Three lessons from transforming mental health in Lambeth
Authored by The Collaborative. Dr Adrian McLachlan is chair of the NHS Lambeth CCG, Denis O’Rourke is assistant director of integrated commissioning (mental health) at NHS Lambeth CCG and Lambeth Council, Aisling Duffy is chief executive of Certitude, and Dr Soumitra Burman-Roy is consultant psychiatrist at the Living Well Network Hub
In Lambeth we realised a few years ago that despite the big efforts and money we were putting into mental healthcare – particularly acute care – we weren’t getting great health outcomes.
The number of local people with severe mental illness remained among the highest in London. In addition, local people were experiencing difficulties with poor housing and limited employment opportunities, which were impacting on our ability to support people to get on with their lives.
We saw the need to drive fundamental change. We reframed the conversation around mental health. We started to talk to – and engage with – those who used our services as ‘people with skills and assets’, rather than ‘cases’ or ‘patients with a diagnosis’.
We created a new framework of outcomes that looked beyond the clinical results to one which focused on people holistically, supporting people to regain hope, connections and get on with living their lives. We also built strong collaborative relationships with those involved in supporting local people with mental health issues.
This work to date has brought better outcomes – supporting up to 400 people a month, well before they reach crisis point, and a 43 per cent reduction in referrals to secondary care which has led to a reduction in waiting times.
We are still a long way from where we want to be, but feel we’ve learned some important lessons along the way which may help others looking to drive transformational change – in mental health and beyond.
Building collaborative relationships trumps everything – and unsurprisingly, it isn’t achieved easily. Collaboration requires a big investment of time, trust, and letting go of old ways.
Even more difficult, it requires all parties to put to one side the short term interests of their organisation, provide strong leadership and have tough conversations.
Investing in strong relationships is the single most important thing that’s led to our bold, new plan (the Living Well Network Alliance) in Lambeth – to bring all spending for adult mental health under one contractual alliance agreement worth £600m over 10 years.
As commissioners, we’ve had to learn to step back, enabling others to step up and refocus our energies in helping to foster effective collaboration.
The whole system is not just the NHS and local government – the voluntary and community sector, housing and employment agencies and communities are just as important – too often teams work together but with little understanding of each other’s skills and assets.
Through the Lambeth Living Well Network Hub we’ve proved that bringing teams and people from all parts of the system together to achieve agreed outcomes increases connections, releases previously untapped talents and leads to more effective solutions.
In 2015, we managed to expand the Hub with support from Guy’s and St Thomas’ Charity, but we still have some way to go. Integrating our work with services which are also a lifeline for our users – like addiction services – is something we are working towards, so too is connecting better with our new Local Care Networks.
We are a long way from ‘transformation’ – as a sector, we are some way off the level of breakthrough needed.
For a long time in Lambeth, we kept our promising new ways of working relatively under the radar. Instead, we piloted interventions and took one step at a time. This allowed us to move in a more agile and connected way. However, it will take applying a relentless approach to innovation, co-design, prototyping and seizing the many digital opportunities on offer, to make deep, sustainable and scalable transformation in mental health a reality.
Our proposed whole system Living Well Network Alliance will take us nearer our ultimate goal of radically transforming the outcomes of people with mental health problems.
This is an abridged version of an article originally published in The MJ. Read the full article here.
The Collaborative spoke at Nesta's The Future of People Powered Health 2017 in partnership with Guy's and St Thomas' Charity on May 9.
The Collaborative reflected on the work in Lambeth that has transformed mental health over the last 5+ years, supported by Nesta through the People Powered Health programme and Guy’s and St Thomas’ Charity.