By Sarah Appleby, WMAHSN Mental Health Programme Lead
NHS Digital reported in England for 2016/2017 that, “more than 2.6 million people are known to have had an open referral with mental health services at some point during the year. 560,000 of these were under 18 years of age.” 50% of mental health problems are established by age 14 and 75% by age 24 and more worryingly, 70% of children and young people who experience a mental health problem have not had appropriate interventions at a sufficiently early age. There is an urgent need to do more, earlier, for children and provide this support in a more integrated way. This is emphasised in the Five Year Forward View for Mental Health (2015), “Prevention matters - it’s the only way that lasting change can be achieved. Helping people lead fulfilled, productive lives is not the remit of the NHS alone. It involves good parenting and school support during the early years, decent housing, good work, supportive communities and the opportunity to forge satisfying relationships”.
So how could this be achieved, who would need to be involved and what would this look like? We’ve all heard the old African proverb “It takes a village to raise a child”, meaning it takes an entire community of different people interacting with children in order for a child to experience and grow in a safe environment. In other words, a ‘community assets-based approach’ which could be applied to a community to enable their children to grow, to become resilient and productive adults. This is the premise for the work the West Midlands Academic Health Science Network has been doing in developing a strategy and a plan of action.
In 2017, the West Midlands Academic Health Science network along with Forward Thinking Birmingham was commissioned by the Mental Health Systems Strategy Board to develop the Getting it right first time: Prevention of Mental Illness Strategy. This strategy identified key priorities in order to provide primary prevention to mental illness using evidence to develop a collaborative, sustainable and effective approach to the prevention of mental illness for children and young people. This evidence has been provided in the identification and acknowledgement of Adverse Childhood Experiences and how they influence health and wellbeing outcomes for children and adults.
In order to really innovate within this space the strategy emphasises the principles of co-design and co-production in order to develop approaches, services and products to support primary prevention of mental ill health and early intervention. In other words how organisations can work together with communities to create ways in which mental illness could potentially be prevented or acting early when things are not going well to prevent them from worsening. The end result, creating sustainably resilient communities and the strategy outlines the process of how this could be achieved.
Taking on board this process, the next step was to bring together representatives from organisations across Birmingham and Solihull statutory (e.g. NHS organisations, local authority) and non-statutory organisations (e.g. charity and social enterprises), to form an Advisory Board which was able to provide their resource, knowledge and passion to this piece of work to undertake a study.
These organisations included:
- The West Midlands Combined Authority
- Birmingham City Council – Public Health
- Solihull Metropolitan Borough Council
- Forward Thinking Birmingham
- Birmingham and Solihull Mental Health NHS Foundation Trust
- Birmingham Community Healthcare NHS Foundation Trust
- Health Education England
- Birmingham and Solihull CCG
- Birmingham Education Partnership
- iSE (Social Enterprise experts)
- NIHR CLARHC West Midlands
The first step was to map existing current primary prevention/early intervention activity in areas across Birmingham and Solihull. This was, of course, necessary to identify gaps and areas for improvement/innovation, however also important to develop an agreed way of describing and selecting a geographical area where new way of working could be demonstrated. The study looked at current prevention activity, the organisations who provide these activities, the population, what need there was/planned for and what the potential was to develop/enhance any existing community assets. When identifying and describing community assets we looked at anything that could improve the quality of life of the community and more specifically the mental health and wellbeing of the children, young people and their families who lived in these communities. After applying the agreed criteria for an optimal site, Nechells in Birmingham and North Solihull were identified as potential demonstrator sites and Sparkbrook and Kingstanding respectively as relevant control sites.
With the potential demonstrator sites identified the next step was to describe how a programme could be delivered to demonstrate the vision or a proof of solution – the integration of current activities, enhancement of current community assets and fill gaps to improve the mental health and wellbeing of children, young people and their families. The result was the Mental Illness Prevention Demonstrator Site Programme.
The programme can be delivered through a series of process and delivery work-streams over a period of three years. It articulates the necessary stakeholders who need to be involved, how and by whom this could be delivered and what this would require in terms of funding, resources and structures. The workstreams within the programme each have specific aims to support current efforts to integrate services and add value by prescribing activities which are currently missing from the prevention and mental health wellbeing landscape such as:
- The development and adoption of digital tools and technologies. For example levering the potential of data and how to share this to get better outcomes as well as refurbishment of the current Youthspace website (a website aimed at young people who are seeking information, guidance and support with their mental health problems);
- Workforce development of both formal (organisations) and informal (people from the community) including the development of new roles, new and flexible ways of working and specific training e.g. Universal Introductory Training Course in ‘Adverse Childhood Experiences and Resilience Building’;
- Schools-focussed work: ensuring children aged 3-4 years old are ‘school ready’ and well as supporting a whole-school approach to strengths-based resilience building for children 5-14 years;
- Development of Community Based Interventions – mobilising individual, community and organisational assets within the demonstrator sites to support mental illness and ACEs prevention within 0-14 year olds and their parents/carers.
The proposal has been developed to demonstrate how ownership and responsibility can be shared and does not seek to replace any future planned or current activity but seeks to align and integrate this activity to enable potential greater benefits. Given limited funding and resources available to organisations, the proposal suggests sharing ownership and risk. That being said funding for innovation and/or enhancement does not solely need to be provided through statutory budgets, this could potentially be provided through other funding opportunities. Where innovative solutions are identified, the WMAHSN has the ability to identify other funding opportunities from regional, national and international innovation sources and funding bodies. This has the added benefit of being able to seek experience/knowledge from outside the statutory sector and create mutually economic beneficial relationships within the region.
Given the evidence that 70% of children and young people who have experienced a mental health problem have not had appropriate interventions at a sufficiently early age, it is imperative that any approach will need to be one which supports primary prevention and early intervention. This programme seeks to do this where the child lives, and provide the communities in which they live with a way to improve mental health and wellbeing outcomes. Perhaps even improve the way in which the village is raising the child.
The WMAHSN is extremely grateful to all the organisations throughout Birmingham and Solihull for contributing their time and effort to producing this proposal. The principles and recommended implementation approach reflect best practise in the prevention space and adds the development and refinement of relevant technological innovations that will improve outcomes. The model can readily be adjusted to other places within and outside of Birmingham and Solihull and in our progress towards adoption we welcome inquiries/conversation with other organisations that may be interested in taking this forward.
This programme presents an opportunity to do something truly unique and innovative to improve the mental health and wellbeing of children and families. Although we are not unaware that in these times of restricted budgets and increased demand the programme has the potential to do more than just that – it has the potential to provide the evidence that this approach will be able to create efficiencies for the investment required and most importantly be sustainable. In order for this programme to be delivered it requires the investment, ownership and support of organisations across health, social care, local authority, education, justice, business and the third sector.
Id like to speak to organisations within the West Midlands who may be interested in finding out how they may be able to implement this within their area. You can contact me on firstname.lastname@example.org or via Twitter @InnovateSheila
Alternatively, if you have an innovation or approach which you feel would add value to such a programme, please see our current campaign https://meridian.wmahsn.org/subdomain/mental-illness-prevention/end/campaign_wizard_edit/2414/idea_def