Successes and setbacks - learning from two years of implementing a new integrated framework for community mental health in London

The UK National Collaborating Centre for Mental Health and NHS England published a new national "Community Mental Health Framework" in September 2019 outlining a coproduced vision for a place-based community mental health, and how community services should modernise to offer whole-person, whole-population health approaches, aligned with primary care services and neighbourhoods. West London NHS Trust successfully bid to be a pilot site for the development of these services and, despite the parallel challenges of the Covid-19 pandemic, progressed with major reconfiguration of our local mental health services, and receiving substantial additional investment. We radically redesigned our: - Single point of access - 3 small primary care mental health teams - 3 assessment services - 5 secondary care specialist 'recovery' teams into nine place-based Integrated Network Teams supporting a range of patients with common and complex mental health needs. The plans were coproduced with staff, local partners and informed by patients and carers, and implemented at scale. New investment and team structures were designed using population health approaches to address predicted need for the services rather than historical patterns of referral demand - with an acknowledgement that areas of high deprivation and certain populations may require alternative approaches to delivery. We developed new team structures and created new roles including rapidly expanding the role for Peer Support Workers (with lived-experience of mental illness), alongside contracted partnerships with community organisations, the relaunch of our Wellbeing and Recovery College and the relocation of two teams into local Premier League and Championships League football clubs. We describe our transformation experiences, including: - the challenges of changing culture and operating models whilst continuing to provide care for a caseload of 12,000 local people - clinical risks identified during the transition, and actions to ensure patients were not lost-to-follow-up and that caseload segmentation was introduced to support assertive approaches to clinical care delivery for the patients with most complex needs and highest risk - workforce challenges and efforts to attract and retain clinical staff to reduce vacancy rates in expanding teams - the benefits and challenges of migrating clinical activity from a secondary care to a shared primary-care clinical record system - actions to gain clear visibility of performance data - unforeseen challenges related to the Covid-19 pandemic and a backlog of need, and heightened awareness of mental health At November 2023, the services collectively increased in productivity from a mean of 1200 recorded clinical contacts per week to >2000; clinical caseloads stabilised, and routine referrals were seen in a median of 33 days against a target of 28 days. Adverse incidents were routinely monitored, including patient suicides and homicides, as well as complaints. Work with voluntary sector organisations in just one borough supported over 800 recipients of targeted wellbeing support, of whom 75%+ were from non-white ethnic backgrounds - these approaches went beyond the biomedical and psychological models to include community massage, movement and dance, and photojournalism. We share our learning others seeking to innovate in the integrated mental health space.