A key part of the Living Well approach is decentralising leadership and the work of change, and distributing it to the people who will eventually be asked to deliver what emerges. This is often called co-production and, in our experience, results in new services and new solutions that are far more likely to meet people’s needs holistically and effectively.
But distributing does not mean giving away all responsibility or letting others get on with the work on their own. By contrast, to be successful, leaders must distribute in a way that builds shared purpose and a common identity among and between people.
What is leadership?
Across the globe, there are perhaps hundreds of definitions of leadership - the ability to hold people towards a shared vision, to personally embody the values and mission of an organisation, to inspire others to follow you into the unknown, or, as the ability to help people recover from disaster. Whichever definition you choose, one truth always holds - there is no leadership without uncertainty. When things are going swimmingly, or when there is apparently no need for change, good management, rather than leadership, is required.
Uncertainty comes when you are faced with a challenge, or challenges, for which you are unprepared - for which you have no ready made template or well-rehearsed answer. The challenge creates a breach between the future you had in mind and a different, disruptive future that you can barely see or imagine.
Transforming community mental health
Thanks to The National Lottery Community Fund, since 2018 the Living Well UK programme has helped to create new systems of community mental health in sites across the UK. 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. Living Well is being scaled in Derbyshire, Greater Manchester and Edinburgh.
Living Well delivers on the NHS’s new vision for transformed community mental health. The NHS rightly describes its national three year investment programme (2021-24) as “an historic opportunity to … achieve radical change in the design of community mental health care by moving away from siloed, hard-to-reach services towards joined up care and whole population approaches, and establishing a revitalised purpose and identity for community mental health services.” (1)
Embracing complexity
Transforming community mental health is a complex leadership challenge and one that provokes uncertainty, because:
Mental ill health is complex in and of itself, and hard to address - as the Wellcome Trust suggests, globally there has been no improvement in outcomes over the past 50 years. (2)
In service delivery, there are many people, teams, workstreams involved, many expectations to meet and many perspectives to understand, embrace and influence
Change requires undoing what is already in place - dismantling the old
Change requires creation - imagining and building the new
Creation requires learning about the nature of the problems with which you are confronted, and this in turn requires dedicated energy and focus.
Creating holding environments
In Derbyshire and Greater Manchester, Living Well is creating new kinds of groups and conversations in which leaders from across different services can work collaboratively to confront complexity. In Derbyshire, a ‘transformation group’ of senior leaders from the mental health trust, local authority, VCSE and CCG come together to build around shared vision and shared purpose, to develop new ideas and to work through conflict honestly and productively. In Greater Manchester, a new ‘coordinating group’ does the same, in addition to trying to create the right culture in which trust and collaboration can grow.
In Derbyshire, we facilitated a ‘design team’ that gives practitioners working in Community Mental Health Teams (CMHTs) the time and space to co-create new principles, and co-design a set of new functions, to achieve the “revitalised purpose and identity” imagined by NHS England. Drawing inspiration from the work of world-leading leadership theorist Ron Heifetz, the design team is an example of a ‘holding environment’ that mobilises others to solve problems by placing the work where it belongs. In particular, Heifetz encourages leaders to consider ways in which they might be holding on to work that naturally falls to someone else.
Distributing leadership
Distributing leadership means decentralising power and enabling others to bring their direct experience and expertise to complex challenges. Handing over an element of control and responsibility can be challenging for many leaders.
Our years of experience in Living Well means we know how to hold leaders through change, helping them to build a shared purpose and a common identity among and between people, while maintaining accountability.
Building community
Marshall Ganz, the globally celebrated guru of storytelling in leadership, points out that leaders often focus narrowly on creating strong relationships between them and groups of co-workers, often through individual line management or leadership of team meetings. For Ganz, this misses entirely the crucial leadership task of actively building relationships among and between group members.
“It’s one thing for people to relate to you [as a leader], to respond to your need, it’s something else to relate to each other.”
Marshall Ganz
Ganz calls this the ‘us’ - a community who can relate to each other emotionally because they have been helped to draw out the values, experiences and ambitions that they have in common. In Living Well, we enable this, for example, by supporting our sites to gather and share stories of lived experience of mental health issues. The power of connecting emotionally with these stories - however senior you are! - of seeing oneself in them empathetically shouldn’t be underestimated. Stories help people answer the question of why they are here in the first place, why their personal call to leadership has brought them to mental health, and what they want to do about it.
In Living Well, it is this building of a sense of ‘us’ - between and among statutory, voluntary, primary and secondary leaders and practitioners - that has enabled trusting and creative collaboration and a sense of shared purpose, and which in turn has been crucial in successfully designing promising new services that have real potential to genuinely improve people’s lives.
Yet communities of ‘us’ are rarely nurtured by leaders in the public sector. Without them, teams and groups of people may co-exist, co-operate and even collaborate, but they won’t feel and act like a community, or bring their full selves, or their full commitment, to the work. They will continue to see themselves as separate, disconnected actors working in siloed teams and inward looking organisations, unable to think and work as a single organic system. They will continue to privilege their own priorities, power and resources, and so fail to deliver the flexible, integrated system that the NHS has imagined.
With more than 10 years experience in transforming adult community mental health, we have the knowledge and expertise to hold leaders through the uncertainty, and complex challenges of change. To address our country’s worsening mental health, we know how to support leaders with the foundational task to actively create a sense of community in the people who are best placed to do the real work of change.
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.
Living Well UK Programme is funded by The National Lottery Community Fund, the largest funder of community activity in the UK.
