What would an effective mental health service look like?

A Liverpool team on their 'Working Conversations' project.

There has been a great deal of activity over the last 10 years relating to the thorny issue of mental health, also called mental wellbeing. The government decided to back a project called Improving Access to Psychological Therapies (IAPT). This service was touted on the basis that it would be cost neutral. The improvements that it made in people’s mental health, and the number of people who return to work as a result of being ‘treated’ by its specially trained psychological therapists, would outweigh the costs incurred. This has been proved time and time again to be not true. Only about 15 per cent of people referred to the service actually make some kind of recovery. Of those, a further 50 per cent subsequently relapse.

IAPT is premised on the thinking that the problem lies within the individual. The error here is that our mental wellbeing is firmly rooted in our social and environmental conditions. The greatest changes in physical health have come not through interventions with the individual, but through environmental change, for example, clean water, proper sewerage, secure housing and regular incomes. Psychological services in England have fallen into the same trap in believing that their individual interventions can make any kind of real difference. Real benefits to our mental wellbeing will not come through seeing the individual as having a problem but through recognising the stresses created by a toxic environment.

In 2017 we launched a ‘Working Conversations’ project, intent upon questioning what constitutes an effective mental health service. What is it people want? What will help them improve their wellbeing? What changes need to be made both by individuals, and in the environment in which they live, to enable them to live better and more productive lives? It is a grand project, but there are already many possibilities for change in place. We started our project by asking charities and other non-statutory organisations involved in mental health service delivery in the Merseyside footprint to come together to share their experiences. We are now developing a four-year programme in which we hope to expand the knowledge base and begin to build a clear picture of what an effective mental health service would look like. What we already know is that it will be based much more upon community, collaboration, connection and security.

There is a real irony in this situation, for our vision of an effective mental health service does not involve vast numbers of trained psychological therapists, but a programme of education flowing out into a community that enables each and every one of us to think more clearly about what it is we want, and what it is we might need to do to achieve that as members of the public. It is a low-tech, low-cost set of changes that involves everyone. Instead of being passive recipients of an ineffective intervention, each one of us becomes an agent for change in our own right.

Amongst other things we are now setting up volunteer and apprentice programmes that enable members of the public to learn about improving their own mental health and that of others. The whole point of these programmes is that the ideas will flow out into the community and, no matter how diluted they become, they will still have a positive impact. ‘Solution-focused practice’, as it is called, is a do-no-harm intervention. Our project challenges the very assumptions of the ‘science’ that is currently seen as a gold standard in English mental health services. Interested in finding out more, or getting involved? Do drop us an email at: [email protected]

Dr Philippa Hunter-Jones, L. Crolley, K. Neary and J. Vazquez
University of Liverpool Management School

D. Ozkaramanli
School of Engineering, University of Liverpool

S. Flatt
Psychological Therapies Unit, Liverpool

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