Talking leadership: transforming mental health services

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This month we're talking leadership with Mandip Randhawa about the challenges of transforming mental health services for children and young people. Mandip is a consultant in the leadership and organisational development team at The King's Fund, who has been on secondment at Forward Thinking Birmingham for the past 18 months. 

Tell us a bit about the work you have been involved in?  

Traditionally, mental health services for young people are delivered by child 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 was set up nearly two years ago to address this. It delivers mental health services for children and young people aged up to 25, combining the expertise of Birmingham Women’s and 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 young people’s mental health services being driven by the partnership are rooted in the need to improve care by addressing disjointed and fragmented provision, complicated service models, long waiting lists and rising demand. Almost two years on, many of these challenges are still being addressed. These complex, systemic issues will take time and perseverance to overcome. We recognise that we are on a journey.  

I have been working as an internal organisational development consultant, supporting the partnership with team integration, culture change and developing new ways of working. I work across the partnership with leaders at all levels. 

What have been the challenges? 

Bringing together two previously distinct services (child and adolescent mental health services (CAMHS) and adult mental health) with two different cultures, both with strong identities and unique histories, has been and continues to be one of the most challenging aspects of transforming the service. Some clinicians had concerns about the new service, such as the challenges of working with a different age range, making referrals to services outside the NHS and different working hours, to name but a few. For leaders, this new service model has presented challenges in terms of cross-sector working, decision-making and accountability, governance and information-sharing.  

The challenges of integrating the services persist and progress, albeit slow, continues. The work here is systemic change and there is no overnight solution or ‘silver bullet’. Some of this is about getting the basics in place in order to address some of the wider challenges. Like many other mental health services, we face difficulties in recruiting staff, budgetary pressures and ever-increasing demand for services alongside our ambitious transformation agenda.   

The factors that helped the organisational development (OD) agenda gain traction were support and sponsorship from the senior team, building relationships with key leaders and making the case for the importance of staff engagement by using the established research on the link between staff experience and patient experience.  

As part of my role, it was initially very difficult to establish a ‘voice’ for OD within the service. Coming from the leadership team at The King’s Fund I was used to working with colleagues who ‘lived and breathed’ organisational and leadership development and this was a regular part of our ‘day job’. I hadn’t anticipated quite how different my new environment would be in terms of the operational focus. On reflection, this makes sense within a busy mental health service that had recently undergone huge change.  

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 service model and setting up a ‘buddying’ programme for experienced and new team managers. The impact of some of these interventions has been increased confidence among managers, staff having protected time and space to work through challenging issues with peers and staff coming into the organisation with a clear understanding of the model and our aspirations.  

What lessons are there for others undergoing similar challenges/change? 

There are no simple answers! Change on this scale is rewarding but challenging and complex. It is really important when implementing change and working in dynamic cultures to preserve our own energy and resilience. Find people who share the same passion and ambition as you and help each other to achieve the small-scale changes that will eventually add up to bigger change. Not everybody will want to come on the journey with you – some people can be influenced but there will be others who will never take part. We have to accept that and work with the people who are enthused about the change.  

Through this work, I have learnt that trust is essential, engagement is a constant process that has to take place every day, and that in this type of 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 in the wider system. 

Has your thinking about the role of leadership changed as a result of this project? 

Yes and no. I have a much deeper understanding of ‘leadership on the ground’, of leadership in practice and that leadership really is a way of being and behaving rather than a position or title. I have always known the importance of leadership at a theoretical level but now have a much deeper practical understanding of what it really means. It is a skill that needs regular development and nurturing.