As part of the Fabian Health group’s new Fabian perspectives on mental health project, Lambeth council’s Jim Dickson writes about innovative local approaches to delivering mental health services at a time of austerity
On the face of it this may seem a strange time to launch fresh local strategies to tackle mental health. 57 per cent of clinical commissioning groups (CCGs) say they are planning to spend less of their total funding on mental health during this year. And despite government lip service to parity of esteem, the proportion of local spend on mental health remains stubbornly at or below 10 pr cent for the majority of CCGs. Whilst the Tories launch yet another review of mental health services, it remains vital that Labour continues to campaign to make the case for mental health to be properly funded via NHS England.
But where Labour runs or commissions services locally, we owe it to our residents to do more than simply campaign. Take the case of 51 year old Airdrina. She suffers from schizophrenia and until recently was in a 24 hour residential home in Streatham funded by Lambeth Council and the NHS, rarely going outside and living a life with little independence or hope of change. The system – which had found it hard to help her with the risk of harming herself and others – had effectively locked her and many others Lambeth residents away at an average annual cost of £80,000 or more. Three years later, Airdina is living in a community setting - playing the piano, doing arts and craft work and, with the help of a personal assistant, going out on regular shopping expeditions, visits to friends and to her late husband William’s grave. The cost of support to her is now closer to £15k per year.
Lambeth has some of the highest rates of mental illness diagnosis in the country. Commissioning mental health services, together with Lambeth CCG, is one of the biggest challenges facing us as a council. We have less and less money, but diagnosis rates for mental health issues are on the rise. So how do we deliver a more successful service, which is better for patients, and on hugely stretched budgets?
Essentially, we are giving mental health service users like Airdrina the power themselves to decide what services they want and personalised budgets to pay for them.
Inspired by the values of Lambeth’s Co-operative council, the biggest innovation has been a transformation of the commissioning approach. The council and CCG has joined forces with providers, including excellent organisations like South London and Maudsley NHS Trust and community support provider Certitude, in an ‘Alliance Contract’. Pioneered in the construction industry, this approach radically re-writes the purchaser-provider relationship. Instead of being focused on existing assets or activity (such as secure residential settings or clinics), contract incentives (both the ‘gain’ as well as the ‘pain’) are focused on the rehabilitation and recovery of service users themselves. Thanks to the alliance structure, all partners in the Integrated Personal Support Alliance (IPSA) now have an equal financial stake in getting – and then keeping – people well.
Guided by the Lambeth Living Well Collaborative, a collective led by users of mental health services and including carers, GPs and providers working with council and the CCG since 2010, commissioning has been turned on its head. Where in the past service users were often treated at the point that their condition became a serious problem and frequently placed in expensive residential care, now the Living Well Network gives service users a voice before their problems become too serious.
The Living Well Network, at the instigation of service users, is investing significantly more in prevention via our Network Hub and community prevention programme. There is Mosaic’s Living Well ‘Clubhouse’ in Brixton, where people can go if they feel they might have a mental health issue or may be referred by GPs or other professionals giving opportunities for peer-to-peer conversations, advice and an understanding of what is available to help. New crisis services – with peer support a key feature – have also been launched.
The Living Well Network also provides earlier support and a ‘front door’ to mental health services for people with everyday needs. To encourage people to seek earlier help, the decision was made to remove eligibility criteria and introduce ‘self-introduction’. This shift towards a more preventative approach has produced impressive results. The number of referrals to secondary care per month has fallen by 43 per cent and there has been a marked increase in the number of people accessing support. And we have been able to begin addressing the debilitating over-representation of BME populations in our mental health system via our new Black Thrive partnership.
The approach is now being formalised into a £63.8m whole system alliance, comprising all the Council and CCG mental health services into an alliance contract, with the new agreement expected to be in place by April 2018. The aim is firmly focused on preventing people developing mental health problems and to treat them early when they do.
Service users have wanted this change but it has not been easy to achieve. Providers have been able to change their business models in radical ways to meet shifts in service need and priorities across the borough. Change has been hard won. Hopefully Lambeth is a lesson for the next Labour government about how we can put people in control and focus on outcomes when we deliver mental health care.To find out more about the Fabian Society’s health network contact: [email protected]