our practitioners play a hugely influential role determining and shaping our services. Just as the stories of the people they support have amplified their initial passion, reflecting on their own lived experience - and that of their colleagues - has strengthened their motivation to change the system.

For Pat, Transformation Lead in Tameside & Glossop, her early career as an occupational therapist, with its hands-on and practical approach, ignited her passion “to make a difference, to do more … to shift resources to those who needed them… I feel blessed to have worked with people who are really struggling with their mental health – talk about the golden nuggets that you get … that you would never, never normally hear. Being able to talk to people about their experience - why don’t I do it more – what’s stopping us doing that?”

For Donna who set up peer support charity, The Anthony Seddon Fund (ASF) in Tameside after her son took his own life. “The people who are delivering services might [for example] have a mother with dementia, or a child with poor mental health. … A vast majority of people working in these services are doing it for their own reasons. ... I love this and I love being able to share that with people.”

Wendy, Chief Executive of Health in Mind in Edinburgh, told us about her early work in the voluntary sector: “During this time I learnt about the power of a shared ambition. … I really loved the freedom of working with people as a whole.

“Covid has taught us that change can happen quickly if we’re all working in the same direction. If push comes to shove we can make these major changes together.”

Transformation as human experience, not strategic intent

We know from stories and our wider work in Living Well that the process and experience of transformation is rarely easy or straightforward - it’s a deeply human experience, messy and complex, one that moves between hope and despair, confidence and doubt, safety and risk, joy and distress, harmony and conflict.

We also know that transformation is a near constant process of renewing energy, hope and commitment against a backdrop of often inhibitive ways of thinking and working - for example, the divisive way in which clinical and social approaches to mental health are held apart, rather than as complementary, or the way that specialist secondary care is not available for everybody.

The Living Well process we use to support our sites aims to carefully hold and encourage people through the often challenging experience of questioning traditional ways of thinking and doing - and so promoting the need for new kinds of leadership and new ways of working.

Our approach to transformation is therefore highly person-centric, captured in a six-stage process:

  • Reconnecting practitioners and leaders emotionally through the art of ethnographic story gathering and telling

  • Enabling a non-hierarchical working environment to craft visions for change and develop new ideas

  • Developing collaborative leadership across organisations and sectors through one-to-one coaching, leadership development and cross-system leadership forums

  • Ensuring system change is co-designed and co-produced, built out of the voice of lived experience enabled by collaborative spaces

  • Using prototyping labs to encourage fast-paced testing, learning and service development enabling managed risk taking

  • Developing and nurturing practice leadership, enabling recognition that transformation happens between professionals and between them and people using services

We’ll be exploring the ‘how’ of system transformation against elements of these six stages in a series of blogs starting this autumn where you can expect to read more stories from people making real change.

We’re also creating our third and final storybook which will focus once again on the people who need support - this time we’ll look at the stories of people benefitting from Living Well systems. Their stories will help us test the extent to which Living Well services are making a difference. Early evaluation data suggests that for the majority they certainly do.


In the meantime, keep an eye out for the official launch of ‘Working for Something Better’. We’d love to hear what you think.

How transforming Edinburgh’s mental health system meant leaders needed to change first

At Living Well UK, we know that reviewing structures and processes is not enough to transform mental health systems. Deep and sustained change can only come after people challenge their own beliefs, status and values to unlock more effective ways of working. As an innovation coach with the city’s Thrive Edinburgh programme, it was my role to support teams, especially senior colleagues, in ways that help them make these hard. sometimes uncomfortable, changes. Living Well’s approach in five sites, including Edinburgh, is to help practitioners and service users create new ways of accessing mental health support - where the person who needs help is placed at the centre of a network of relevant agencies and organisations. As you can imagine, turning the current system on its head to bring co-ordinated support to the person rather than leaving them to navigate routes on their own, means a significant shift in relationships across complex structures in the statutory and voluntary sectors - and that’s why the role of leaders is so important. In Edinburgh, there are four Thrive Welcome Teams made up of people from a range of services, backgrounds and expertise including peer workers, support workers, nurses, social workers and occupational therapists. These teams act as a ‘front door’ to all integrated support for mental health. I joined Edinburgh as the teams, located in different parts of the city, were ready to start prototyping the Thrive Welcome Team model which had been developed through an extensive, collaborative, co-design process, involving the voluntary and public sector, people with lived experience, and carers. Prototyping is part of the discipline of innovation, where we ‘learn by doing’ – trying out what has been designed, reflecting on what’s working and what’s not, testing new ideas, and adapting the model through an iterative process. My innovation coach role is to provide support and challenge to the individuals and teams doing the work of adopting and adapting ‘on the ground’ - especially helping leaders to focus on the ‘how’ more than the ‘what’ and to stay true to their vision and the change they want to see. In my experience, change is always challenging - it requires us to be honest and vulnerable, and involves loss as we let go of old habits in service of new ways of working in new contexts. Edinburgh’s ambitious strategic and systemic change was made so much harder by the demands and constraints of the Covid-19 pandemic. That’s why we applied a bespoke ‘adaptive leadership’ approach - “the practice of mobilising people to tackle tough challenges and thrive”, according to Professor Ron Heifetz, senior lecturer in public leadership at Harvard University. This bespoke leadership programme drew on Heifetz’ work, exploring the challenges and rewards of leading complex change, including the art of ‘getting on the balcony’ - the mental activity of stepping back from the action and asking, “What’s really going on here?”. Adaptive leadership requires learning the art of alternating between being an observer and participant, diagnosing in the midst of change, and creating a ‘holding environment’ which helps people to tolerate the distress inherent in the process. Through the work, I saw for myself how conflict can serve as an engine of progress, releasing energy and driving change. This is not easy work for leaders to do, but it is vital: to keep observing and noticing in order to monitor and regulate the ‘heat’ and distress of change for people in your teams, at a productive level, so that they feel energised and challenged, but not overwhelmed. My coaching role on this project is over, but the Living Well UK national programme, funded by The National Lottery Community Fund, continues for another year, with ongoing practice development work as well as an external evaluation by Cordis Bright. As I live in Edinburgh and am now more able to get out and about (mask-at-the-ready), I am looking forward to seeing for myself the progress made in delivering services that allow the citizens of Edinburgh to get the mental health help and support they need.

Author: Siobhan Edwards


This work has been made possible thanks to funding from the National Lottery Community Fund.

We would love to hear your thoughts / @lwuksystems

Our latest Living Well UK learning event this month brought together the brilliant people who have been working with us for three years in a joint endeavour to imagine and create new Living Well systems for better mental health.

Living Well UK learning events are a chance to step outside of daily work and Covid pressures. They give people much needed space to question, learn, grow together and imagine new possibilities.

We were joined by ambitious change makers in Derbyshire, Edinburgh, Luton, Oldham, Salford and Tameside & Glossop, all of whom are working incredibly hard to transform adult community mental health support. Thanks to their effort and enthusiasm, more and more people are now finding it easier to get person centred, holistic help where and when they need it. Fantastic.

We focused our learning event on how our collective relationships to our mental health systems can hold us back.

Together, we asked:

“How can we maintain the energy and commitment required to realise the change we have started?”

“Why do people seem to both commit to change whilst resisting it?”

“Why do some parts of our systems seem to remain stuck?”

We looked at case studies from around the world where inspiring leaders had reframed and reimagined long standing problems - from ‘half houses’ in Chile, to a school without walls in Brazil, to reducing violent youth crime in Glasgow. In these examples people freed themselves from unhelpful mental models that had kept systems “stuck” in old patterns and ways of responding to complex challenges. In doing so they focused their collective capacity for imagination in the service of the new and the possible, rather than in maintaining the old. Results for local communities were life changing, as they are starting to be for Living Well practitioners and the people benefiting from new kinds of help.

Through conversation and dialogue, we surfaced two key learnings

  1. Transformation requires deep imagination, and currently imagination is in the service of holding up fragile systems. For example, we talked about the understandable desire many professionals have to “protect my colleagues and our part of the system”, and how this only serves to maintain fragmented and fragile relationships across organisations and sectors.

  2. "A focus on the "how" not just the "what", unlocks transformation. For example, we looked at how the Living Well emphasis on collective learning and testing through co-design and prototyping (rather than top-down prescription and ‘piloting’), helps avoid ‘right’ and ‘wrong’ thinking in a complex system where there is often no easy answer (which is certainly true in adult mental health, where professionals have struggled for decades to improve outcomes for people with severe mental illness).

We know from our wider work in adopting and adapting proven innovations in health, education and social care, that offering up core elements of a new solution helps inspire and energise people to apply their imagination to the new and de-risk it (other people have done this, so we can too!). This is true of Living Well, and our pioneers took real courage from connecting to colleagues in Lambeth, south London, where the Living Well concept was originally born.

As we enter the fourth and final year of the Living Well UK programme, we’ll be exploring and unpacking our top learnings in a series of blogs over the summer and autumn of 2021. Crucially, we will share insights on how to “unstick” inhibitive ways of thinking and doing that hold us back, and how to enable people to embrace new possibilities that are so critical for imagining and building different and better systems.


This work has been made possible thanks to funding from the National Lottery Community Fund.

We would love to hear your thoughts / @lwuksystems

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