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.
Sheffield
Sheffield is a vibrant and diverse city in the north of England, with a population of over half a million people. It is renowned for its industrial heritage, cultural scene, green spaces, and friendly communities. However, like many urban areas, Sheffield faces significant challenges in terms of mental health and wellbeing. Some of the factors that contribute to these mental health issues are poverty, social isolation, unemployment, discrimination, trauma, and substance abuse – the ‘big ticket’ issues for cities. There are multiple challenges in providing adequate and accessible mental health services for its diverse and complex population.
One of the key policy documents that guides the provision of mental health services in Sheffield is the Sheffield Mental Health Strategy 2019-2024, which was developed by the Sheffield Health and Wellbeing Board, a partnership of local organisations that aims to improve the health and wellbeing of the city’s residents. The strategy sets out a vision, priorities, and actions for improving mental health and reducing inequalities, based on evidence, best practice, and consultation with stakeholders.
Priorities of the strategy include: promoting positive mental health and resilience; preventing mental illness; providing timely and appropriate support; and enabling recovery and inclusion. The strategy recognises the importance of coproduction, collaboration, and integration across different sectors and services, as well as the need to measure and evaluate outcomes and impact (Sheffield Health and Wellbeing Board, 2019).
What does the Sheffield mental health alliance do?
One of the innovative initiatives that emerged from the Sheffield Mental Health Strategy is the Synergy VCSE Alliance for Mental Health, which is a pioneering initiative that brings together diverse organisations and people with lived experience of mental ill health to address the complex and interrelated needs of individuals and their support networks.
Synergy is a partnership of voluntary, community, and social enterprises (VCSEs) that work with Primary Care Sheffield and over 100 other VCSE organisations to create a more collaborative and person-centred mental health system. Synergy has a strong commitment to involving and empowering people with lived experience at all levels of decision making and service design.
The alliance is composed of a partnership board with representatives from seven VCSE organisations and two experts by experience, and a lead accountable body, Rethink Mental Illness, that handles the administrative tasks and supports the lived experience engagement. The alliance aims to transform the mental health system by fostering greater cooperation among different support providers, setting standards for meaningful lived experience involvement, and putting the needs and preferences of people with mental health challenges and their supporters at the core of their work.
By working with experts by experience and over 110 VCSE organisations, Synergy seeks to improve mental health outcomes and wellbeing for people and communities in Sheffield. The alliance draws on the lessons learned from the Changing Futures programme – a national initiative that aims to improve the lives of people who face multiple disadvantages, such as homelessness, addiction, mental health issues, and criminal justice involvement – which showed the value of involving people with lived experience in designing services.
The next steps for Synergy are to evaluate and share their learning and impact, and to scale up and replicate their successful initiatives in other regions, as well as to ensure that funding is sustained.
The Peer Support Framework was a key achievement of the alliance. Its purpose is to make sure that all 15 primary care networks in Sheffield have a peer support offer for their patients. The peer support workers are hosted by VCSE organisations embedded in the communities that will be supported by the offer. This contract is managed by Synergy, and this means that the procurement process for host organisations was not hindered in the ways it can be when contracts are offered to VCSE organisations through NHS trusts. Synergy managing the contract also means that VCSE organisations were able to input on the documents that would guide their delivery of the contract, meaning that they accurately described what would be delivered and reflected the work that would result.
Traditionally, VCSE organisations have felt that the work that they deliver for statutory services is not reflected in the service specification. Also, as a contract managed by Synergy, experts by experience were also able to input on the design of the service. This means that the service as a whole has been shaped by the people who have experience of accessing the services. Without the input of experts by experience, there was a risk that the service would not work as intended. Synergy is equipped with the capacity and experience needed to ensure that lived experience input is meaningful and representative of Sheffield’s population.
Synergy members frequently comment that barriers to accessing mental health services are particularly pronounced within minority communities. There are also concerns that services developed from a Eurocentric perspective deliver poorer outcomes among people from these communities. These opinions are validated by statistics on outcomes for racialised communities that have shown little improvement. By having a standing Marginalised Communities Working Group, Synergy is well situated to make proactive proposals and tailor service design to the needs of the community.
What have we learnt?
To tap into the diversity and innovation of stakeholders across Sheffield, the Rethink Mental Illness team, as the driving force behind Synergy, actively sought out and engaged with groups and individuals who could offer new perspectives about the city-wide strategy. This took a lot of time but was fruitful and fostered positive relationships. They identified and worked with organisations that shared their vision and values, while acknowledging that, for the alliance to be successful, it had to have a broad membership with diverse interests.
The Rethink team did a thorough and participatory analysis of the mental health system in Sheffield, involving different stakeholders and using their insights to shape their strategy and actions. This helped them to understand the system and its challenges better, and to design more effective and appropriate solutions. A key learning from this is that other alliances could profitably do the same: conduct a comprehensive and inclusive mapping of the existing landscape of the mental health sector and its stakeholders, and use this information to inform their strategies and actions.
One of the key principles of system transformation in Sheffield was to coproduce solutions with the people who use and deliver mental health services. The Rethink team applied this principle by engaging a diverse range of stakeholders, including organisations, community representatives, and experts by experience, in every stage of their work. They ensured that these stakeholders had meaningful roles and influence in decision-making processes, rather than being tokenistic or consultative. This enabled them to design and deliver services that were responsive to and representative of the local needs and preferences, and to build trust and legitimacy among their partners.
Another key principle was to foster a culture of trust and accountability among system partners. The Rethink team achieved this by establishing clear and transparent governance structures, roles and responsibilities, decision-making mechanisms, and communication channels. They regularly reviewed and revised these arrangements as their work evolved and new challenges emerged. This enabled them to work effectively and efficiently with each other and with other system partners, and to avoid duplication or confusion of efforts.
A third key principle was to promote diversity and inclusion among system partners. Some organisations and groups were likely to be more robust or dominant than others, and this could create imbalances or biases in the system. They recognised that some organisations and groups may be smaller or marginalised, and that they may face barriers to participate and benefit from the system transformation. To address these issues, they addressed any imbalances that might favour the more robust or dominant organisations over the smaller and marginalised ones. They advocated for the smaller and marginalised organisations, and helped them increase their visibility, voice their concerns, and access resources and opportunities for development.
Synergy created opportunities for dialogue, knowledge exchange, and joint action among different sectors and disciplines. This helped them break down silos and foster collaboration among system partners, which is essential for delivering integrated and holistic care. These spaces and opportunities can be in the form of regular meetings, workshops, events, networks, or platforms that bring partners together to share their perspectives, experiences, and expertise, and to identify common goals for system transformation.
In Sheffield, Rethink colleagues secured fair and consistent pay, recognition, and support for experts by experience, as well as ensuring their representation and influence in decision-making processes. This helped them value lived experience involvement as a crucial component of system transformation, which can enhance the quality and relevance of services, and importantly can impress on other partners (notably statutory sector organisations) the importance of appropriately resourcing their engagement. There is a clear message for others that experts by experience bring unique insights, perspectives, and skills that can enrich the system transformation process and ensure it is responsive to the needs of people with mental health difficulties and their communities.
Synergy developed and maintained effective partnerships with a range of stakeholders, including people with lived experience, VCSE organisations, statutory sector agencies, and academic institutions. This fostered trust and collaboration across the system, and leveraged the diverse expertise and resources of partners to support system transformation.
Synergy implemented initiatives that addressed system gaps and enhanced peer support and crisis care provision – an example of how VCSE organisations can help address population need. This led to notable improvements in health and wellbeing.
