How do you transform a complex mental health system? Let's look at what we are learning

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 lwuk@innovationunit.org 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.



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