“Caring in the Community” – Really?
About the author
My name is Steph de la Haye. I am the chair & founder of Survivors of Depression in Transition aka S.O.D.I.T a user led charity.
I am a member of the development team for community MH, as well as a freelance trainer, consultant and researcher delivering in mental health and well-being with 30 years of expert by experience and as a health & social care professional working in pre-hospital care.
I am currently a member of research teams with Leeds and Sheffield Hallam universities looking at people who attend the ED dept on a regular basis and Exercise & Depression & a member of the co-production steering group at SCIE.
My favourite album is Def Leppard – Hysteria
Putting the “community back into the community”, was a quote from one of my colleagues around the table at the National Collaborating Centre for Mental Health (NCCMH) when, as a group of academics, clinicians, commissioners, carers, and people with lived experience of using mental health community services, we worked on developing the new MH community framework for NHSE.
As someone who has used community services for over 10 years, I was passionate that any new framework needed to be driven from lived experience and that the real journeys of people’s experience, with the good, the bad and the damn right ugly, were incorporated within it.
There was a genuine drive to create something that could be a game-changer and even remove the failed Care Plan Approach (CPA) and develop something evidence based, user driven, but also co-produced - what in the light of the current ‘transformation’ of mental health services nationally was a big ask!
I felt the final approach achieved a balance within the competing and changing world of health services in England, but was also going to challenge the people and organisations that would have to deliver it.
Community Mental Health Framework NCCMH 2019
Yes, much of what we were saying has been said before, and those who are as long in the tooth as myself have been shouting, kicking and screaming about it for what seems a lifetime. Bringing health and social care systems together, genuine co-production with the community, place based, network of networks, connectors, equalities, cohesive neighbourhoods, quality benchmarks, holistic and family centred care are some of the aspects of the vision.
Yes, yes, yes, this is what people and communities need and WANT- services that are consistent, easier to access, support agency, are trauma-informed, see the person not just the diagnosis or distress and make the best supportive use & connection of community assets we already have.
The translation and delivery with pilots nationally through NHS England, as I had discovered from previous work for NHSE, was inevitably going to be a cause of those repeated headaches! Yes, I get the political and financial challenges when national policy is published, but really, the very brief translation and interpretation of the framework that NHSE produced for the national pilots, was totally inadequate and did not make the essence and core focus of the framework clear for NHS Trusts who applied for the pilots.
Also, as I found out through working with one NHS trust, the idea that the money could be used to just uplift staff numbers and then do the community co-production with what was left over, had left a sour taste, and was something that concerned us as a development group, well before the framework was published.
And this brings me to our local ‘transformation’ pilot in Sheffield, who were successful in gaining funding to develop it. Wow, whilst I may be one of the ‘usual suspects’ and I’m sure a thorn in the side of many, the lack of clarity, communication and genuine co-production from the team who were tasked with moving this forward was astonishing. As a user-led provider organisation, who has been working in Sheffield for over 25 years, the experience of the women we support was not echoing the sentiments coming from our local delivery team or commissioners.
One of the themes that the published framework clearly has as a core element is the alliance and connectivity of the local Mental health Trusts, voluntary sector, and community. As a small Disabled person user-led organisation (DPULO) we were very keen to be part of this, as most commonly it is the larger providers who get the cash or contracts. Again, while we have some progress locally in that we have much improved networks around providers in the voluntary sector, the process always seems to end up being too top heavy and administratively complex, which excludes many small, often volunteer-led, organisations.
More learning is needed, from examples such as the National Survivor User Network's (NSUN) small grants over the covid pandemic, from which we had gained a small amount of funding. This was so much more straightforward, friendly to small organisations and groups (even for those without a formal constitution), and light on bureaucracy! But the so-called integrated commissioning locally, the bureaucracy and having to jump through many hoops causing organisations like us either to withdraw or not apply in the first place, is devastating in the context of implementing the framework at a grass roots level.
Sheffield now has another strategic partner for the community MH framework in Rethink, who have created a Community Mental Health Framework unit and have worked with the Somerset early implementer site. I am hopeful that this might be more progressive and will establish improved connections and better ways of working with the smaller organisations and groups within the Sheffield community. But - and yes, there is always a but - previous experience of the large national mental health organisations parachuting in organising and ‘taking over’ still has us on heightened alert, and the initial connection has not been so good thus far!
For me, a recent example of what does and can happen in the context of community mental health is the interface between the local services, which as clearly set out in the framework, is fundamental to the actual person who needs the support. Someone we support who needed community support, ended up in an assessment centre, only to be discharged with a non-agreed safety plan (not co-produced). They were left to support themselves even while desperately wanting support from the in-patient unit, but ended up drifting alone. It was only due to continued contact and support from ourselves and others that they managed to get into a crisis house for some respite, which has helped enormously.
The moral of that short example is that, although we do not get any additional funding from the ‘transformation’ plan, nor are we part of the wider community connections they are trying to develop as they do not seem to want to connect with us, nevertheless we go beyond our roles and remit because we have experience of this ‘trauma’ and ‘ping pong’ service ourselves. And yes, we care, we are peer supporters and we are part of the community in question as we live within it.
My message to those with the ‘power’ and money is a simple one: STOP, REFLECT, and make the VISION of the framework a REALITY WITH us not TO us!
Steph de la Haye - CEO & peer consultant, trainer & Researcher Survivors of Depression in Transition (SODIT)
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