No assumptions: a narrative for personalised, coordinated care and support in mental health

This new report, from National Voices and Think Local Act Personal, considers what matters most to mental health service users in terms of their experience and outcomes. The report accompanies an earlier publication which considers evidence from research and consultations on what patients and service users want and expect from support which is person-centred and coordinated.

“No Assumptions” was produced in collaboration with people who have experienced mental health services via Think Local Act Personal and with contributions from the National Survivor User Network, Mind, Rethink Mental Illness and Certitude.

Key messages

The report highlights the need for a truly integrated and person-centred approach to care and support, acknowledging that current service provision is often delivered across multiple silos with limited engagement and involvement of service users:

The coordination of support is critical – service users often experience a fragmented service and a lack of continuity which impacts the effectiveness of the care and support they do receive;
Peer support is considered as an important part of care;
There needs to be more done to help service users prevent crises through self management;
Support needs to be addressed at a whole person level – taking into account physical and mental health needs as well as social and emotional aspects;
Services need to involve service users in planning their own care and support through shared decision making and informed choices about information sharing and types of therapy;
Service users feel more confident in services which have been co-designed and planned with current and previous service users;
Staff in services need to be responsive to fluctuating needs, particularly in the anticipation and management of crises.

Continuity of care is important to service users who often have to deal with various staff members during crises.

There are various examples in the report of public and third sector services which offer support, counselling and advice – here are just a few examples:

Mothertongue provides multi-ethnic counselling and listening and provides interpreting services (including training for clinicians) for Reading CCG and Berkshire Healthcare;
Psypher Community Timebank coordinates peer support for young people who have experienced psychosis;
Travel Buddies helps people with mental health problems to avoid isolation by providing public transport travelling companions;
The SHINE Mental Health Support Network helps people find the support they need and connects various service providers together;
Star Wards, Wardipedia is an online tool to collect innovative ideas for improving inpatient experience in psychiatric units;
The Wellbeing Peer Supporter scheme is a pilot enabling GPs in Willesden, Harlesden and Wembley to refer patients with social and emotional support needs to a peer supporter based in the practice – the 118 patients in the pilot reduced their GP visits by 85%.

Leeds Mind is one of the examples of services offering peer support

The practice examples offer some useful learning which may be adaptable to other contexts. These stories are from a self-selected sample via an open call earlier this year. Whilst I’d like to see a more systematic process of gathering and validating case studies with more evidence of impact, I know that collating stories and case studies is not always easy and the stories featured did make me stop and reflect. It would be useful if this collection were built on, to capture more examples and to follow up on the stories featured.

The messages in the report shouldn’t be new to readers and are recommended as good practice in NICE’s quality standard for service user experience in adult mental health. But it’s clear that 3 years on from publication of the standard, whilst there are examples of good practice, service user experience is not consistent across services.

Commentary

The report includes a series of “I” statements clearly outlining service user expectations of mental health services which relate to their culture and identity, preferences for support and overall experience. Given recent interest in personal health budgets and in outcomes-based commissioning, this report will be interesting reading for commissioners, offering a concise summary of what matters from a patient perspective.

Service users need to be involved in decisions about their care including developing plans for their care in the event of a crisis

Commissioners may wish to consider:

What initiatives are in place locally to engage with and directly involve service users?
How should local processes adapt to ensure the user perspective informs the commissioning cycle?
What is happening locally to ensure the outcomes which matter to patients/service users are captured in contracts and service level agreements?
Do you know enough about the range of support services offered locally? How are you keeping your knowledge of user-led, community-led and third sector services up to date?