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Cultural change is as important as funding in transforming mental health


There is a growing disquiet around mental health. Across the board people are calling for change, but what exactly is it that needs to be done and how can we bring about the ‘parity of esteem’ that we all seek?

As the London Health Commission considers how best to provide for the health and wellbeing of Londoners, the London Mental Health Trust Chief Executives Group asked The King’s Fund to engage with stakeholders to help develop a vision for London’s mental health over the next 5–10 years. Our report, Transforming mental health: a plan of action for London, is the culmination of that process.

Our engagement events attracted a wide range of attendees, including:

  • NHS mental health and primary care providers

  • social care providers

  • specialist housing providers

  • local authority and clinical commissioning group (CCG) commissioners

  • representatives from NHS England, Public Health England and the Metropolitan Police Service

  • independent and voluntary sector providers and innovators

  • academics

  • clinicians

  • service users and carers.

These events were booked up immediately, showing that there is a real passion to improve the mental health of those living in London. The experiences that were shared at those events also demonstrated an abundance of expertise in the capital. By the end of the workshops participants had developed a strong consensus on what was working, where the problems were and, importantly, what needed to change.

So, are Londoners unique? It appears not. Many of our findings are reflected in the most recent national vision, Starting today. And a more thorough search of the literature highlights the same issues arising again and again in reports going back over a decade. For the organisations writing these documents alarm bells should be ringing!

Mental health can rarely be considered in isolation; its impact infiltrates every part of our lives and all sections of society. As mental health cannot be separated from physical health, so improving health outcomes overall requires the involvement of multiple stakeholder groups. However, while attendees at our sessions could agree on a vision for the future, they held disparate and often conflicting views on how to achieve this. This was matched on the ground by widespread reports of disharmony between providers and commissioners; a lack of engagement with services users, carers and clinicians; and numerous strategies with duplication of effort and little in the way of shared agendas. Therein lies the problem.

These cultural issues create a significant barrier to implementing change. While we are not blind to the financial pressures that face mental health provision (our previous work on mental health transformation highlighted the importance of financial support for transformation), funding alone is unlikely to deliver the systemic changes being demanded without a shared plan of action.

But there is light at the end of the tunnel. Our work on collective leadership demonstrates that collaboration is at the heart of culture change. Observing commissioners, providers, service users, academics, carers and clinicians working together to create the first parts of the action plan proves that it can be done. Groups such as Lambeth Living Well Collaborative are already putting this into practice at a local level. Our report highlights nine key steps to facilitating collective solutions and ensuring progress at an organisational and systemic level.

As we move towards a general election, the voice of the mental health community has not gone unheard, but shouting about the siloed status of mental health is not the same as breaking down the walls of that silo. As anyone who lives with mental health problems will tell you, navigating life is a continual process of reaching out and building relationships in order to overcome barriers – isn’t it about time everyone else stepped up to do the same?