Mental health services for children and young people is the most challenging area to commission in because there have to be so many different people involved. I am deliberately using the word people and not services or commissioners or even service users and their families because it’s the people in those organisations who are key to making it work. At the moment health commissioners have been tasked with bringing about transformation. Not service redesign, not transition but TRANSFORMATION.
We all loved the transformers when we were young because they transformed from everyday objects into amazing, life saving, beings who changed everyone’s lives for the better; although there was always sacrifice and the need for humanity along the way. This is what a transformation plan must achieve. We keep being told “there’s no money, we are standing on a burning platform, change is inevitable”. But transformation requires vision, courage, and team work. It also means putting aside petty political differences between health, social care and the voluntary sector, in order to transform into something amazing.
Before rushing in with your great ideas, it’s good to look around for any evidence base you’re your transformational plans. Good reliable evidence in this area is often difficult to find. Look for services in Britain and around the world that have achieved transformation in young people’s mental health and contact them. It’s usually easy to do this as most successful services will have a website with data/outcomes and who to contact to find out more details. In my experience people are incredibly generous with their time and knowledge and it’s always good to ask them what went wrong and how they overcame those problems. It’s also interesting to ask how long it took them to achieve their outcomes. For example the Canterbury System in New Zealand took around 15 years to achieve.
When changing-transforming – such a complex system with so many often changeable players it’s important to be realistic with everyone from the beginning that they may have to be patient. Initially people are often keen to engage but change is tiring and unsettling and it’s easy to fall back into old ways because they are safer and easier, and anyway, you’ll be gone soon, so then it will be someone else’s problem, right? This is especially true of local commissioning support, who will often be on interim contracts and looking to move somewhere else as soon as the next career step becomes available. Not everyone needs to commit to the long haul but some do need to see the vision and commit to it or everything you have worked for can easily disappear with any significant change in senior staff.
Practically, of course, it’s important to create your transformation with everyone involved – always being aware of conflicts of interest that may arise. Most importantly, right from the beginning involve young people and their families and friends. They can help contact, visit, and talk to other people like them who are experiencing other processes of service transformation. This is vital because not only do they have insights that no commissioner could ever have but they are also able to challenge commissioners and providers. Additionally, they can help design ways of monitoring and measuring the new services created and also the pace of transformation. Only they can give real time feedback on how things are going.
Its also important to establish an expert reference group of local GPs (not those who are directly commissioning) local councillors and third sector organisations. These groups are, in a way, service users too (or front line staff as we usually call them) and will have a different perspective on what will and won’t work. They are also important to directly engage because these groups can easily undermine a transformational change so it’s important to make sure their voices are heard.
Transformation requires courage: both to initiate a programme, but also to admit that things aren’t working and be willing to listen to challenge. It also requires the people involved to put aside their differences and work together as a team: sharing ideas, mistakes, blurring professional boundaries and even, dare I suggest it, sharing budgets (look at DevoManc- that required real courage). Transformational change in mental health services for young people and families depends on everyone being willing to share and take the good times and the bad times together. Just like Optimus Prime in The Transformers it requires the courage to risk failure and a selfless love for the people you serve, regardless of where you come from.
