Five lessons from transforming mental health in Lambeth

By Dr Adrian McLachlan | 03 May 2017

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 stayed 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 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% 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 and 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.

Aligning agencies, professionals, users and carers on the vision, outcomes and ways of working has been essential.

It demands constant renewal and a creative approach to bringing people together to showcase, story tell and inspire. Testing new approaches hasn’t come without its challenges to all involved, including clinicians, managers, commissioners and service users. We are continuously trialling new things with the people who use our services, and inviting clinical staff to work side by side with non-clinical professionals often with a different culture, language and outlook. Yet, it is our commitment to get out of our silo and professional comfort zones that’s made the biggest difference.

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.  

People and their support networks should form the bedrock of what we do from how we design and organise services to the support we provide.

In 2015, we started the Integrated Personal Support Alliance (IPSA) – a commercial alliance agreement between multi-agency providers and commissioners – to radically transform the outcomes for 200 people with complex needs previously supported in inpatient rehabilitation and residential care settings. So far 70 of those 200 people are now living more independently. 

The IPSA has also achieved savings of 20% against the original £12m budget. It has shown that using an asset-based approach, with the starting point being a person’s strengths rather than shortcomings, really does pay off. Services, clinicians, professionals should be on tap, not on top.

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. 

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 LBC, Aisling Duffy is chief executive of Certitude, and Dr Soumitra Burman-Roy is consultant psychiatrist at the Living Well Network Hub

The Collaborative will be speaking at The Future of People Powered Health 2017hosted by Nesta Health Lab in partnership with Guy's and St Thomas' Charity, on 9 May

For more information and to watch the live stream visit here

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