In October 2018, in a local community building in Salford, a new group of frontline workers, people with lived experience, voluntary and statutory sector workers, commissioners, providers and system leaders, sat in a room together to embark on their journey to design the future of community mental health support in Salford. This was the first step in becoming a Living Well system, as part of the Living Well UK programme, delivered by Innovation Unit and funded by the National Lottery. I had the privilege of being the designer that worked with Salford. – Words by Ella Walding, Senior Service Designer, Innovation Unit.
Collaboration and co-production were not new words to Salford, quite the opposite, you could see these values being lived across the system, from the supportive and empowering conversations on the front line, to leaders listening to peers at the top. But what was new, was a structure that enabled all of these groups to come together and make joint decisions about the future of the system, in a way that joined up leaders, managers, front line staff and people with lived experience.
This group became the Design Team in Salford, the beating heart of the change process that would work, on behalf of the wider system, to design and support the implementation of a bold new vision for mental health support. In addition, a Collaborative, a group of system leaders, front line staff and people with lived experience, was also brought together to help steer the vision, troubleshoot problems and create a movement for change. This process built the engagement of people with lived experience into the heart of design work, and thus into the model.
What is a Living Well System?
Living Well systems are designed to help people recover and stay well as part of their community. They ensure that good mental health matters to everyone, and enable communities and systems to embrace and nurture everyone’s mental health.
The first place to create a Living Well system was Lambeth, in South London. National Lottery has funded adaptations of Living well systems in Tameside and Glossop, Salford, Luton, and Edinburgh. All Living Well systems are underpinned by a set of core features and values.
Together, Living Well sites are part of a national community of practice intent on reimagining mental health systems to really work for those that use them.
‘The process you use is the change you get’
In Salford, the Design Team’s role was to redesign the way community mental health is delivered. Fundamental to design is understanding the way people experience services to ensure these are actually helping people to transform their lives. Salford Design Team started the process by listening to, and amplifying, the real experiences of staff and people. They approached this with eagerness, curiosity and a willingness to learn.
The stories gathered were stories of adversity, bravery, suffering and hope. They exposed the full complexities of people’s lives and the inflexibility that, despite best efforts, the system can show in the face of complexity: getting people to retell a story many times; asking people to translate their complex experiences into the language of ‘mental health’; and people not getting the support they need, and deserve, because of the boundaries that have been created to manage demand (or to use a more appropriate word, need).
The Design Team used these stories to cocreate a new front door to mental health that would ensure that people in Salford felt ‘empowered, supported, heard, and able to live the life they want to lead’. They held extra sessions with a wider group of more vulnerable people to explore how the ways of working they were creating would be understood and experienced.
It is often said that the process you use to create a change determines the change you get, this was true in Salford. Salford wanted to take the experience of listening to stories and to place this, not only at the heart of solution development, but also at the heart of service delivery. As a result, Salford developed the idea of listening lounges, spaces people can go to, that operate from different places in the community at different times, for example, in the library, church or GP surgery. They are a safe space for people to share their stories, reflect on their situations and be supported to take action to improve their wellbeing.
Salford also wanted people to be in charge of their own stories and narrative, and to ensure their needs and aspirations were at the centre of everything. They created My Story and My Plan, a personalised recovery and support plan, created and owned by the individual, facilitated by the listener and team. Storytelling has transformed the concept of care planning from something that gathers the information the professional needs to slot the person into the best available care pathway – to a holistic community response to a personalised narrative that is told and owned by the person. This would ensure that no one has to retell their story and that conversations are guided by what matters to the person, rather than what the system needs.
My Story My Plan was created using story gathering tools, local resources and new creations developed in the design team. It was then tested, prototyped and iterated with people with lived experience of mental ill health. The group made subtle amendments to the language used which often reflected a shift in the culture of the relationship between professionals and people. For example, starting the conversation by asking the person to list, “What is important to me? What do I need you to know?” rather than focusing on what is important to the system.
What has Salford created?
Salford has designed a new community mental health offer, accessed through a new welcoming Living Well multi-disciplinary team who connect to people in their community spaces. This team brings together statutory, voluntary workers and peer support. They work using a common practice model and share decisions, responsibility and risk. They ensure the support that they provide considers the whole person, treats people as citizens within communities, rather than ‘patients’, and looks beyond people’s mental health challenges. The team connects into an integrated network of support, united by a set of joint working principles. It is the team’s job to ensure that people have a seamless experience, the right support when and where it is needed, and go on to be held and supported by the community.
A multidisciplinary team are prototyping the new ways of working with people with lived experience, over a 3 month period, before they start to grow. Starting with a prototyping approach allows the team to experiment, take more managed risks, and gives staff the permission to redesign the offer to meet people’s needs. This means the practice model being developed is grounded in the feedback from those being supported. Design is not just a process the team used to develop new ways of working but design has become a way of thinking and doing, to deliver the work.
Salford are currently:
- continuing to gather stories. Staff have received ethnographic training and they have appointed a new post to oversee the gathering of stories. These stories are the heart of learning and practice;
- building reflection and learning into their practice model and are running regular ‘learning sessions’. There is a culture of learning and empowerment in a context where staff are inspired to innovate;
- running ‘prototyping labs’, open workshops, to include the broader system and community in the development of the design;
- continuing to meet as a Collaborative to embed collective system leadership, a space where leaders sit alongside people with lived experience and make decisions about the future of the mental health system.
Collaboration and coproduction are not just values that are lived in Salford but also structures that are built into their system as ongoing learning loops. Listening to people and improving the model will never cease, these activities are not just one stage of a process, but story gathering and learning loops are a part of their practice. I, for one, cannot wait to see what they do next!
Words by Ella Walding
Senior Service Designer, Innovation Unit
Published on September 25, 2020 at 11:57 am