- UK CASE STUDY -
What is it?
Lambeth Living Well is a whole-system approach to commissioning, developing and providing services which has has
co-production at its heart. The support provided helps those with mental health problems to recover and stay well, make their own choices and participate on an equal footing in society.
The Lambeth Living Well Collaborative is at the centre of the system. This coalition of local stakeholders (service users, carers, voluntary sector providers, primary care, social care, commissioners and secondary care) first came together in 2010 in order to start driving change. They wanted a new mental health system that could: shift investment from secondary to primary and community care; make it much easier for people to get help where and when they need it; focus on people’s assets and strengths; and blend medical/clinical support with social offers that address the wider determinants of ill health.
Living Well system features:
How does it work?
Three key initiatives come together to deliver the Lambeth Living Well support offer:
THE LIVING WELL NETWORK HUB is the “front door”: a single point of access to mental health services delivered by three multidisciplinary teams. The Hub provides integrated support that bridges the gap between primary/secondary care and works
preventatively to reduce pressure on secondary care.
Four core principles define the support
provided by the Hub:
Introduction led: anyone can introduce a person needing support, including the person themselves. There are no referrals or ‘handoffs’ between organisations.
Social and medical: different providers work as one team. The multidisciplinary team understands and respond to mental distress in context. They address it by combining social and medical solutions, recognising the importance of social networks and relationships. Clinical interventions are important but not the default option.
Conversational assessment: a asset-based, conversational approach is used to understand the person, their needs, wants and aspirations. The focus is on building strengths and assets, working systemically so as to support recovery, reablement and wellbeing.
Easy in, easy out: there is easier access to reablement, to preventative support below thresholds, and quicker access to secondary services when needed. There are also clearer pathways back to primary / community and no one is discharged from the network.
THE LIVING WELL NETWORK is a collaboration between commissioners, hospitals, local authority and voluntary sector, community providers and people. Together they help citizens of Lambeth live well by delivering a placed-based local offer to resolve the problems that trigger mental ill health, including housing, employment, debt, benefits and isolation. A shared practice model underpins all interactions within services in the Network.
THE INTEGRATED PERSONALISED SUPPORT ALLIANCE (IPSA) is an integrated care model that helps people with complex, long term mental health needs to move out of in-patient rehabilitation wards into alternative community placements and independence. Primary and secondary care clinicians are co-located and work side by side with voluntary sector staff and volunteers in multidisciplinary teams. There is a shared culture and joint approach to risk management, decision making and accountability.
The difference it makes
"The Living Well Network Hub did in two weeks what others had been trying to do for two-and-a-half years."
- Bill, service user
From the evaluation
A 25% reduction in referrals to secondary care mental health teams and a 27% reduction in secondary care caseloads since its introduction
A Hub evaluation dated September 2017 found:
Reduced waiting times for support at the front door - from within one month to within one week
A reduction in the average (mean) cost of support per person. The average (mean) cost per person introduced to the Hub was £76. Making
comparisons with nationally published costs, this suggests that for many people the Hub is likely to offer a relatively lower cost (and high volume) alternative for support
An increase in the number of people receiving support: 500 people were supported by the Hub each month, whereas
previously only those eligible
for input from secondary care would have received help
An increase in the number of people who were able to access mental health support in primary care. In its third year of operation the Hub supported 6388 people (against its original target of 1500)
An increase in the number of people who self-introduced from 4% in year one to 11% in year three
16% of service users in complex care placements were supported on a pathway to work (2+ hours)
19% of people in placements were supported to use a personal budget to improve their wellbeing