A hopeful place to start

Last week I was fortunate to spend the morning with a mix of policymakers and practice leaders in mental health. We spent some time thinking about how out of hospital mental health care should integrate into the ‘new models’ set out in the NHS Five Year Forward View being developed across England.

The people in the room had very different day jobs: leading clinical teams, commissioning services, and working in local government, versus navigating the jungle of central bodies, ministers and critical spending review discussions.

People’s backgrounds became clear when they spoke about improving services. Policymakers were concerned with improving mental health data, changing payment systems, and access standards for evidence-based services. People closer to practice spoke about changing local culture around who is eligible to receive services, the difficulties of finding funding for double running, and the importance of peer support. There was passion to improve services on all sides of the room, as well as valid concerns and priorities. But sometimes the worlds of policy and practice seemed to be talking a very different language.

Talking about new models of care – changing the way organisations are set up to deliver care in different ways – caused challenges all round. Care models are the fashionable mainstream policy of the moment, and this difference possibly illustrates the differences between mental health and physical health thinking.

Mental health trusts don’t necessarily fit easily into the new care models. Much of their care is already out of hospital, and issues concerning them are different: reversing the trend of ever raising thresholds for care and rebuilding services for children and young people. The majority of people with a mental health problem never get near a mental health trust – so new models of care need to build capacity for high quality support for mental health problems within primary care (rather than focus on integrating existing capacity), including making further progress on access to psychological therapies.

Do differences in perspective between policymakers and local leaders matter? The answer of course is ‘it depends’.

On the one hand, differences are necessary. We are all creatures of the systems we inhabit, and need different sets of language to thrive in them. In government people working in mental health making the case for investment need to evidence change for investment provided (needing data) and convince others they have the ‘levers’ to make this happen (requiring national initiatives). Equally, a local leader is not going to be interested in national efforts to collect and publish data she already has access to, and will have her own priorities for improvements.

On the other hand, if differences in perspective mean efforts are not aligned or policy is disconnected then this is a waste of effort and resources. If, for instance, the overarching barrier to improving mental health services is the local attitudes of leaders to risk then all the transparency and targets in the world will do little – and will distract locally from the changes that matter (for more on when targets can be used effectively, see our new report).

The best policy is made when it addresses the issues at the heart of the matter, and resonates with people’s motivation locally. This requires:

• an understanding of what is happening locally and the pressures services face,
• knowing the likely impact of the different measures available to drive change through policy, and
• building a consensus between policymakers, professionals and people using services as to the way forward.

Creating this set of factors is not an easy task, but we believe it starts with conversations. Conversations between those delivering services, those using them, and those advocating for them and shaping them nationally. And not separate conversations – but one discussion encompassing all those with a stake in services.

Reflecting on our mental health and new models conversation, the aspect that has stayed with me is not the differences between people but the similarities. Everyone there was passionate about making services the best they could be: and agreed this meant supporting people to be hopeful. And, despite the differences between policy and frontline professionals, this feels like a fairly hopeful place to start a conversation.

Felicity Dormon is Senior Policy Fellow at the Health Foundation.

Follow her on Twitter @FelicityTHF.