Creating a new landscape for mental health - with
co-production at its heart
Living well collaborative
With Lambeth Clinical Commissioning Group & Lambeth Council, London, UK
Those commissioning public services are increasingly being expected to oversee rapid large-scale local change that achieve financial savings, but also to make services more accessible, personalised and focused on prevention. In Lambeth they have seized the opportunity to transform the mental health care system. By creating a radical new commissioning model and set of healthcare services that demonstrate co-production working at scale, they have turned the system on its head, and drastically improved outcomes for people with mental health problems in the process.
the average stay on acute wards in 2012.
in residential and inpatient placements across Lambeth CCG and Lambeth Local Authority in 2014.
2 times higher
rates of psychosis than the average rate for England, with poor outcomes for people with severe and enduring mental illness.
At the heart of the ambition of Lambeth Council and CCG was to demonstrate that ‘co-production’ could work on a large scale and drastically improve outcomes for people with mental health problems, regardless of the severity of their condition. Co-production is a radical alternative to the traditional model of service development and delivery that’s driven entirely by professionals. It puts citizens at the heart of their own care and focuses on their assets (what they can and want to do) not just the presenting problem. Co-production works because people’s needs are better met when they work together with professionals, on an equal footing, to get things done. Co-production happens when citizens don’t just participate in the process of designing and delivering new services, but when they own it.
In Lambeth there was a focus on achieving three big outcomes. That all citizens, including those with mental health problems, should have the opportunity to:
- Recover and stay well
- Make their own choices and achieve personal goals
- Participate on an equal footing in daily life.
Using co-production as the route to making this kind of change was not just about coming up with new structures or mechanisms for involving ‘service users’. It was more fundamental than that. Professionals needed to work in entirely new ways – people who needed help, not for them – and build a vision for an entirely new system of care.
There are three key components to Lambeth’s new approach to delivery mental health care services:
- Lambeth Living Well Collaborative – a platform for a partnership of service users, GPs, providers and commissioners dedicated to transforming Lambeth’s mental health care system.
- Living Well Network – a community of providers, support agencies, statutory organisations and people who help citizens of Lambeth to live well.
- Integrated Personalised Support Alliance – an alliance contracting approach that manages funds for those who need personalised care and Personal Budgets.
in referrals to secondary care since the introduction of the Living Well Hub.
supported by the Living Well Network each month, many of whom would not previously had any support at all.
in waiting times for support in secondary care (down from 1 month to 1 week).
“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 its 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
In the early stages of working with Lambeth, a series of storytelling and co-design sessions over three to six months helped set a bold and shared vision change. The sessions were well-attended by individuals from across different parts of the local system and used design thinking tools (such as stakeholder maps, personas) to set out and bring to life a vision for a system that was poised for prevention rather than crisis care.
At the same time it was critical to start to build a culture of co-production – sowing seeds of a change that would need to be embedded and sustainable. A series of workshops generated insights from both professionals and service users to create a framework and set of processes that could shift responsibility from the professional to the patient, seeding a cultural change and helping to evolve co-production within Lambeth’s workforce.
“Working with the staff has enabled me to build up my confidence in dealing with day to day issues, and coping when things get difficult. I also feel better equipped to make confident decisions and when I am well I enjoy every moment playing with my son.” Hannah
We helped professionals start to recognise the value of working with people with lived experience of mental health problems. The creation of a resource map identified the imbalance of funds in the current system – with very little resource going to services designed to help people live well in their communities – and this map was brought to life by peer supporters who were trained as peer researchers so they could tell rich stories that had previously existed only as anecdotes of system failure and tragedy. Capturing the words of people with lived experience highlighted the humanness of the system failings and, in combination with the resource map, provided a clear case for radical change.
“The way I work with Elaine now differs in many ways to how I used to work in the community mental health team setting… The rewards are that Elaine has more independence in her life. She is happier than before and I as her social worker feel proud for her achievement.” Mohammed
As part of the borough-wide expansion of the Living Well Hub in 2015, the Collaborative invested in a practice development hub for professionals. The aim was to support professionals to co-produce new practice built from a foundation of people’s experience, as well as building the capacity for more proactive leadership. By bringing stories of people’s experiences of the Living Well Hub, professionals have identified ways to do things differently, and carry on doing more of the things they do well. ‘Recovery Stories’ are captured and shared on an ongoing basis by the Collaborative’s volunteer writer and journalist, Karen Cooper.
Lambeth CCG and Council are in the process of establishing a new Living Well Network Alliance – an intensive partnership of commissioners and providers who will oversee continued transformation in the way that adult mental health services are delivered.
Between October and December 2017 Innovation Unit completed work with Lambeth’s Alliance partners to support service transformation in three priority areas.
- Build an integrated and stronger ‘front door’ to mental health services
- Improve targeted, specialist care coordination for people who need more intense, medium-term support
- Improve rapid response support, especially out of hours and alternatives to bed admission
Innovation Unit brought together stakeholders, including people with lived experience, in a series of design group workshops to enable Lambeth colleagues to imagine ideal future approaches to these priority areas.
- 6 collaborative sessions in 6 weeks – with multidisciplinary groups of service users, staff and Alliance leaders to redesign the three priorities
- 6 materials – including blueprints and a financial model, to visualise a set of new functions covering front door, targeted support and rapid response
The new approach to community support will inform more detailed design work in early 2018.