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
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