Tackling culture change to transform mental health services

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I work as a consultant in the leadership and organisational development team at The King’s Fund, and for the past eight months have been on secondment at Forward Thinking Birmingham – an innovative mental health partnership seeking to transform mental health provision for young people. My role has involved supporting the organisation with team integration and culture change.

Traditionally, mental health services are delivered by Children and Adolescent Mental Health Services (CAMHS) up until the age of 16 or 18 – or when a young person leaves school or college – at which point they’re expected to transition to adult mental health services. It’s long been recognised that this is a poor boundary for service transition, often having a further detrimental effect on mental health.

Forward Thinking Birmingham delivers mental health services for children and young people aged up to 25, combining the expertise of Birmingham Children’s Hospital, Worcester Health and Care Trust, Beacon UK, The Children’s Society and The Priory Group. The partnership’s vision is that Birmingham should be the first city where mental health problems are not a barrier to young people achieving their dreams. The transformational changes to the service were driven by the need to address disjointed and fragmented care provision, complicated service models, long waiting lists and rising demand. The service operates a ‘no wrong door’ policy and aims to provide joined-up care, focusing on individual needs, with improved access and choice for young people.

Though it is difficult to argue with the need for this reform, the change has brought about unprecedented challenges to the way services and organisations have traditionally been set up, the way mental health services are commissioned and delivered, and crucially to the way mental health professionals are used to working. Bringing together two previously distinct services (CAMHS and adult mental health), from two different organisations, both with strong identities and unique histories, has been one of the most challenging aspects of transforming the service. Many clinicians had concerns such as working with a different age range, making referrals to services outside the NHS and different working hours, to name a few. And for leaders across the organisation this new model has presented challenges in terms of professional status, decision-making and accountability, governance and information-sharing. They are also having to carry the expectation of this model being a success.

Changing culture in the workforce is crucial to the success of any transformation programme – maintaining morale and encouraging staff to adopt new ways of working while supporting them through the change process has been a huge challenge. For us in Birmingham this is still very much work in progress, and part of my role has been helping people to understand that embedding change of this kind will not happen overnight.

Some examples of the work I have been involved in include co-designing and delivering strategy development sessions, running action learning sets (working collectively in small groups) with service managers, developing an induction programme for staff to explain the new model and setting up a ‘buddying’ programme for experienced and new team managers. Through this work, I have learnt that trust is essential, engagement is a constant process that has to be worked at every day, and that in this type of coaching role you are very much the oil and not the engine. My experience of working with people who are challenging themselves to deliver a new model of care that puts service users firmly at the heart of what they do has given me a real insight into the scale of change needed.

However, I’m proud to say that this is not stopping us from trying to achieve our vision for young people to flourish and achieve their potential. Forward Thinking Birmingham’s innovative model of service delivery calls for a particular type of leadership – leaders who can work across organisational boundaries; who are willing to share power and resource in pursuit of a shared vision; and who can, in the words of The five year forward view for mental health, ‘take decisive steps to break down barriers in the way services are provided to reshape how care is delivered, increase access to the right care at the right time, drive down variations in the quality of care on offer, and improve outcomes’.

I am encouraged by the passion, commitment and tenacity of leaders in Birmingham working to achieve transformation in mental health services for young people. There is still a long way to go but now – almost a year since Forward Thinking Birmingham was launched and just over a year since the Mental Health Forward View was published – might be a good time to pause and reflect on the real progress made so far.