Three reflections from working on mental health prevention
At Shift, we’ve been researching, designing and co-creating in the mental health sector for more than 15 years. We’ve been proud to be a part of some successes, and have also experienced some more challenging programmes, all in the backdrop of an ever-deepening mental health crisis. We recently shared how we’d approach a youth-led mental health prevention programme in this blog — which has spurred three bigger reflections for us on how to fund and create the change that’s so desperately needed.
1. Mental health prevention — an impossible boundary to draw
Working in the prevention space is inherently difficult. Particularly when looking at the growing mental health crisis across the UK and the many divergent and changing drivers of poor mental health for people across a lifetime. How can you determine whether an exclusion in secondary school was the catalyst for crime or depression? And, ultimately, who cares? If we want to create a better world where people are able to thrive and live the life they want to, does it matter which ‘bad’ outcome is prevented?
Unfortunately, the atomisation of the world is how the current system works. It’s how budgets get divided and it’s how professionals and academics justify their speciality. But if we continue working in this blinkered way, we’ll not only turn our backs on bad things that are happening in society because it isn’t fundable, we’ll also be less effective at making lasting change. If we know that one of the largest indicators of living a good, happy, and healthy life is connection and community, why is it the very thing we refuse to invest in?
We want to see more funders, academics and change-makers advocating for a whole-person and whole-system response to change. That’s why we think that meaningful social change is led by the people negatively impacted by today’s system. People do not have a ‘mental health’, ‘violence reduction’ or ‘health and wellbeing’ view of the world, they understand the complexity of life because they live it. We love New Local’s vision for a community-powered NHS, particularly the contrast between a state and market-led organising principle around ‘standardisation’ and ‘efficiency’, while the community paradigm is focused on prevention. We’ve seen how the act of coming together and organising around local change can be a preventative healing process in and of itself.
2. The pull of the existing system — holding power imbalance
We know that innovation programmes that are completely disconnected from existing systems of power and practice happen in isolation and when funding ends, so does all of the work that’s gone into it. We also know that innovation programmes that are reliant on the cooperation and consent of existing power holders end up with pretty similar results to what’s already been done. If a programme has some of the most inclusive participatory processes, but its outcomes rely on support from politicians, civil servants or funders, it’s unlikely that we’re going to be able to create much change.
Equally, we’ve experienced when academics or ‘experts’ dictate a project direction or set limiting narratives on what could be seen as evidence or rigour. We believe the right partnerships are the ones led by those with experience of the issue we’re trying to address. But these people, whoever they are, cannot be left alone and expected to solve these issues without access to resources and those with specialist or technical expertise. To borrow Hélène Landemore’s phrase, ‘experts should be on tap, not on top’.
We want to see more funding that can carry multi-partner collaborations and new combinations of expertise and experiences from imagination to action, appropriately disconnected and embedded into the current system for sustained transformation. This means we’ll make less promises about what we’re going to make, and more about how we’re promising to be. We need to reimagine how funding gets distributed, how we share risk in delivering change and how all this change is governed effectively in collaboration with communities, organisations and state. We agree with the Civic Power Fund that you need a new model of time, risk and impact to ‘build power’. We’ve been inspired by Dark Matter Lab’s Beyond the Rules — exploring and sharing the collaborative infrastructure for interdisciplinary, multi-partner and non-hierarchical collaboration.
3. The capacity and infrastructure for people to participate
We know that people in the UK feel like they have little power and influence over decisions that impact their lives. But nowhere is this felt more than in the communities where public services are crumbling and supporting infrastructure is non-existent. And at no time in the last 30 years has this been felt more widely in the UK than now. That makes it a tricky time to work in community participation, innovation and power. What use is power to direct change around mental health services if you can’t get an appointment at your GP? And what’s the risk of running community innovation programmes if there’s no ongoing funding to maintain the community infrastructure after a programme?
The answer is — it’s really risky. That’s why we’ve been working hard to build partnerships with local grassroots organisations that are established and already doing good work, so that innovation funding can build ongoing capacity, not just the shiny new way of working. And because of the lack of investment in public and community services, more and more core service providers have been pushed towards funding that normally supports innovation. This ‘doom loop’ of short-termism and little investment means that it’s difficult for the sector to justify investing in change. We’ve had to question whether our applications for innovation funding might be taking money away from core services. While we don’t think this should be the use of innovation funding, it’s a good prompt for us to consider our role in the innovation ecosystem, and recognise that the most innovative work is the stuff that transitions from the sandbox to the everyday. This only happens through meaningful partnerships that can build on and transition local community infrastructure for participation and support.
We want to see more capacity-building innovation funding that requires innovation teams like ours to work in longer-term partnerships with grassroots organisations for effective collaboration and shared risk. We think this is how you demonstrate horizon two of community-led healthcare, bridging the world we need with the world we have. We’ve been inspired following Healing Justice London, and their work that both does the big system shifting work and creates and supports the infrastructure for people to thrive — from collaborations with grassroots organisations around Land Justice to their regular events programme and Rehearsing Freedoms festival from last year.
While we’re talking about some quite major changes in how we approach health and change in the UK, what’s promising is that the solutions don’t require a breakthrough in AI or another period of economic boom. It’s about better collaboration, stronger communities, and the infrastructure to get us there. We’ll be sharing more in an upcoming blog.
