How do you transform a complex mental health system? Let’s look at the power of imagination

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.

The long read is available here.


If you’d like to talk to us about Living Well, including developing a programme in your area, then please email lwuk@innovationunit.org 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.





Living Well Logo