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.
North East Lincolnshire
North East Lincolnshire is a deprived local authority in England, with 156,972 residents according to the 2021 census. The region is the 29th most deprived in England for the Index of Multiple Deprivation (IMD) average score measure, with two of its wards being in the most deprived 1% of wards in England and five in the most deprived 10% (Ministry of Housing, Communities and Local Government, 2019).
62.5% of people in North East Lincolnshire have long-standing mental health conditions (Public Health England, 2020). This disparity is further exacerbated by emergency admissions for self-harm, with East Marsh, the most deprived ward, having an alarming 185.3 admissions per year, nearly double the England average (NHS Digital, 2020).
How does the alliance work?
The North East Lincolnshire VCSE alliance is a collaborative network of VCSE organisations that work together to improve the mental health and wellbeing of a deprived population. It was created as a driving force for community mental health transformation, the aims of which include shifting the focus of mental health services from hospitals to communities, and blending provision from across all sectors. It partners with the NHS and the local authority to shape the commissioning and delivery of mental health services locally. It has also achieved notable success in its work with people with lived experience of mental health issues.
The alliance – which has 66 members – set up its governance and membership structures through a Terms of Reference and an Expression of Interest process in early 2022, and since then has been working to set a strategic vision for its work, engage a range of stakeholders including experts by experience, and influence how resources are deployed across the system, including through voluntary sector providers.
The alliance developed a unified mental health strategy, which was launched by the North East Lincolnshire Health and Care Partnership in late 2023.
The strategy outlines the following key priorities for improving mental health and wellbeing in North East Lincolnshire:
- A culture of kindness
- Focus on prevention
- Better communication
- Reducing stigma around mental illness
- ‘No wrong door’ approach
- Person-centred care
- Waiting well
- Shared training offer across all organisations
Expert by Experience Leaders played a vital role in supporting the development of the strategy and driving its implementation. They organised a listening event where they invited key stakeholders, including members of the integrated care board (ICB), local health commissioners, CEOs, senior leaders from Navigo – the local mental health service provider – and local authority councillors. The experts by experience have gained confidence and skills since they started, and North East Lincolnshire has seen a transformation with respect to coproduction and inclusion of the voice of lived experience.
Under the auspices of the strategy, the alliance has influenced a range of projects and collaborative approaches to address emerging needs such as post-Covid mental health support, children’s mental health, measures to prevent early mortality, and suicide prevention. It worked with – and increased the impact of – four Mental Health Navigators who helped people with mental health needs to access appropriate services and support. They work closely with primary care teams in four settings in North East Lincolnshire, and liaise with other agencies (such as social care, housing, education, and voluntary organisations) to ensure that people receive coordinated and integrated care across different sectors. They offer advice, information, signposting, referrals, advocacy, and practical assistance to people who experience mental health difficulties and their carers.
The alliance has guided and supported funding for projects which focus on addressing the complex needs of vulnerable people, for example dementia services. As the Charities Aid Foundation funding is ending soon, more funding is being requested from the system to sustain the work.
What have we learnt?
The alliance is a remarkable example of how VCSE organisations can collaborate to enhance the mental health and wellbeing of a disadvantaged population. It has benefited from its strong leadership and collaborative approach.
The alliance work has been a mixture of success and frustration, with the mental health strategy being the biggest success. Accessing funding has been a huge challenge, with, as one workshop participant noted, the ICB “not seeming ready, or able, to fund properly, and Rethink bids were either not submitted or successful”.
Some of the key insights and learning points from the alliance work are:
The mental health strategy in North East Lincolnshire is a remarkable achievement that demonstrates the power of coproduction with experts by experience. It reflects the needs and aspirations of service users and sets out a clear vision for improving mental health outcomes. It demonstrates the value of championing and implementing strategy, as well as sharing learning and best practice with other systems that want to adopt similar approaches.
Accessing funding from the ICB has been a major barrier that threatens to hinder the sustainability and scalability of the alliance’s work. Alliances should seek to engage more effectively with ICBs and communicate the value and impact of their work. Exploring alternative sources of funding, such as grants or social investment, can support their innovative and collaborative initiatives over time.
The mental health alliance is recognised as a leading example of how VCSE organisations can work together to address complex and systemic challenges. The alliance has leveraged its reputation and influence to create new strategic opportunities. There is a strong potential role for alliances elsewhere in taking the lead on local strategies and building on the opportunities they bring, and in seeking to expand their networks with other organisations and sectors.
Working with experts by experience has been a rewarding and transformative experience that has enriched the alliance work and culture. The experts by experience have brought valuable insights, perspectives, and skills to the coproduction process and have contributed to the design and delivery of services. The experts by experience have also benefited from being involved, as they have gained confidence, skills, and peer support. Alliances would benefit from continued involvement of experts by experience in all aspects of their work, and should ensure that they are adequately supported and rewarded for their contributions.
Collaborative working is a key strength and asset of the alliance, as evidenced by the high levels of trust, communication, and coordination among the alliance members and other stakeholders. The alliance has used various methods and platforms, such as the mental health strategy and listening events, to engage with a wide range of people and organisations and to foster a shared vision for mental health. There is a clear message here for alliances facing similar challenges: remain committed to maintaining and enhancing collaborative working practices, and seek to involve more diverse and marginalised voices in the work.
