Over the past three years, Centre for Mental Health has conducted a research project on the impact and groundbreaking potential of the local mental health alliances led by Rethink Mental Illness in Coventry and Warwickshire, North East Lincolnshire, Sheffield and Tower Hamlets.
Funded by the Charities Aid Foundation, the programme ran from January 2021 to December 2023. Its purpose was to build on the success of their work in Somerset leading an alliance of voluntary, community and social enterprise (VCSE) sector organisations and collaborating with other partners to improve mental health locally. The funding enabled the development of four more alliances across the country, based on this model.
The evaluation questions focused on:
- How mental health alliances are formed and governed
- The benefits and challenges of working with VCSE organisations and experts by experience
- The influence of mental health alliances on the provision and quality of mental health services and support
- Commonalities and differences between alliances
- Key lessons and recommendations for developing and supporting mental health alliances in other localities and regions in the future.
Coventry and Warwickshire
Coventry and Warwickshire is a large area with diverse demographics and contrasting urban and rural spaces, including the city of Coventry, north Warwickshire, Rugby to the east, and south Warwickshire. According to the Office for National Statistics (2019), Coventry and Warwickshire has a population of about 1.1 million, with Coventry being the second largest city in the West Midlands region after Birmingham. The area has a diverse ethnic composition, with 16.3% of the population belonging to racialised communities, compared to 14.6% nationally. The largest racialised community is Asian/Asian British, accounting for 12.5% of the population.
The resourcing of services has been primarily focused on large charities and organisations, with short-term pilots often failing to be re-funded. A report by Voluntary Action Coventry and Warwickshire Community and Voluntary Action (2015) found that the voluntary and community sector in Coventry and Warwickshire faced significant challenges in funding, sustainability, and capacity. The report noted that the sector was dependent on grants from public bodies, which were subject to cuts and changes in commissioning practices. The report also highlighted the need for more collaboration and partnership between voluntary and community organisations and other stakeholders, such as health and social care providers, local authorities, and businesses.
Services in Warwickshire are based in towns like Nuneaton, Bedworth, Leamington Spa, Warwick, and Stratford Upon Avon. The rural areas of north Warwickshire and south Warwickshire on the peripheries of the towns lack access to public transport and resources, making health care access difficult and putting pressure on primary care networks (PCNs) and GP practices. A study by Warwickshire County Council (2017) explored the health and wellbeing needs of rural communities in Warwickshire. It identified several issues that affected the access and quality of health and social care services in rural areas, such as: lack of transport, isolation, an ageing population, deprivation, digital exclusion, and workforce shortages. The study recommended developing more integrated and community-based models of care, enhancing digital infrastructure and skills, and improving engagement with rural communities.
How does the Coventry and Warwickshire VSCE Mental Health Alliance work?
The Coventry and Warwickshire VSCE Mental Health Alliance is a pioneering initiative that was launched in 2021 to address the urgent and complex needs of people with mental health problems. The alliance aims to fill the gaps in mental health services that exist due to the lack of a coordinated and comprehensive strategy across the health and social care system. The alliance sought to bring together a diverse range of organisations from the VCSE sector, who have expertise and experience in delivering person-centred and holistic support for people with mental health challenges.
The alliance faced initial tensions and uncertainties as it was not clear what value it would add to the existing landscape of mental health provision. It encountered difficulties in managing the expectations and interests of different stakeholders, including the NHS and local authorities. To overcome these challenges, the alliance adopted an incremental approach of building relationships with willing allies and a determined focus on engaging with people with mental health needs and their carers. The alliance has worked closely with PCNs to coordinate multi-agency multi-disciplinary teams (MDTs) to discuss and plan support for people who fall through the gaps of the current system, as they are too unwell to receive primary care but do not meet the threshold for secondary care. They meet frequently and have had a demonstrable impact on improving the lives of people with complex needs.
The alliance’s flagship service is REACH, which is a provider collaborative comprising 11 VCSE organisations, including Coventry and Warwickshire Partnership NHS Trust, Valley House, Citizens Advice Coventry, Artyfolks, and members of the Cultural Inclusion Network. REACH provides a range of interventions, such as peer support, counselling, advocacy, befriending, social prescribing, arts and cultural activities, and debt and welfare advice, to support the wellbeing, recovery and social inclusion of people with mental health problems. REACH also works to reduce stigma and discrimination and to promote awareness and understanding of mental health issues among the wider community.
In 2022, the alliance received funding for infrastructure development and established the partnership board, which oversees the strategic direction and governance of the alliance. The partnership board consists of representatives from the VCSE sector, PCNs, the integrated care board, Coventry City Council, Warwickshire County Council, and experts by experience. The partnership board was briefed to ensure that the alliance is aligned with the national and local policies and priorities for mental health and that it collaborates effectively with other partners in the system.
The alliance secured funding for two new services that address the specific needs of some of the most vulnerable and marginalised groups in the population: a VCSE Talking Therapies service promoting engagement with NHS Talking Therapies; and a winter pressures dementia service, which offers support for people with dementia and their carers to cope with the challenges of living with the condition particularly through the winter months.
What have we learnt?
There is a lot for others to learn from the experience in Coventry and Warwickshire.
The Coventry and Warwickshire VSCE Mental Health Alliance has demonstrated its ability to adapt and maintain strategic relationships with key stakeholders in the health and social care system, such as trust and ICB leads, GPs, PCNs, and clinical teams. This means that it has influenced policy and practice at various levels and has worked hard to ensure that the voice of the voluntary and community sector, and experts by experience, are heard and valued. It is clear from the work in Coventry and Warwickshire that alliances should nurture and expand such relationships in their areas and share learning and best practices with other areas that may benefit from hearing insights about the alliance model.
The data suggests that the alliance model in Coventry and Warwickshire has been effective, but the shift from competition to cooperation has been challenging, as it requires a change of culture and mindset among voluntary and community sector organisations. This means that the alliance needs to continue to invest in building trust, mutual understanding, and shared values among its members, and address any power imbalances or conflicts that may arise. Alliances should provide sufficient opportunities for learning and development, peer support, and joint working, and work to resolve any issues or disagreements in a constructive and respectful way.
Agreeing on clear, measurable outcomes and indicators is beneficial. Whilst the alliance’s initial focus on building relationships was widely welcomed, for some the absence of a concrete and quick-yield work programme led to a sense of frustration at the slower realisation of benefits.
This means that, in hindsight, the alliance might have developed a more robust and realistic plan of action, with clear roles and responsibilities, timelines, and budgets, and also monitored and evaluated its progress and impact. In light of this insight, alliances should involve all their members in planning processes, and also use a participatory and evidence-based approach to measure and report on the outcomes and impact of its work. The successes in Coventry and Warwickshire came from the alliance’s willingness to encourage all its members, including experts by experience, to engage.
Future funding opportunities are expected to be influenced by the Mental Health Collaborative, which is a partnership between the NHS, local authorities, and the voluntary and community sector to improve mental health outcomes. Sustained support for the alliance will enable it to access more resources and support to deliver its aims and objectives, and also contribute to the wider, ongoing transformation of mental health services. There is learning here for established and nascent alliances and their funders when making decisions related to resources. Funding should be allocated in ways that reflect the needs and priorities of local communities, which can vary significantly, even in small areas, as well as the voluntary and community sector. As part of this, it is crucial that alliances agree how to monitor and evaluate the funding’s impact on the quality and accessibility of mental health services and the lives of people with mental health difficulties.
When set in the context of demonstrable mental health need and local inequalities, funding for grassroots groups and organisations in Coventry and Warwickshire had been insufficient for years, sometimes leading to competition and limited collaboration, as smaller and more marginalised groups felt excluded and overlooked by the larger, more established organisations. There is a strong message here. Funders need to acknowledge the role that these smaller organisations can play, and must ensure a fair and transparent distribution of funds. In parallel, there needs to be opportunities for engagement and involvement of the grassroots groups in an alliance’s activities and decision making, and it can take time to build their capacity and confidence to take a seat at the table.
Smaller organisations from the voluntary and community sector in Coventry and Warwickshire sometimes saw larger charities, and statutory players as having power and resources, and felt intimidated, ignored, or threatened by them. The alliance strove to foster a more equal and respectful relationship between the organisations, and also advocate for more recognition and support for the voluntary and community sector’s role and contribution to mental health. Alliances should promote awareness of the local voluntary and community sector’s strengths and challenges, and also lobby for more representation and influence in the strategic and operational decision making of local health and social care systems.
NHS commitment to the alliance gathered momentum over time. This resulted in clear support for the alliance’s vision and mission and deepened colleagues’ understanding of what the voluntary and community sector can do, as well as their deep connection to the communities with which they work and their skills in innovation. The experience in Coventry and Warwickshire shows that alliances thrive when communication and collaboration with NHS partners is strong and sustained. Progress can be made when alliances show their value in helping the NHS, and other statutory providers, meet their priorities and goals. Our analysis leads us to conclude that alliances should strive to establish more regular, meaningful interactions and feedback mechanisms with NHS partners, and also showcase the achievements and benefits of the alliance’s work to the NHS’s outcomes.
A strong commitment to coproduction has been fundamental to the programme’s achievements in Coventry and Warwickshire, as the alliance has involved people with lived experience of mental health issues in all aspects of its work, from design to delivery to evaluation. This has ensured that the alliance’s work is relevant and responsive to the people it serves, and that it has learned from their insights and feedback. Alliances should sustain and enhance their coproduction approaches, and share the learning and good practices with other VCSE organisations that may want to adopt or improve their engagement methods.
