How thinking differently can support community mental health transformation

I'd like to tell you about Max*. Max has been in and out of secondary care mental health services over the years. Sometimes getting support from his GP. Often escalating into crisis. Never really getting the support he needs to stay well.

One Monday morning a colleague working at a small local charity met Max who was in the street, in a state of distress and agitation. Max's benefits had been stopped and he was without money or food. His mental health was deteriorating and he was escalating into crisis. Max was accompanied across the road to the local community mental health hub. Colleagues from the hub worked with Max to help him to ground himself and to de-escalate the situation. Subsequently a range of support was arranged:

• A food parcel from a local food bank
• Specialist citizen's advice casework
• Voluntary, community and social enterprise (VCSE) community crisis safe space
• Peer support.

Within a few days, Max's benefits had been reinstated and he was linked up with a multi-disciplinary team. A VCSE recovery and wellbeing worker worked with Max's clinical team to create a single recovery plan. He was safe, his needs being met and on the path to recovery.

Max's situation will be familiar to many people working within mental health systems across the country. Sadly, the story for many people living with mental illness has often been different. A&E, primary care and emergency services will frequently be the place people first seek help, but not be able to provide the care that is really needed. While it may not be possible to prevent crisis escalation in every situation, we can and should be doing more to provide the right support in the right place at the right time. It was Open Mental Health – the community mental health transformation that has taken place in Somerset, as one of 12 early implementers of the community mental health framework – that made a different, better outcome for Max possible.

Commitment from Somerset's senior health and care leaders to doing things differently has been crucial. This has enabled the co-produced model that is Open Mental Health Somerset. Open Mental Health has been developed, not only by a group of NHS professionals sitting around a table, but by mapping community assets that already exist.

Collectively, we have built a voluntary sector alliance that can collaborate with Somerset NHS Foundation Trust, Somerset Clinical Commissioning Group (CCG) and Somerset County Council on the design, development and delivery of a new way of working together. A 'whole system' workforce has been created to enable people to access the support they need when they need it.

Rethink Mental Illness has gathered the learning from early implementers to develop our blueprint for the implementation of the community mental health framework. NHS trusts and CCGs across the country are now grappling with the implementation of this transformational framework – and the implications of getting this right are huge. Rethink Mental Illness has been campaigning for this sort of change for the past 50 years. This is a once in a generation opportunity to make a difference for people like Max. The time really is now.

In our first guide, Thinking differently, we set out the first five steps to take on this transformation journey:

1. Leadership and governance – convening and mobilising the system wide group of leaders (NHS, social care, VCSE and experts by experience) that are empowered to make decisions and drive forward the transformation.
   
   
2. Co-production – embedding a co-productive culture as a key enabler of transformation – putting the voice of lived experience at the centre of design and delivery.
   
   
3. Mapping community assets – understanding what already exists to support people severely affected by mental illness and complex needs. Consider the wider determinants of mental health. Consider institutions – faith groups, sports clubs. What's strong? Where are the gaps?
   
   
4. Alliance building – bringing together a 'coalition of the willing' – VCSE partners aligned around a shared vision to work in partnership with statutory colleagues.
   
   
5. Workforce – thinking broadly and beyond the usual scope of traditional NHS roles. Peer support, for example, is crucial.

In our second guide, Keep thinking differently, we set out the next five steps:

1. Address and overcome barriers – there will be roadblocks to overcome. Scepticism, resistance to change, lack of trust – these are common themes. Demonstrating what is possible by learning from others, creating buzz and momentum around the transformation and actively challenging existing power structures can all help.
   
   
2. Measure and evaluate – a transformed community mental health system needs a new approach to measuring impact. We must continue to challenge the status quo – innovative approaches will not fit the existing mould and so we have to be willing to test and learn.
   
   
3. Commission and contract – there is no 'one size fits all' approach, but there are useful examples from across the country. Somerset's innovation partnership and Lambeth's alliance contracting are both interesting models to consider.
   
   
4. Recruitment and skills development – transformed models of care provide great opportunities for diverse multi-disciplinary teams that bridge statutory and voluntary sectors. In Somerset, a whole staff team training matrix is being co-produced and a system wide peer support framework has been developed.
   
   
5. Co-delivery of the model – transformational change takes time to embed and become business as usual. Relationships and trust that have taken time and effort to build must continue to be nurtured. There will be challenges along the way – there is no time for complacency.

It's clear that none of these steps are straightforward. A model that's right for Somerset won't necessarily work in the same way in Coventry and Warwickshire. The governance framework for a VCSE alliance in Sheffield can't be lifted off the shelf and used in Devon. There is, however, a growing bank of helpful tools, structures and processes and many good practice examples that can support integrated care systems across the country with the challenge and opportunity that lies ahead.

At Rethink Mental Illness, within our new community mental health unit, we are working in partnership with NHS, local authority and VCSE colleagues across the country to build on and develop approaches to community mental health transformation. Some key questions are emerging:

• How can the voluntary sector successfully form alliances that will be equal partners with statutory colleagues?
• How can systems use relational forms of commissioning that encourage collaboration and reduce competition?
• How can co-production be embedded for continued involvement and participation of people with lived experience?
• How can a cross sector workforce begin to address health inequalities?
• How can social care become a crucial part of the community mental health framework?
• How can we embed culture change to support transformed mental health services?

There are some great best practice examples that begin to answer some of these questions. We will be working with partners across the country to share and spread as we test and evaluate approaches. The challenge is great, but the opportunity to really make a difference for people severely affected by mental illness is one that must not be lost.

* Max's name and some details of his story have been changed to protect his anonymity.