Authors: The South-West Community Mental Health Knowledge Mobilization Network. Collated by Charley Hobson-Merrett and approved by network members.
Previous blogs:
Part 1: roles needed to implement the Framework
Introduction
The South-West Community Mental Health Knowledge Mobilization Network is a safe space to share experiences of implementing the Community Mental Health Framework For Adults And Older Adults 2019. Our second blog discusses working together across the voluntary sector, secondary care, primary care, including some ideas for best practice and some ongoing challenges.
Working with and across the voluntary sector
Members reflected that the voluntary sector is composed of many different organisations, providing a wide variety of services and each with their own culture. It is difficult to know what each voluntary sector organisations is, their remit, and ways of working. Traditionally some of these voluntary sector organisations would have been competing against each other for the same funding, so have needed to learn to trust each other and work together. A common solution has been to use Framework funding to create a local voluntary sector alliance. Members reported that these alliances develop a unified culture across the local voluntary sector, allowing voluntary sector organisations and staff to feel a part of something bigger and better, making it easier for statutory providers to commission voluntary sector services, and allowing the voluntary sector to work together to secure more funding to increase stability.
Members noted the importance of ensuring smaller organisations were involved when implementing the Framework. Smaller organisations have a greater idea of the needs of local people, and also which local community assets can be mobilised to support these needs. Some members described using an asset-based approach when involving smaller, grassroots organisations to understand how different local organisations could work together to strengthen the mental health offering. Others have addressed power imbalances between different voluntary sector organisations by giving smaller local organisations within their alliance right of first refusal over new opportunities, with national organisations only able to undertake new opportunities within the alliance if the local organisations declined to.
Creating voluntary sector alliances has challenges: it works best when done through building trusted relationships between individuals and organisations. It takes time for trust and relationships to be built and maintained across voluntary sector organisations. The personnel and financial resources required for this should not be underestimated when agreeing funding; neither should the proportionate burden of such ‘back door’ work on small voluntary sector organisations. NHS commissioners and providers need to be brave and respond to the need for on-going funding with long-term contracts that inspire confidence, allow time for culture change, and are respectful of the staff and work done within the voluntary sector.
Joint work between voluntary sector alliances and secondary care works best where there is genuine collaboration and co-production at all staffing levels, and a shared vision of what is important is created. Examples would be the voluntary sector alliance being represented at community mental health strategic groups, and local team meetings composed of frontline staff who deliver both NHS and voluntary sector services. Having time built in to learn and think critically about work done by the alliance helps improve the quality of joint working.
Working with and across secondary care (including community mental health services)
Members described how having integrated management structures that operated at location level, rather than professional role level had improved integration within secondary care, reducing silos of care. This structure also creates integrated local team meetings, which voluntary sector staff can also be invited to, contributing to improved integration between voluntary services and secondary care. These meetings create an effective space for different staff groups to co-produce care plans and offers of care, reducing waiting lists, as people are not ‘bounced’ between services.
Like working with/across the voluntary sector, a key challenge in working with and across secondary care is understanding all the different services and offerings, and how these can link together. This means that when utilising a locality model each locality must evolve to working together in its own ways and its own set of joint voluntary sector/secondary care offerings.
Working with and across primary care and social care
Members reflected that integrated working with primary and social care is harder, and still a work in progress. Notably, the knowledge exchange network currently has few members working in primary care and no representatives from social care (if you work in these services and want to join us – we want to hear from you!). Members from secondary care explained they had sound working relationships with social care, but there does not appear to be a strong desire within social care colleagues to become involved in integrated working within the ethos of the Framework.
Members reflected that the ways of creating integration between the voluntary sector and secondary care via relationship building and joint care meetings do not work well for primary care practitioners, as their working practices make it difficult or even undesirable to attend these meetings. New ways of creating joint working therefore need to be explored. Some members reported that as part of implementing the Framework they now allowed people to self-refer to secondary care services without the need of a GP appointment, reducing burden on general practitioners and making services quicker and easier to access. Joint working with primary care has also been addressed by creating secondary care funded roles that sit physically within GP practices, offering appointments to GP patients. Sometimes these roles were funded via Additional Roles Resource Scheme Network and/or instigated by Primary Care Networks. Members reported that these joint roles were successful in improving relationships with GP practices (i.e., fewer complaints), but did not know how these roles were perceived by people with mental health problems.
Working with public health
Although public health is not currently well represented in the Network (again – please do come and join us!), members reported benefitting from strong relationships with public health, and that jointly funded projects that span the space between prevention, resilience building, and recovery were helpful in working within the ethos of the Framework. These jointly funded projects were often undertaken by voluntary sector organisations and addressed issues such as improved access to services for people from communities of identity, and increasing community provision of services that support mental health (e.g., groups, activities, peer spaces). This kind of joint working required all organisations to be flexible in defining their remit: activity that might improve public health for certain sectors of the population could also be recovery and early intervention in mental health for other sectors of the population.
Working with the person who has asked for/needs support
Members reflected on the need to work with the person who has a mental health problem. Integrated working with service users/clients is an opportunity to find out what the service user/client would most benefit from. For example, if the service user’s experience was that the usual dictated pathway of care did not work, here was an opportunity to explore together what other options are available when working within the ethos of the Framework. Implementing the Framework also provides new opportunities to involve people with mental health problems in the design and delivery of services: expert by experience groups forming part of strategic leadership groups, connecting via smaller grassroots organisations, and listening to individuals when providing/offering mental health services.
The Future
Members felt that the more integration there was, the more opportunities for further integration were identified. Such as how to integrate between community mental health and inpatient mental health, and between secondary care mental health and secondary care physical health.
Members identified next steps for improving integrated working, including: improved sharing information/data, how to prevent a retreat from joint working under financial and capacity pressures, how to improve understanding and respect of the different pressures of different organisations (e.g., ongoing funding reassurance within VCSE, vacant posts within NHS Trusts), adjusting to varied approaches to risk, and continuing to improve clinicians’ understanding of the value of VCSE and non-medical services.
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)