From crisis management to prevention: How the Lambeth Living Well Collaborative is driving the transformation of mental health services

Lambeth is a central London borough with a population of around 300,000 people. The area has nearly three times more people registered with severe mental illness (SMI) than the national average. As a result, Lambeth spends above national average on mental health care provision. The council and NHS now face the challenge to save up to £13 million in social services over the next four years. This financial imperative and collective consciousness that mental health services could be radically improved triggered the formation of the Lambeth Living Well Collaborative (The Collaborative) in 2010. 

Read this case study to find out how The Collaborative has begun to transform mental health services in Lambeth. 

The Collaborative comprises around 30 people, including commissioners, providers of health and social care services, service users and carers. It provides a platform for these stakeholders to come together to radically improve the outcomes experienced by people with severe and enduring mental health problems.

The Collaborative was informed by a vision that “the Lambeth Living Well Area will provide the context within which every citizen whatever their abilities or disabilities, can flourish, contribute to society and lead the life they want to lead.” This vision requires public services to understand that the wider determinants of health have the most significant impact on health outcomes. The Collaborative focuses on enabling people to build personal resilience and networks in order to minimise the occasions they suffer the detrimental impacts of crises. 

The Collaborative established in its first two workshops in 2010 that it would operate according to the following principles:

• Designing its new service offer on the principles of co-production where citizens and providers jointly design and deliver services.
• Use its collective power to ensure that access to universal services and facilities is enabled for all citizens who are diagnosed with a long-term condition or serious mental illness.
• Encourage the development of strong resilient communities in the geographic area designated as the Lambeth Living Well area.

The Collaborative is targeting the 4,000 people currently registered on the primary care SMI (serious mental illness) register within Lambeth’s 48 GP practices and about 2,000 people case-managed via Community Teams by the South London and Maudsley NHS Foundation Trust (SLaM).

Over the longer term, The Collaborative is striving to enable people with mental health and complex life problems to achieve the following ‘Big Three’ outcomes:

1. Recover & Stay Well: experience improved physical and mental health.
2. Choose: experience increased self-determination and autonomy.
3. Participate in daily life on an equal footing with others and specifically:
   - to 'connect' with family, friends, neighbours;
   - to 'give' in the community (eg community activities, volunteering, peer support);
   - to be included in society with reduced stigma and discrimination (especially in relation to mainstream services such as education, employment, and housing.

The Collaborative was created in January 2010 after a group of about 25 key stakeholders involved in mental health care were invited by commissioners to develop a radically different service offer. This group comprises of commissioners, providers of health and social care services, service users and carers. Organisations from both the statutory (Lambeth Borough Council, NHS Lambeth, SLaM, and GP practices) and the voluntary sector are represented on the platform. The involvement of Vital Link, a user and carer engagement organisation in The Collaborative ensured a strong process of engagement with service users and carers.

Following this initial invitation two more externally facilitated workshops in March and May further explored the development and remit of The Collaborative. At the May 2010 event, The Collaborative decided to produce a prototype new service offer within a month that would be based on a new ‘experience model’ of public services.

The new service model was based on the understanding that people diagnosed with severe and enduring mental illness need to be supported and enabled to contribute to society.  More specifically, a service experience model was co-produced which shows how The Living Well Collaborative wants public services to be experienced. 

Graph 1: How the Living Well Collaborative wants services to be experienced

Weekly meetings were held to achieve this, and group members each took on the responsibility to discuss aspects of this new service offer with colleagues at their respective organisations. Shortly after the new offer was devised, it was then made public and three consultation events took place, in August and September, to give the local community an opportunity discuss this new service model and make suggestions how it could be improved.

The key elements of the new service offer are:

Provide opportunities for service users to:

1. Co-design new services and recommend ongoing changes.
2. Support other users to work as personal guides, peer supporters, befrienders, or volunteers.
3. Control their own social care and health budgets.

Other elements are:

• Improved Access: Through ‘easy in, easy out’ arrangements for all services focused on supporting recovery and independence that will enable people to get the help when they need it.
• Easier access: to secondary care assessment and treatment; support for primary care including link workers; easier access back in should users require this; improved discharge arrangements.
• Better Guidance: personal guide/community recovery workers within the Voluntary sector will be responsible for coordinating all agencies and services involved in care and support for anyone who needs help.
• Recognition of assets: each and every person has assets and services will be designed to harness the best of everyone’s contributions.
• Capacity where it counts: improved capacity for primary care and GPs to support and manage mental health patients including easier access to social and community support options and peer support services led by service users.
• Development of an improved resource information service: creation of a virtual and physical service to support patients, carers and providers. These resources ensure that service users have up-to-date information and support to access what is available in the community. The physical resources also represent a space for people to drop-in to meet, build their networks and access the kinds of support they may require.
• Getting Connected: ensuring social inclusion through a variety of means such as time banking and volunteering.

During the discussions and consultations, providers suggested what they can put forward to the new service model. This included the development of a number of time banking partnerships and a range of peer support networks, led by the Voluntary and Community sector.

The new service offer has been implemented incrementally from January 2011 and involved initially 15 of the 48 primary care practices in Lambeth. The next stage of development in October 2013 is to introduce a major structural change to the system of care and support via the new “Front door” – the Living Well Network which will provide help and support much earlier than the current system and provide a personalised and co-productive response via integrated multi-agency, multi-disciplinary teams.

QIPP (Quality, Innovation, Productivity and Prevention) savings of £3m have been linked to interventions developed by the Collaborative over the 2011-13 period. 

The Collaborative has evidence of the value of commissioners supporting collaboration across the market and service supply chain. We are now exploring the viability of an alliance contract across primary care, social care, the VCS and secondary care encompassing the full health and social care spend (£65m per annum) on Adult Mental Health.

Check out The Lambeth Living Well Collaborative website.

Read this summary detailing the Collaborative’s principles.