View from afar… a review of different mental health care initiatives
8-minute read
Listening to external viewpoints
Hearing outside perspectives is a fantastic way to gain different viewpoints and help us not fall into the trap of thinking that current way is necessarily the best, just because it works.
In that light, this month we are presenting our guest blog.
Last summer, we were treated to an insightful and fascinating ‘Mental Health Tour of the City’ in Utrecht, Netherlands where we were shown four very different mental health and peer support services.
A reciprocated tour
In January, it was Habitus' turn to reciprocate. We presented three of four initiatives in mental health care that were visited to help inform a two-day mental health global exchange event to be held later this year.
We were delighted to meet-up again with Beverley Rose (Head of the User Research Council) and Dr. René Keet (Chair of the European Community Mental Health Services network) and showcase some interesting examples of mental health support in London.
Here is René's experience of and thoughts on his two-day trip:
Travels in urban and suburban London (guest blog)
Introduction
On 11th and 12th January, Beverley Rose and I, travelled across a great part of London to explore new initiatives in mental health care. We were there to prepare a match on peer leadership that we will organise for the Global Leadership Exchange on mental health on 24th and 25th June.
Our hosts were Callum Ross and Lisa Androulidakis of Habitus Collective UK.
In our visit, there were three overarching themes: Peer expertise, Collaboration between NHS and charities and Learning processes. This is my personal report of our travels in urban and suburban London. Your feedback, additions and corrections are very welcome! I also posted short video’s on LinkedIn, you are welcome to connect: https://www.linkedin.com/in/ren%C3%A9-keet-a2539525/
England revisited
For me a visit to England is always special, as I lived and worked there in 1987 and 1988 when I worked as a medical doctor in the Royal Free Hospital in Wolverhampton. I was a senior house officer in Accident and Emergency (A&E). I was a young doctor and learned a lot: the English language was way different from what I learned at school, the English way of living, and the context of the National Health Service. I worked in a dynamic team, with an interesting mix of severe and minor cases. I learned rapidly to deal with crisis situations. I worked together with stakeholders, such as primary care and the Police. I also saw the need for alternatives to A&E for people experiencing a mental health crisis.
The promised land of community mental health?
In my later career as a psychiatrist, I went back to the England in the 90’s and 00’s. I often looked at England as the ‘promised land of community mental health’. The NHS created an infrastructure of assertive outreach teams and early intervention services for people experiencing psychosis. I saw these as sources of inspiration for my own country, the Netherlands. I was also inspired by the developments of psychotherapeutic and family interventions for people experiencing psychosis. The crisis resolution home treatment teams (CRHT) provided a good ambulatory alternative to crisis admissions.
However, I also saw a downfall of community mental health care. The REACT study on assertive outreach teams in 2006 was, for me, a turning point and unfortunately not for the better. In the years after, assertive outreach teams disappeared. Competitive tendering allowed other NHS trusts to compete for services outside of their patch, which can endanger a strong community network. Also, I saw reports of underfunding, fragmentation of care, an aging infrastructure, long waiting times and pressure on emergency services.
“I was also inspired by the developments of psychotherapeutic and family interventions for people experiencing psychosis. The crisis resolution home treatment teams (CRHT) provided a good ambulatory alternative to crisis admissions”
NHS community mental health framework
Since 2020, my interest in the developments in England was renewed by the Community Mental Health Framework published in 2019. https://www.england.nhs.uk/publication/the-community-mental-health-framework-for-adults-and-older-adults.
This framework describes a long-term vision for a place-based community mental health model. It describes how community services should modernize to offer whole-person, whole-population health approaches, aligned with the new Primary Care Networks. It refers to community both as a geographical location, or a group in which people find or place themselves that provides a context for people’s lives. It has a foundation in human rights: no quality without equality. It also has the spirit of an ecosystem approach in which mental health needs can be met across all layers. Networking is at the heart of the plan that involves the recruitment and training of over 1,000 social prescribing link workers. The model has been tested across 12 regions, including North West London. So we were really lucky that this was one of our visit regions!
The framework acknowledged that CMHTs have long taken a central role in the delivery of mental health services, but their development has stagnated over many years. Recent focus has been on specialist teams introduced in response to the National Service Framework or primary care and assessment teams. The creation of these separate specialist teams has, in most places, led to fragmentation and discontinuity of care. The NHS Long Term Plan seeks to address this, however with added pressures and limited budget, realising the long-term plan is challenging for many NHS trusts.
“The creation of these separate specialist teams has, in most places, led to fragmentation and discontinuity of care.”
Our learning visits
1. Community Housing and Therapy (CHT): a learning organisation
Community Housing and Therapy is a charity that runs residential units for those with severe and enduring mental health difficulties. CHT's therapeutic and rehabilitative programme is designed to create a structure that will lead to recovery, employment and eventual independence. They are an example of a well-organized learning structure. Their chief executive, Peter Cockersell, explained the vision of Community Housing and therapy, an organisation that deeply invests in the learning process of their employees and creates small scale communities with and for people, where connection with mental health care is complex. In their vision relationships are the treatment. They have seven therapeutic, psychologically informed teams across Southern England. Most residents and staff are 20-30 years old. The staff is provided graduate training in relational practices in mental health. It is a combination of classroom and onsite learning.
We saw an example of this community approach in one of their locations in the Highams Lodge in North London. Their manager Alistair Dinsmore explained how they create a community of professionals and clients and deal with complex treatments by investing in the relationship. Clients are referred by local authorities. Professionals include music- and psycho -therapists.
2. iGNITE: reaching young persons with peer support and collaboration between NHS and a charity
In Northwest London, we visited a location of iGNITE, a youth community for and with young persons, organizing sport and music and providing support with education and employment. During my many work visits across Europe and beyond, I learn a lot and maintain a fresh look on how we organize mental health care in The Netherlands. Sometimes there is an extra spark, a team that captures the spirit of community mental health in a way that moves me. This happened to me while visiting iGNITE youth in the London borough Harrow.
They work with young people aged 11-25 to help them re-engage with education, find employment or move away from anti-social behaviour, gang involvement and exploitative relationships. They work together with local schools, colleges, sport facilities, parents and other charities.
We spoke with the executive director Donna John and with Alawi Abdalla, who was supported by their services and now works for them as an intern. I now follow his work on TikTok and Instagram.
3. Harrow Cove: collaboration between the NHS and the charity Hestia
One of the themes of this visit was the collaboration between NHS and charities. A beautiful example of this we found in the Harrow Cove, an initiative of Hestia Charity. Hestia delivers high quality & empowering housing, support, protection & care services in partnership with service users & local communities in 22 London boroughs. Hestia provides services to people with mental health needs, physical disability, substance misusers, offenders, women & children fleeing domestic abuse, older & young people, personal budget holders & other wider community groups. They operate in collaboration with the local NHS community mental health team.
Catherine Fallon of the Harrow Cove and Roshni Ardeshna of the Central and Northwest London NHS Foundation Trust told us with shared enthusiasm about the crisis café, a safe and inviting, space where residents of the borough can go if they are experiencing mental health crisis. It is a better alternative to A&E department of the hospital. They are open 2-10 pm every day of the year.
4. NHS north London mental health trust: working with peer expertise
In total, the NHS now employs 5,000 trained peer experts, growing lived experience into a central place in community mental health care. Our final visit focused on this in the heart of London. Near Kings Cross, we met Cerdic Hall, working for the NHS in North London, an NHS trust that has employed 70 peer experts and has expanded into a partnership for North London residents. He is an inspiring mental health professional and has the role of Recovery Lead of the Camden and Islington NHS Foundation Trust. He promotes recovery-oriented care and co-production for those who use the services.
He introduced us to Nil Suner, who works there as a senior mental health peer coach. She told us, she has been a peer coach since 2018. She explained to us that peer support is a fast growing much-needed addition to community mental health and will be the ultimate power in establishing community support in the modern age.
Lessons learned
England is no longer the promised land of community mental health, yet it remains a country of interesting examples. One may also wonder if you need such a promised land. The developments in recent years are inspiring for us. Dealing with mental health is in all contexts a journey in complexity, and with international connections, we can learn together and improve our work. Going back to the three topics of our visit, we summarize how we were inspired by our visits:
Peer expertise
We were happy to learn that in total NHS now employs 5,000 trained peer experts, giving lived experience a central place in community mental health care. Also, we see that the charities we visited, clearly work with the spirit of lived experience as a resource of expertise, both for clients and professionals.
Collaboration NHS and charities
We saw several good examples of such a collaboration. Here, we see the context of a collaborating ecosystem.
Learning processes
We saw good examples of investment in young professionals and processes of social learning, learning of professionals together with their clients.
What next?
A reminder that EUCOMS are organising the Global Leadership Exchange on mental health on 24th and 25th June.
We hope to stay connected and invite all our relations in England, to connect to the European Community mental health services network (www.eucoms.net).
Our webinars are for free and full participants can with our support host a network meeting for international collaboration.
At Habitus, we have helped develop and design successful peer support and community programmes for various charities, health organisations and businesses both in the UK and internationally. Find out how we can help your organisation do likewise and for other types of support we offer by clicking the button below.
We are accomplished in peer research, co-production, action-based and anti-oppressive research and evaluation. We are experts in helping organisations to engage wider community participation in their projects so that their work is more inclusive and impactful. Through this approach we are dedicated to increasing lived experience leadership.