Authors: the South-West Community Mental Health Knowledge Mobilization Network. Collated by Charley Hobson-Merrett and approved by network members.
Introduction
The South-West Community Mental Health Knowledge Mobilization Network is an open-invite group which meet regularly to share information about the implementation of the Community Mental Health Framework For Adults And Older Adults 2019, and the sustainability and continuation of providing mental health services in a manner aligned with the ethos of this Framework. In our October meeting we discussed which roles and responsibilities are necessary to implement the Framework. Members discussed a wide range of roles; it is clear that the roles utilised vary across the region. Roles can be broadly classified into two purposes:
1. Roles that work to develop community provision or better utilise existing community provision;
2. Roles that work to prevent people falling through ‘gaps’ between statutory care provision.
These are discussed in more detail below:
Developing and better utilising community provision
The Framework calls for better use of the community to support people to be and stay well. The definition of ‘community’ is not well explored in the Framework, but has been interpreted by most systems to mainly consist of the voluntary and charitable sector (VCSE). In some areas in the South-West this is being approached by creating an alliance of VCSE organisations (e.g., the Open Mental Health voluntary sector alliance in Somerset, the Devon Mental Health Alliance) that is supported by subcontracted funding from the NHS. However, the nature and role of these alliances varies. In geographical areas where there is already good VCSE presence and provision this role is about linking up existing offerings: enabling different organisations to become aware of each other and work together, improving visibility and access to these offerings for people who might use the services. One network member working in such an alliance role described themselves as “a professional dot joiner” whose job is to help address the disjointed and underfunded nature of existing VCSE provision. Where there is less existing VCSE provision this role includes understanding gaps in provision, and enabling people or organisations to work together or separately to fill these gaps and apply for funding to fill these gaps. The variation in existing provision and these roles being funded by a variety of VCSE organisations, means that people in these roles are often working in different ways. This makes it important to meet with one another regularly to share learning.
Roles are also needed to improve communication about, and awareness of, community provision to secondary and primary care providers. In some areas this is the responsibility of new roles in the voluntary sector alliance, in other areas it is the responsibility of new roles within the mental health secondary care trust, in some areas it is the responsibility new practitioners placed in primary care under the Additional Roles Resource Scheme (ARRS), in some areas this role is shared.
Network members explained that the success of all of these ‘community provision’ roles is contingent several factors:
A. Building trust between individuals belonging to different organisations;
B. Creating an understanding that mental health can be affected by psychosocial causes, rather than purely medical solutions. One clinical member of staff at a statutory provider was happy to offer a quote describing her shift towards a psychosocial understanding of mental health problems: “I’ve learnt a lot in the last few years, I now know I less than I did when qualified 20 years ago”;
C. Addressing power imbalances between small and large organisations, and between voluntary and statutory sector providers.
Network members highlighted some key challenges that they still needed to address in these roles: How to manage funding, capacity, and equality between providers when it is not possible to manage who attends VCSE provision? How to create equality in partnerships with VCSE providers? How to shift medical practitioners’ ethos, so that they stop seeing mental health as a purely medical problem and more as a psychosocial problem, thus increasing their engagement with VCSE providers?
Preventing people from falling through ‘gaps’ between statutory care provision
The Framework suggests that there needs to be a better joining up of primary and secondary care services, to ensure that people do not fall into gaps between care. Several roles designed to fill these gaps in care were discussed by network members. Although again these roles vary across systems, they can be broken down into four categories:
A. People providing interventions to those who would have previously not met the threshold for existing interventions (e.g., DBT offered by recovery and wellbeing workers, short course psychological therapies for people who do not meet IAPT thresholds);
B. People offering modified services to people who usually found it difficult to access services (e.g., physical health checks offered by outreach teams, community mental health and wellbeing workers that attend people’s homes, pharmacy clinics to explore interactions between medications);
C. Roles that bridged the gap between secondary and primary care (e.g., primary care liaison workers, health and wellbeing coaches);
D. Roles designed to make it easier to navigate available care (e.g. primary care liaison workers, ARRS workers, community connectors).
Some roles fulfilled more than one of these purposes. The roles selected by each system appear to be in response to where their existing services gaps are, suggesting that the first piece of work is to identify local gaps in care.
Network members highlighted key challenges in implementing these different roles that still need to be explored: How to manage overall staff retention when you might lose staff to these new exciting, less exhausting roles? How to manage ongoing service level agreements for ARRS? How to create and update job descriptions and promotions with the advent of new roles? How to manage difference across independently run primary care networks?
The Future
In discussing utilising the creation of new roles to improve the provision of mental health services in the community, network members were reflective of many areas that were still unexplored that they wished to improve. They feel that it is necessary to continue to be curious and strive to create more change, but that this is difficult as time to reflect on the implementation and success of new roles is not built in. Members suggested that in addition to new roles being created, it might be necessary for some existing roles to be removed, as they are not compatible with the new ways of working. For many ensuring sustainability is a challenge: funding is often not on-going, and many new roles have high levels of staff ‘burn out’ that are not fully understood. Network members felt a key challenge not yet addressed by new roles is understanding what is necessary to reach people who do not normally access services, but who have a mental health need.
Interested in joining the South-West Community Mental Health Knowledge Mobilisation Network? Please email charley.hobson-merrett@plymouth.ac.uk
This blog post is supported by the Peninsula Clinical Trials Unit (PenCTU) and the NIHR ARC South West Peninsula (PenARC).