Leicester, Leicestershire and Rutland
This case study shares key learnings on:
- Building local relationships through a neighbourhood lead.
- Collaboration with the voluntary sector.
- Targeting under-served populations.
Background
Leicestershire Partnership NHS Trust provides mental health, learning disability and community health services to a population of approximately 1.1 million people across Leicester, Leicestershire and Rutland.
Since 2018, the trust has been working closely with local commissioners to ensure that high quality and timely mental health support is accessible to local people when they need it.
Engaging to understand the needs and priorities of local people
In 2018, mental health services in Leicester, Leicestershire and Rutland (LLR) faced serious challenges; caseloads were high, demand was rising, and patient satisfaction falling.
To address this, the trust led co-production work to understand the priorities for local people and stakeholders, including those from the voluntary sector and local authorities. The trust engaged with 6,650 people, including service users, NHS staff and stakeholders, through online and paper surveys and in-person workshops and events. The findings showed that people wanted better access to services locally and more joined up care.
Improving access to mental health services in neighbourhoods
In 2021/22 the trust sought to expand the number of cafes operating in LLR based on the co-production outlined above. This was part of a national drive to increase mental health crisis alternatives, and improve local access to support for adults in distress. The cafes are open access, do not require booking, and act as an alternative to GP appointments or A&E attendances.
The initial ambition was to expand from four to 25 cafes by 2023/24, which aligned with the number of primary care networks at that time. This target was achieved in March 2024, and there are now 39 cafes operating across the patch every week. The cafes are situated in areas with higher rates of deprivation and/or higher referral rates to urgent mental health services. They are generally based in local authority or community centres which are owned or rented by voluntary sector organisations.
A grant approach has been used to fund local voluntary sector organisations to deliver the mental health cafes. These organisations have significant insight into the diverse needs of local communities in the area, as well as the right skills to provide support and high levels of trust and engagement from local people.
The enablers
A flexible approach has been key; no two neighbourhoods are the same. The trust covers areas with varying demographics, geographies and levels of deprivation. Flexibility is needed to tailor services to local needs and tackle health inequalities.
Building strong relationships with local partners has also been critical to delivering this neighbourhood model of care. The trust has invested in building these relationships by appointing a neighbourhood lead in each area. These are generally employed by Leicestershire Partnership NHS trust (a couple are employed by the local authority), and act as a facilitator, bringing people together and driving forward collaboration across the NHS, primary care, local authorities and the voluntary sector.
Shifting away from a transactional way of working to collaboration with the voluntary sector has been another key element of this approach. The system has worked closely with the sector and has taken the time to understand the challenges it faces. As part of this, LLR works closely with a voluntary sector representative group, comprised of eight elected members from local organisations. This group acts as the voice of the voluntary sector, shares information, identifies risks and supports planning of mental health services.
In addition, the trust’s chief executive chairs the mental health collaborative, and each place in LLR has a mental health group. This contributes to whole system buy-in, reflects the diversity of the localities and prioritises key areas of focus for mental health.
Delivering benefits for local people
In 2024/25 the cafes received 9,147 visitors. However in some areas people from ethnic minority backgrounds, such as the people from the black community, have a slightly lower rate of contact with the cafes compared to the local population as a whole. To tackle this, Leicestershire Partnership NHS Trust have formed a partnership with the local African Heritage Alliance to improve engagement, awareness and support.
Stress, anxiety, depression and isolation were all common reasons given for attending. Where an individual attending a cafe needs a higher level of support than can be provided in this setting, the cafes are embedded in the urgent mental health pathway and can refer for a clinical view. The trust is beginning to see a reduction in the number of mental health escalations, and an increase in the number of people who can maintain their mental health in the community, without specialist support.
Next steps for the trust
The trust is now looking at expanding both the hours of the day the cafes operate and the delivery points in neighbourhoods. While the trust does not have the resource to build new spaces within neighbourhoods, it is exploring other options to ensure that mental health staff are embedded locally, for instance, using non-NHS buildings for the co-location of integrated teams. Having staff based or working more regularly in dedicated neighbourhoods would give a richer understanding of local communities and their needs.
The trust is also an associate site of the national 24/7 mental health pilot scheme and connecting, supporting and accessing learning from other sites, but does not receive additional funding for this. The principles of the 24/7 approach fit with LLR’s mental health collaborative values and ambitions to make it even easier to access support in neighbourhoods, and with less criteria. To do this at scale however would require additional funding to pump-prime developments and provide resources to key organisations to deliver the approach.