No Health Without Mental Health – Implementation Framework

Review by Glenn Roberts

The national implementation framework for the current DH strategy for improving mental health services, ‘No Health without Mental Health’, has just been published – and it’s good news for Recovery.

‘No Health without Mental Health was the coalition successor to the Labour Government’s, ‘New Horizons’, and clearly set, ‘More people will recover’ as the second of its six strategic outcomes for all mental health policy. It defined what it meant by ‘recovery’ in terms we have become very familiar with, using Bill Antony’s definition. It operationalised that as meaning that, ‘More people who develop mental health problems will have a good quality of life – greater ability to manage their own lives, stronger social relationships, a greater sense of purpose, the skills they need for living and working, improved chances in education, better employment rates and a suitable and stable place to live. (DH, 2011, p6). It also specified the DH sponsored ImROC (Implementing Recovery through Organisational Change) programme as a contribution to clarifying the key organisational principles involved in achieving better outcomes and better experience for people using services. Perhaps uniquely this policy implementation framework is co-signed by CEO’s and leads from the major NGO’s and non-statutory organizations too.

The implementation framework aims to ‘translate ideals into concrete actions that can be taken up by a wide range of local organisations to bring about real and measurable improvements in mental health and wellbeing’ across all of the 6 of the original objectives. It also emphasises the swing towards both local leadership and local accountability as a route to engaging with local populations and designing ‘what works for us’.

Specific Recommendations

There are a range of specific endorsements and descriptions of the significance of recovery and the ImROC programme for future services. These include:

(Future) ‘Health and care services focus on recovery, rehabilitation and personalisation.’ (p5)

(The ambition that) ‘ Frontline workers, across the full range of services, are trained to understand mental health and the principles of recovery.’ (p12)

Key outcome measures will include: self reported wellbeing, reduced avoidable harm, increased positive experience of services which includes ‘helping people to recover.’ (p13)

Outcomes will be published using existing data – those in support of ‘more people will recover’ under consideration include: employment of people with mental illness, settled accommodation, people feeling they have control over their daily life and the IAPT recovery rate. (p14) But it also mentions that ‘there are key aspects of mental health, such as recovery, for which agreed outcome measures are not yet available’ and are being developed. (p15)

Commissioning via Clinical Commissioning Groups (CCG’s) is seen as a key route towards service improvement with mental health one of the 8 key areas across all health. Suggested actions include: ‘Commission for recovery. Recovery-oriented services aim to support people to build lives for themselves outside of mental health services, with an emphasis on hope, control and opportunity. The Implementing Recovery through Organisational Change programme provides tools to assess how well they are doing and take steps to become more recovery-oriented. The Individual Placement and Support approach to employment is effective for working age users of mental health services.’ (p18)

Provision of services – Trusts and independent services are given a range of suggestions including: ‘Focus on choice, recovery and personalisation. This includes considering how service users’ perceptions of recovery can be incorporated into all elements of clinical practice and working to ensure people have appropriate support and access to advice and information. The Implementing Recovery through Organisational Change programme can help here.’ (p20)

Recovery Colleges are cited as a specific example: ‘A Recovery College is a key element of recovery-oriented practice in mental health services. Recovery Colleges complement existing services by offering an educational approach to supporting people in their personal recovery journeys. The defining features of Recovery Colleges include co-production between professionals and service users and carers to offer a range of courses that people attend on a voluntary basis, not as a form of therapy but as a way to build up their skills, knowledge and confidence.’ (p20)

Social services are described as essential partners in improving mental health and wellbeing and it suggests: ‘Adult social services already work closely with NHS mental health services and have a major role to play in fostering a stronger recovery orientation in the support offered to people with mental health problems.’ (p26). In terms of actions it also suggests, ‘Use community care and carers’ assessments to identify ways to support independence and promote recovery’, and ‘Work alongside CCGs to remodel existing support to focus on early intervention, service integration, personalisation and recovery.’ (p26)

Payment by results is about to be implemented. At present it is a diagnosis driven tariff for proving agreed packages of care, but there is a stated intention that it is more tangibly related to ‘results’ in terms of people’s experience of outcome: ‘We will develop indicators which will connect payment to recovery and to the patient’s experience.’ (p40)

The role of national mental health organisations in supporting outcomes and improvements, whilst retaining their independence includes, ‘The Implementing Recovery through Organisational Change programme – run by the Centre for Mental Health and NHS Confederation’s Mental Health Network and supported by the Department of Health – supporting the uptake of recovery based practice.’ (p50)

There are many other aspects to the implementation framework in relation to the general commitment to public health and wellbeing and the other specific goals and objectives. But these specific references to both promoting recovery and to the value and learning of the ImROC initiative are to be welcomed and giving additional momentum, focus and commitment to pursuing the recovery agenda and in sustaining all our efforts to ‘make recovery a reality’.

Glenn Roberts
25th July 2012