Pinpointing barriers and mitigating issues will be vital in developing your new model. There is a step-by-step guide in our previous resource, Thinking differently, setting out how to go about working in partnership with stakeholders and experts by experience to co-produce the model, along with tools such as an expert by experience role advert.
However, time is short to deliver this redesign, and you may have experienced a number of challenges when trying to complete these steps. You are not alone and common barriers exist across many areas trying to enact this level of change. Through our webinars, interviews and meetings with STPs we have identified these particularly common roadblocks:
- Scepticism and resistance to change
Some staff, particularly those who have been involved in change processes previously, may feel cynical about the possibility of real transformation – and understandably so, as past ‘transformations’ have often been prompted by funding cuts. Others may resist change, perhaps because they are concerned about the risks involved, or that such a move will make their work more challenging or workload heavier.
- Limited notions of what is possible
Many of those responsible for this transformation will have spent years working in the existing under-funded system – with such familiarity with the way things have been within significant financial constraints, it can be hard to imagine how they could look different.
- Concerns about the cost or difficulty of delivering better care
Some believe that better care will ultimately be more
expensive to deliver!
Of course, the pandemic has taken vital time, resource and attention away from many members of staff, reducing capacity to focus on this. Clinicians and commissioners are also telling us they are seeing increased demand and more complex cases.
This redesign involves dismantling long-held notions by
some that the medical model of care is superior to other forms of mental health support. People have told us that respect doesn’t always exist between different
professions, and different sectors frequently use language that can exclude others.
We have also heard about significant concerns regarding sharing power, decision-making and funding with other sectors.
Poor levels of trust can hinder the early, relationship-building stages of this transformation. It may be that historically poor relationships exist between one or more of the agencies instrumental to the transformation process, or that those with lived experience lack trust in the direction of the
transformation due to previous negative experiences of support or attempts at co-production.
- Prevalence of single organisation agendas
• VCSE organisations are, in particular, used to operating in a competitive funding environment – this will be particularly prevalent with the COVID-19
pandemic significantly impacting on the sector’s funding.
- Putting off involvement of certain groups until later in the process
We have heard some STPs considering delaying working with other groups, whether that’s experts by experience, VCSE organisations, or the local authority, until their own house is in order first. However, this goes against what the Community Mental Health Framework is trying to achieve and ultimately will not lead to joined up support that improves outcomes for the local population.
We have also heard some areas considering delaying engaging with certain populations or communities until further down the line. For example, delaying
co-producing a model for older adults because commissioning processes with other older adults services aren’t aligned, or finding certain BAME community groups ‘hard to reach’.
Tips for overcoming these barriers
1. Use evidence to articulate positive changes that can emerge as a result of the transformed system
Demonstrate the cost and demand within the current
system, versus reduced costs possible by providing more proactive care and investing in expanded teams and services that can reduce pressures.
2. Demonstrate what is possible
Share case studies included in this guide and elsewhere and consider working with a person
or organisation to facilitate co-production with experts by experience to innovate and think
outside the existing system. Engender a culture of positive risk-taking and willingness to
make and learn from mistakes.
3. Appeal to what motivates staff
Encourage leaders to reflect on what motivated them to get involved in this area of work in the first place, particularly moral and emotional motivations such as overcoming injustice and ensuring public value.
4. Actively dismantle the hierarchy
Host collaborative groups involving people at all levels - commissioners, CEOs, clinicians from across primary and secondary care, service users - but ensure "lanyards are left at the door." Encourage "human-to-human" interaction and use the space to develop beliefs and values that the group share as citizens, rather than as services, service users or decision makers. Commit to using language that people understand.
5. Create buzz and momentum around the transformation
It is important to generate excitement - this is a once in a generation chance to use a large pot of money to get community mental health right. Connecting with staff elsewhere in your region and beyond can support learning and help staff to feel part of something bigger.
6. Building trust
Reflective practice is vital in recognising what has and hasn't gone right in the past. Good governance and agreeing ways of working that promote transparency and accountability are all key for bringing down walls between agencies.
7. Be open and honest about how people may feel and address barriers head on
Sweeping issues under the carper could ultimately hinder your transformation process in the long term - be real with staff about how they are potentially feeling about the proposed changes. Strong leaders at all levels of the partnership have a role to play in doing this.
8. Bring people together digitally
Due to the COVID-19 pandemic, many early implementer sites have had to make use of technology to bring together transformation partners. In Somerset, they have found that this has made it easier for all parties, particularly smaller VCSE organisations, to find the time to participate. Ensure that digital inclusion is considered when recruiting expert by experience leaders.
9. Think about how everyone can be involved from the start
To ensure balance and avoid gaps further down the line, it is important to involve a range of partners from the off and consider how you reach the entire population. Its worth taking a moment to reflect from the perspective of those in need of care, support and treatment.