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Living Well UK Building new systems of community mental health

Organisation

Living Well UK (opens new window) is a programme led by Innovation Unit (opens new window). It supports pioneering places in the UK to build Living Well systems of support for good mental health and wellbeing.

Living Well systems 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.

Innovation Unit is a not-for-profit social enterprise. We 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.

We partner with places, organisations and systems, in the UK and globally, to ensure innovation has lasting impact, at scale.

What is the innovation?

Innovation Unit is helping to build Living Well systems of mental health 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. 

Living Well systems of support are distinguishable by a set of key features:

Refreshed and renewed vision for mental health & wellbeing, that includes:

  • Outcomes
  • Citizens
  • Voice

A reinvigorated practice and way of working shared across each local system, including:

  • Co-production with people
  • Strengths based
  • Learning focused
  • Multi-disciplinary, across statutory and VCS

A different way of organising our shared capacity to improve people's lives:

  • Bridging the gap
  • Networks
  • Collaboration
  • Bringing together insights

What is the problem this innovation solves?

Mental health is a rapidly growing issue that by 2030 will be the leading cause of morbidity globally. Traditional, medically led mental health care is struggling to meet this growing demand and seems unable to provide the holistic support required to tackle the root-causes of mental health challenges in order for people to recover and stay well. Improvements in existing systems and practices fail to respond to this challenge. Instead, whole system approaches are required that aim to leverage a wider range of resources and engage more diverse networks of support.

Our research, conversations and work with people with lived experience, front line staff and system leaders have helped us to get a better understanding of the challenges we can often see in the current system:

  • The current system is not designed to put people, and their families, at the centre of support
  • Services are not always holistic and so don’t support the whole person in their context
  • The system needs redesigning, so everyone gets the help they need and deserve
  • Professionals are prevented from practising in the way that best meets people’s needs
  • Mental health support is rationed according to diagnosis, criteria, thresholds, set pathways, waiting lists, referrals and handoffs.
  • The system is fragmented, resulting in discontinuity of care and people falling through the gaps

Mental health services are often highly medicalised and not designed to deal more holistically with the social and economic factors that affect someone’s mental health. Through the Living Well programme, we have come across many stories of people experiencing poverty, worrying about money, caring for others whilst balancing their own mental health needs, living with the aftermath of adverse childhood experiences, feeling socially isolated, being victims of crime and not having their basic needs met. Struggles with ‘mental health’ are often struggles to work through adversity and its effects.

Despite this, there is an over reliance on clinical interventions in secondary care and a lack of holistic help and support for mental health in the community that could prevent many problems getting worse. Holistic help and support for mental health looks at the whole person and combines medical and social perspectives.

Solution

Living Well systems place a focus on the ‘how’ as well as the ‘what’ of change and transformation. The core functions and methodology of Living Well systems are:

Vision

  • New outcomes
  • Different ways of measuring impact
  • Movement building approach
  • Storytelling & ethnography and new kinds of insight

Practice

  • Community hubs
  • Multi-disciplinary and multi-agency teams
  • My story/My plan (co-produced care plans)
  • Introductory conversational assessment 

System

  • Collaborative platforms
  • Prototyping
  • Focus on creating conditions
  • New kinds of contracts (alliance)
  • New kinds of leadership & governance

Evidence base

Living Well UK published its first Story Book in October 2020. We have found that the gathering and sharing of stories from people with lived experience has immense power to change opinions, reshape practices and improve the quality of peoples’ lives.

Our stories reveal that mental health diagnoses and conditions are organised, in part, according to their own kind of ‘complexity’, and services are offered and rationed according to levels of need. If your need is ‘less complex’, you won’t be eligible for specialist, secondary care help and support. On the whole, the people in these stories don’t qualify for that kind of provision, but their lives are super complex, and their need for help is high. So there is a mismatch between mental health service thresholds and the difficulties with which our storytellers are wrestling.

Only by drawing insight and inspiration from lived experience could we draw out the multitude of practices, and the ways in which the inter-relationship of those practices, affects people’s experience of services and support.

Expected impact

Capabilities and behaviours

  • Development of new, person centred, multi-disciplinary practice that delivers holistic care that is better able to help people recover and stay well
  • Development of the collaborative leadership required to dissolve boundaries between sectors and organisations and unlock collective insight and talent for the benefit of people who use services
  • Confidence in applying co-design and prototyping to continuously iterate and refine new models of care

Mental health

  • Significant improvements in mental health as measured by Requol and other outcome measures
  • Delivery of person-centred and holistic care and support to 10,000s of people who otherwise would receive no support at all, or not get the right help and support where and when they need it

Stage/spread

Currently, Living Well systems are being developed in:

  • Edinburgh
  • Greater Manchester - Salford, Tameside & Glossop, Oldham, Bolton and Heywood, Middleton & Rochdale
  • Derbyshire - High Peak/North Dales & Derby City

What would councils/health organisations/local areas need to do or have in place to enable it to develop?

  • Desire to invest in a collaborative approach and invest in a longer-term view
  • Rich local networks and relationships and desire to work with diverse networks across local system
  • Desire to put lived experience in the heart of the process and ability to protect marginalised voices
  • A conducive political and organisational climate that values the potential of co-production
  • Ability to mobilise funds in order to support transition processes from existing ways of working to Living Well ways of working
  • Desire to join and be part of a national movement for Living Well Systems

What would kill it?

  • Appetite only for quick fixes for technical issues rather than a desire to work with the root causes of systemic challenges
  • Unwillingness to invest time and resources in growing networks and relationships for collaboration across the system
  • Failure to continually honestly appraise the significant shift to move from current ways of working to more collaborative and co-productive ways
  • Inability to mobilise and reconfigure resources to ensure a more effective spread across more diverse forms of support & relationships (including VCS)
  • Unwillingness to recognise the significant shifts in leadership and governance across all part of the system required to grow and sustain living well approaches across

Where to get more information

Website: www.livingwellsystems.uk (opens new window)

Website: www.innovationunit.org (opens new window)

Email: lwuk@innovationunit.org

See Charlie’s story illustrating the power of peer support, in his own words, it saved his life! (opens new window)