Involving service users and carers in decision-making is a key enabler to innovation in mental health service delivery
“Every group that I work with has got people with lived experience and people who have gone beyond that to have lived expertise, who are getting involved in helping us design solutions that are effective, […] they will help us especially in dealing with inequalities in our system which is a key part of what innovations need to do.” Dr Phil Moore, chair, mental health, learning disabilities and autism system group
We often hear of the challenges in providing great mental health support. However, we hear less about the innovative solutions that the health and care system is implementing to meet the challenges, and how these can be replicated. An online event hosted by the NHS Confederation provided real scalable examples of how integration between different parts of the health system can provide solutions to some of challenges that mental health services face.
The panellists were:
To kickstart the conversation, Dr Moore provided a template for implementing innovative solutions, presenting eight key enablers and challenges for innovation:
NHS Hampshire, Southampton and Isle of Wight Clinical Commissioning Group (CCG) worked with partners, including people with lived experience, to develop a seamless, single point of access to mental health crisis support using mental health nurses working in NHS 111. The new service provides easy access to support for patients, takes pressure off the rest of the system by reducing attendance at A&E, and enables people to get mental health support before a problem becomes a crisis. Sonya explained how their service comprising of digital and telephone services, and a frontline response car, staffed by ambulance workers and a clinician, the police and mental health nurses, is “not just a helpline, but a lifeline”. This service is meant to provide mental health support in parallel with physical health assistance.
Co-production has been paramount to the success of the programme, leading, noted Beth, towards a “shared learning and understanding of mental health symptoms and diagnosis”. Sonya added that “the great thing about the service we have is that is completely co-produced where possible, and we are constantly evaluating it with our service users and our carers on a quarterly basis to understand the things that can be changed or improved, and the things that are working great”. She provided an example of how the feedback from service users helped address the disparities in how the clinical staff communicate with carers and next of kin on topics surrounding mental health, highlighting the importance of “making sure that our staff understand how to have those conversations”. Service users were also involved in designating a keyword, which they can use to access local help in their area.
Another priority was education, working with different age groups, so that people understand what crisis help is available. Beth noted that this form of co-production was needed to get people to “understand that the NHS111 is not just for physical health”.
The Doncaster Children’s Partnership set up the multi-agency social and emotional mental health (SEMH) group, which brings together key influencers and decision-makers from the Doncaster CCG, local authority, children and young people’s mental health service provider and other partners.
Andrea recalled how the initial response at the start of the Covid-19 pandemic was focused on providing health and social care for adults, but after seeing data from the Doncaster Royal Infirmary suggesting an increase in suicide and self-harming attempts among children and young people, their group decided to shift the focus of their Transformative Care Programme towards supporting children and young people who presented to the emergency department after attempting suicide or self-harm. She emphasises that their work established that “mental health problems in children surround social aspects – it’s not a health problem, it’s a social problem”, therefore needing a more integrated approach to solve.
Multi-agency working can lead to a shared understanding of the children and young people and their mental health needs. This is how the SEMH group operates, Jill notes, holding weekly meetings to share and discuss cases where a young person had presented into the emergency department that week with suicide ideation, self-harm and/or other emotional mental health issues. The meeting brings together influencers and “decision-makers, people who can make decisions on that day” based on the discussions from the meeting. Having these key people working together was what ensured the success of the programme. “We have educators around the table, police, social care, we have CAMHS, we have someone with SEND (special educational needs and/or disabilities), we have somebody from the emergency department,” Jill said, adding that having someone from such an acute service had been particularly valuable.
Kate followed on, talking about their latest initiative to “monitor the themes and trends” in the situations that bring children to the emergency services, and using these data to inform commissioning decisions and to assess the needs for early interventions. “There’s a real drive around early intervention and prevention, because what we found in our discussions is that the majority of young people have not been opened to any services, whether that’s CAMHS, early help or social care,” she notes.
These open lines of communication facilitated the creation of a solid strategy, co-produced by young people who acted as advisers for the Doncaster CCG. Multi-agency working and co-production within the CCG yielded the following priorities:
Ifti Majid praised their approach towards developing this strategy, emphasising that a good framework should be “starting with needs, and then actions and then strategy” instead of drafting strategies first and implementing actions based on the respective strategy.
This approach also boasts positive financial implications. Kate argued that “as young people have not been opened to services […] they end up in Tier 4 crises, costing considerable amounts of money across the partnership,” while having early interventions preventing those young people from reaching that level of crisis would be extremely beneficial in terms of cost savings. Ifti Majid emphasised that “proactively taking steps and anticipatory care will yield financial benefits”. The discussion members also agreed that the common theme should be designing services driven by people’s needs and in collaboration with the service users.