Creating a new landscape for mental health - with
co-production at its heart
Adult mental health
With Lambeth Clinical Commissioning Group & Lambeth Council, London, UK
Over the last 10 years Lambeth has been radically transforming mental health services, driven by a shared goal to help everyone who is experiencing mental health difficulties to recover, stay well, make their own choices and participate on an equal footing in everyday life.
Led from the start by a small but determined collaborative of commissioners, providers and people with lived experience, Lambeth has:
- Crafted and kept alive a compelling vision for the whole of adult mental health provision – that “every citizen, whatever their abilities or disabilities, can flourish, contribute to society and lead the life they want to lead”
- Defined a set of system-level outcomes for all service users
- Co-produced a set of cutting-edge services that are helping many more people get help when they need it in primary and community settings
- Moved to an alliance model of commissioning that is driving collaboration among providers and integration of services
- Used innovation, service design and system change to manage significant budget pressure.
Lambeth’s story has important learning for commissioners and providers who want to reduce cost and activity in secondary care, and, in line the Five Year Forward View, put early intervention, prevention and co-production “at the heart of commissioning and service design.”
average waiting time to get help and support on mental health, with high thresholds and eligibility criteria stopping people getting help until they were very unwell.
Up to 3/4
of referrals into secondary care could have been managed in primary and community settings.
Support available not helping with practical and social problems affecting mental health (housing, debt, social exclusion).
Service users telling their story many times because of fragmented care, repeated referrals and handoffs.
The Lambeth Living Well Collaborative is a coalition of local stakeholders (service users, carers, voluntary sector providers, primary care, social care, commissioners and secondary care), who first came together in 2010 to start to drive change in the mental health system. They recognised the existence of long-standing challenges that weren’t being addressed by ‘business as usual’: poor service user experience and disjointed care pathways, secondary care services struggling with high caseloads, over capacity in hospital wards and reducing budgets.
They wanted a new system that could shift investment from secondary to primary and community care, make it a lot easier for people to get help where and when they need it, focus on people’s assets and strengths and blend medical/clinical support with social offers that address the wider determinants of ill health.
The Collaborative has:
- Provided legitimacy and authority for change
- Supported co-production at the heart of the change process, and encouraged professionals, service users and carers to work with, not against each other.
- Maintained energy for change among local stakeholders and kept things going when momentum has slowed.
- Held each other to account in achieving the vision.
- Provided a blueprint for collaborative working that helped inspire collaborative commissioning and leadership.
NEW SERVICE MODELS
Innovation Unit worked alongside Lambeth colleagues over the last ten years to support the co-design of new services and to help build a culture of co-production. Three innovative services were created:
- The Living Well Network Hub – the “front door” to mental health services, delivered by a multidisciplinary team from primary and secondary care and the voluntary sector. The Hub was an open access offer, with no thresholds or eligibility criteria, to help people who are experiencing some mental distress.
- The Living Well Network – a community of providers, support agencies, statutory organisations and people who help citizens of Lambeth live well by resolving problems that trigger mental ill health, including housing, employment, debt, benefits and isolation.
- The Integrated Personalised Support Alliance – an alliance contracting that has helped 200 people with complex mental health needs move from rehabilitation services into living more independently in community settings. The IPSA is recovery focused and supports people to improve physical and mental health and work towards goals in education, employment and training.
“The Living Well Network Hub in North Lambeth was launched in 2013 as a large-scale prototype for Lambeth’s ‘new front door to mental health’. The launch marked a key milestone in Lambeth’s ambition to turn the system on it’s head and start to redistribute resources and practice toward mental health prevention and in support of the primary care services striving to reduce the number of people experiencing mental health crisis.” Jo Harrington
Outcomes and impact
supported by the Living Well Network Hub each month, many of whom would not previously had any support at all.
reduction in waiting times for support in secondary care (down from 1 month to 1 week).
reduction in referrals to secondary care teams.
average cost per person - a low cost to alternative secondary care.
Lambeth’s Alliance leaders are now implementing further transformation to mental health services for working age adults. Three new Living Well Centres are the next iteration of the Hub service offer, providing easy access front door support that includes targeted help for people with more complex needs.
SCALING LAMBETH’S SYSTEM CHANGE
Lambeth’s transformation work has inspired a new, three-year, National Lottery funded programme to scale the approach to four new places in the UK (Edinburgh, Luton, Salford, and Tameside & Glossop). Each place is developing their own version of a Living Well system.
The programme is helping to build Living Well systems of support that put people’s strengths and lived experience at the centre and are designed to help people recover and stay well as part of their community.
The aim is that these new Living Well systems will become leading, internationally recognised examples of innovative ways to help people achieve good mental health in community and primary care settings. They will have the potential to be scaled across the NHS in the UK, transforming current provision offered by GPs and community and mental health teams.
For more details see Living Well UK.