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.