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.
Tower Hamlets
Tower Hamlets is a diverse and vibrant borough in East London, with a population of about 317,000 people. It is one of the most ethnically and culturally diverse areas in the UK, with over 90 languages spoken and more than half of the population identifying as being from racialised communities.
The borough has a young age profile, with 44% of residents under 30 years old, and a high proportion of migrants and refugees.
Tower Hamlets also faces significant challenges of poverty and inequality, with some of the highest levels of deprivation, unemployment, child poverty, and overcrowded housing in the country.
These factors have a profound impact on the mental health and wellbeing of residents, especially those from marginalised and racialised communities. Tower Hamlets has higher than average rates of common mental health problems, such as anxiety and depression, as well as severe mental illnesses, such as psychosis and bipolar disorder.
The public and voluntary sector services in Tower Hamlets have struggled to meet the complex and entrenched needs of the local population, especially during the Covid-19 pandemic, which exacerbated existing inequalities and vulnerabilities. The services face challenges such as funding cuts, staff shortages, high demand, fragmented provision, and barriers to access and engagement. There is a need for more holistic, integrated, and culturally responsive approaches to mental health care that address the social determinants of health and enable the communities to coproduce solutions that work for them.
How does the alliance operate?
Tower Hamlets Community Mental Health Alliance is a VCSE partnership of 17 local organisations that aims to improve the mental health and wellbeing of the local residents. The alliance operates on the principles of coproduction, integration, and prevention, and seeks to address the social and environmental factors that affect mental health, such as housing, employment, education, and community cohesion.
The key principles and priorities agreed by the alliance are:
- Alliance building: To develop a powerful community sector alliance to ensure thriving mental health ecosystems within communities.
- Better funding: To ensure the community sector has more power in the design of funding.
- Partnership working: To build stronger trusted partnerships between the community sector, Tower Hamlets Mental Health Partnership Board, East London Foundation Trust, London Borough of Tower Hamlets, and primary care networks
- to deliver excellent services and improve local outcomes.
- Addressing inequality: To take a lead in working towards anti-racism practice across the system and to bring our expertise and intelligence of diverse communities to partnership working.
- Coproduction: To keep lived experience perspective at the heart of everything we do.
- Workforce sustainability: To work with partners to develop a more sustainable mental health and wellbeing workforce.
- Community leadership: To build strong and deep links within communities and develop leadership from the grassroots.
The alliance works with various groups and networks in Tower Hamlets, such as the Health and Wellbeing Board, the Mental Health Transformation Board, the Tower Hamlets Connection Coalition, and Tower Hamlets Citizens. The alliance is also connected with the wider system through the North East London Mental Health Collaborative, and the North East London Transformation Board, to ensure that the voices and needs of the diverse communities are heard and met.
The programme’s main achievements include: creating and growing the Tower Hamlets Community Mental Health Alliance; developing the Tower Hamlets Mental Health Partnership Board; sharing training and learning opportunities; representing and advocating for the alliance members and the wider sector; supporting funding for local Black-led organisations; and implementing Rethink Physical Activity initiatives to help people severely affected by poor mental health and their carers to be more physically active.
Being part of The Tower Hamlets Mental Health Partnership Board is a key achievement for the alliance. The Partnership Board is one of few spaces where the NHS, commissioners, local authority, primary care, experts by experience and the voluntary and community sector share power in deciding local priorities and addressing local inequalities. The alliance has been part of its design from the beginning and elects at least three leaders to the Partnership Board. The alliance also sits on the group which decides the agenda for these meetings. Importantly, trust is being built – but more work still needs to be done around how funding is allocated and (more importantly) designed. The alliance is therefore participating in the writing of the forthcoming Tower Hamlets Mental Health Strategy.
Alliance scope
The programme concentrated on the Tower Hamlets borough, which might have reduced its influence on the bigger North East London Integrated Care System (NEL ICS). This concentration might have also affected the ability of alliance member organisations to work in other boroughs within the NEL ICS. The programme could enhance its impact and reach by exploring partnerships and alliances across neighbouring boroughs.
The alliance is building trusted relationships across the system. Beyond the funding from the Charities Aid Foundation, the East London Foundation Trust (ELFT) has agreed to fund the alliance with £100k over three years. This will ensure the employment of an Alliance Lead, a Coproduction Lead (employed through an alliance member organisation), and money to enable smaller organisations to take a full part in alliance and partnership working. The contract elements were agreed between the alliance and ELFT and the next phase of the programme is due to begin from 1 July 2024.
A recent example of collaboration is the alliance’s support and involvement in the bid for a 24/7 Community Mental Health Pilot in Tower Hamlets. This bid is worth nearly £5 million over two years, with £1.8 million going to VCSE organisations.
What we learnt
The structural challenges that VCSE and other organisations face in Tower Hamlets have deep roots and will not be resolved easily. The local system learnt that it requires a long-term vision and commitment to address the root causes of health and social inequalities, such as poverty, racism, and discrimination, and to enable communities to have a voice and a stake in the system change. A recommendation for policymakers and practitioners elsewhere is to adopt a place-based and asset-based approach that recognises and builds on the strengths and assets of local communities, rather than imposing top-down solutions that may not fit their context and needs.
It is essential to maintain trust and communication between different partners in the alliance, and to balance the interests and perspectives of different stakeholders, especially those who are often excluded or marginalised. A recommendation for policymakers and practitioners elsewhere is to foster a culture of collaboration and coproduction that values the contribution of each partner, and to create mechanisms that support joint working and accountability across sectors.
VCSE organisations need more support and incentives to participate in alliances that aim to transform health and social care systems. Policymakers and practitioners should ensure that VCSE organisations are meaningfully involved and resourced in co-designing and co-delivering system change initiatives, and that their diversity and expertise are valued.
When bringing in large initiatives, while clinical involvement is key, the leadership of change should be more clearly distributed. Integration is impossible if the largest organisations with the greatest resources lead that integration – despite their best intentions. The lack of funding for local authorities to participate fully should also be noted. There cannot be a shift of power without a shift of financial resources.
Much has been learnt about the challenges in developing alliances:
- Structural changes in mental health services require a clear vision and alignment of values among different stakeholders, especially between statutory and voluntary sectors
- Trust and collaboration can be easily eroded if one partner reverts to a traditional or dominant model of service delivery that marginalises the others
- Adequate funding and engagement from commissioners are essential to sustain and scale up innovative and integrated approaches to mental health care
- Participating in alliances or networks can be demanding and exhausting for smaller or less resourced organisations that have to balance multiple roles and responsibilities
- Leaders and champions of cultural change need to be supported and protected from personal harms or burnout that may result from challenging existing systems and practices.
For some alliance members, the expectations they had of incoming resources have not yet been fulfilled, which has, on occasion, created disappointment. In their view, the commissioner is not as responsive as they had anticipated. As a result, alliance members have explored alternatives and have learnt that:
- Local systems should not rely on external funding or incentives to drive change, but rather build on their own assets and strengths
- Commissioners should be more proactive and responsive in engaging with local initiatives and supporting their sustainability and scalability
- Local systems should ensure that participation in collaborative networks is feasible for all kinds of organisations, especially those with limited resources or capacity
- Local systems should recognise and address the emotional and mental toll of leading change and provide adequate support and care for those involved.
Joining the mental health alliance was hard and time-consuming: smaller groups could not muster sufficient resource to participate fully without it affecting their other work. We have learnt that:
- Mental health alliances should consider the different capacities and needs of their members and design their activities accordingly, to avoid overburdening or excluding some organisations
- Mental health alliances should provide adequate support and recognition for those who are leading the change process and address the risks of exhaustion and burnout among them
- Mental health alliances should challenge issues of racism and white supremacy that affect the system and that create barriers for smaller and community-based interventions. They should also promote more inclusive and diverse ways of presenting and evaluating the impact of these interventions.
The mental health alliance in Tower Hamlets is aware of the relentless need to challenge the structural barriers that prevent people from racialised communities accessing and benefiting from its services. It has been reminded of the need to support and value the work of grassroots and community-based organisations that are often more responsive and effective in meeting the diverse and complex needs of these communities. Recommendations for policymakers and practitioners elsewhere include:
- Recognise and address the systemic racism and white supremacy that pervade the health and social care sector and create inequalities and injustices for people from racialised communities
- Invest in and coproduce solutions with people from racialised communities and the organisations that represent and serve them, rather than imposing top-down or one-size-fits-all approaches that fail to acknowledge and respect their lived experiences and aspirations
- Provide adequate, sustainable funding and resources for community-led and community-based initiatives that offer culturally appropriate support for people from racialised communities
- Develop and implement anti-racist and anti-oppressive policies and practices that challenge discrimination, stereotypes and stigma, and promote diversity, inclusion and equity at all levels of the system
- Support and safeguard the wellbeing and safety of staff and volunteers who work with and for people from racialised communities, especially those who experience personal harm and burnout due to the emotional and physical demands of their roles.
