By Pino Pini.

A summary from the SE&LMHS project presentation at the HPFT Recovery Conference, Watford 8/10/2019.

The SE&LMHS project is based on the assumption that mental health is not only a matter for special services, but should include the whole local community. Several activities beneficial for mental health can be created by working together in the community in peer to peer contexts through direct relationships between professionals, service users, carers, the third sector and representatives of the local community. These activities can be very different and can vary according to the local contexts. They have nothing to do with diagnostic systems and are not an extension of services. The aim of the project is to better balance the scientific approach connected with a vision of illness with the subjective approach connected with the day by day living and common sense by facilitating these peer to peer relationships and encouraging these local and community activities.

The roots of the project are based on two previous experiences in Florence and Prato (Italy); in a context where psychiatric hospitals were being closed and the local community was becoming one of the main players in mental health.

In May 2018 a pilot project started officially in Watford with the aim of exploring if there were sufficient conditions to start activities inspired by the Italian project. A monthly steering/development group (Dev) was established with meetings between various stakeholders. The venue, Watford Town Hall, was selected as it represented a community base outside of the clinical mental health services setting. It was acknowledged, by this group, that the mental health situation in the Watford area had several issues including: the fragmentation of services; the revolving door phenomena and dominance of the therapeutic model and symptoms containment which led to clinical interventions and forced treatments. It was the feeling that these issues could be partially addressed by developing a ‘Common Sense’ (CoS) group within the community and outside the services venue. The CoS group was to be a composed of service users, carers, professionals, local government representatives and third sector organizations; who by sharing experiences could create a greater understanding of these issues. The ethos of this group, as in the steering/development group was to be one of coproduction.

About 30 stakeholders have been involved in the creation of a project tailored to the needs of the Watford Area and a charter of the project has been agreed. 

Both the Dev and CoS groups are designed to: provide all the members of the project with the  platform to  share their experiences and views in a free space, provide  potential learning for all participants; promote knowledge of mental health conditions; create opportunities to help communities become more resilient; understand the importance of narratives and social networks; facilitate relationships between the statutory services, ‘third sector’ and the community, prevent fragmentation of services; promote knowledge of local resources and  identify shortcomings in services.

Developments of the project from October 2019 prior and during the Covid-19 pandemic.

The Common Sense group (CoS) started,on a weekly basis, in October 2019 at Watford Town Hall on a weekly basis facilitated by members of the steering group on a rota basis. In January 2020 the group moved to Watford Central Library. To ensure all members were confident to meet outside of services, referrals were considered by all members of the developmental group and numbers of people attending the CoS increased gradually. Referrals were not considered if they had been only made by a mental health professional without discussion with the service user or if they were being used to discharge from mental health services Before the restrictions due to COVID-19 pandemic more than 20 referrals came from Colne House and about 10 service users have been involved in the CoS group with  some attending regularly.  

After the lockdown (March 2020) while the Dev group continued to be active through video meetings without problems the CoS group was interrupted for a couple of months. This was because it was clear that for most users it was difficult to be confident with the video technology and the move to digital meetings had to be carefully considered in terms of safeguarding, risk and accessibility for all members. While the development group considered these issues it was decided that facilitators would continue to stay in touch with those who were already involved in the CoS group. This was to provide support and to see if it would be possible to organize video meetings.  By June 2020 it was possible to resume bi-weekly CoS meetings with the membership consisting of people who had previously attended in a face to face context. ..Although, Colne house professionals proposed new referrals it was decided to proceed gradually as it was felt issues with trust, confidentiality and accessibility of technology needed to be addressed first. 

The Dev group apart from supporting the CoS group has worked towards consolidating the SE&LMHS project as a whole.  In January 2020, a successful application to the HPFT Innovation Fund was made however unfortunately due to the pandemic everything was halted and no funding was given. The project continues with the enthusiastic support of  HPFT professionals, people from the community, third sector and Watford Borough Council. Recently, the Mayor of Watford participated in a monthly meeting of the Dev group and some members of the Dev group have been invited as guest speakers at video conferences organized by Watford Council to support community wellbeing during the pandemic.  A detailed description of the whole SE&LMHS project has been drafted as well as a proposal agreement between stakeholders.

Plan for the next future (both face to face and remote)

Despite difficult, changing and uncertain times both members of the steering and CoS group have already benefited from the sharing of experiences, community relationship building and move away from the paternalistic, clinical setting of mental health services. The intention is to continue with the bi-weekly online CoS group and gradually accept new referrals as participants become more confident. Face to face groups at Watford Central Library will be initiated as soon as it is safe to do so.

The Dev group will continue to meet monthly to oversee the development of the CoS group and the SE&LMHS project as a whole. In the coming months it is the intention of the Dev group to involve other stakeholders including the County Council and the University of Hertfordshire. The relationship between the stakeholders will be cemented with the signing of an official agreement.  Additionally, the SE&LMHS project paper detailing the history, scope and ethos will be prepared and reviewed for dissemination. As part of the project as a whole meetings, seminars, training and conferences will be organised to look at theoretical issues such as the dominance of the bio-medical model and practical issues.

Conclusion

As it has on almost every aspect of life, the COVID-19 pandemic has had a significant impact on the SE&LMHS project. The switch to digital delivery of both groups, has had some difficulties that have been and will continue to be addressed by the collaborative working of all stakeholders. The project and especially the CSG which focuses on sharing experiences and participation at very personal level needs high level of confidentiality which is much easier to achieve through natural direct relationships. People who are not familiar with technology can totally refuse to participate online and risk  being excluded or accept it passively with the risk of being exploited. Modern technology is useful for that part of communication that can be digitalised, but this is a relatively small part of the human communication and natural face to face relationships remain essential and irreplaceable, not only to this project.

Nobody knows if and when the restrictions of the pandemic will be lifted and we may always be in a situation where we need to use the technology much more than in the past. For this project and the world in general there will be positives and negatives to this but we feel confident that in the passionate and collaborative working together of all stakeholders we will find the best balance between technology and natural human relationships.

For more information on the Project please contact:
Pino Pini on p.pini@nhs.net or
Alexandra Hunter on alexandra.hunter@hertsmindnetwork.org or Giovanni Borghini on g.borghini@nhs.net