A bold local route to better mental health

By Tally Daphu | 17 November 2021

Over the past four years, we have been creating new systems of community mental health in Living Well sites across the UK including Edinburgh, Salford and Tameside and Glossop. So far, the sites have supported some 2,500 people who might not otherwise have been helped. They also generated more than £5m of additional investment in local mental health systems.

What is Living Well?

The sites in the Living Well UK programme, funded by The National Lottery Community Fund, help people whose needs are too complex to be met in primary care but are unlikely to be accepted for secondary care due to thresholds set to manage demand.

Often these people – who, for example, face childhood trauma, anxiety and addiction, relationship, work and housing issues – fall through the gaps between various services.

Based on a model supported by Innovation Unit in Lambeth, south London ten years ago, each Living Well site brings together people with lived experience, voluntary and community groups, mental health trusts and local authorities to co-create new systems.

Instead of having to navigate separate services in different places, people who need help can work with one of a number of professionals in a multidisciplinary team and open a ‘front door’ to a range of support in their communities.

Our early impact evaluation is very encouraging. The Living Well model significantly overlaps with NHS England’s ambitious framework for community mental health for adults and older adults and we are now working on local transformation with places such as Derbyshire and Greater Manchester.

What have we learned?

Living Well aims to deliver on four main areas: for professionals, organisations, systems, and – in the case of this article – citizens, particularly around realising self-set goals and improving quality of life.

Living Well teams put people in control of their support. After an initial conversation to understand their needs, strengths and priorities, the person seeking support is encouraged to set their own recovery goals, for example, managing anxiety, improving self-esteem, more independent living, taking part in positive activities.

Our early impact evaluation shows:

  • In Edinburgh, 97% of people* who worked with Living Well during the interim evaluation period** made progress on at least one self-set recovery goal while 66% made progress towards at least two goals.
  • In Tameside and Glossop, 90% of people had made progress on at least one personal goal while 66% had made progress on at least two goals.

In terms of measuring improvements in quality of life, most Living Well teams use ReQoL, an outcome measure co-produced with people with lived experience by the University of Sheffield covering aspects of life such as meaningful activity, belonging and relationships, choice, control and autonomy, hope, self-perception, well-being and physical health.

The majority of people accessing support from Living Well experience a sufficiently large increase in their ReQoL scores to indicate a meaningful improvement in their recovery and quality of life.

According to available data:

  • 59% of people accessing Living Well in Salford showed improvement.
  • 55% of people in Edinburgh.
  • 53% of people in Tameside and Glossop.

Living Well teams also measure improvements in satisfaction across key life areas. There were statistically significant increases in satisfaction among people who received support in Edinburgh, Tameside and Glossop and Salford in personal safety and relationships and family/number and quality of friendships.

In Edinburgh and Tameside and Glossop, people also experienced a statistically significant increase in satisfaction with jobs/studies/meaningful occupation.

We also know the difference Living Well is making to people from the stories they share, as someone who accessed support in Edinburgh said: ‘I came to you a broken woman, very afraid to share my troubles with anyone, but with great help from my worker I was able to express myself… [it] has given me hope that this phase of my life has passed.’

What we also learned from the pandemic

COVID-19 has had a significant effect on service delivery and impact measurement with social distancing and lockdowns affecting people’s perception of their quality of life and access to support.

The breadth of interventions has shrunk as mental health staff shortages worsen and support moves online – at the same time diminishing face-to-face feedback and increasing reliance on email communication, telephone and even post.

What happens next?

We are proud of our success so far and, as the Living Well systems mature, scale and develop, we will continue to return to these places to monitor impact with plans for a full report next year.

If you would like to talk to us about Living Well, including developing a programme in your area, email lwuk@innovationunit.org.

Tally Daphu is Living Well UK programme manager

@lwuksystems

Living Well Systems UK is a programme from the Innovation Unit whose mission is to grow and scale the boldest and best innovations that deliver long-term impact for people, address persistent inequalities, and transform the systems that surround them

*Of the people we have collected data from

**Data is not available for all people who have accessed Living Well. All impact data is based on interim evaluations by consultancy Cordis Bright

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