Raza Griffiths investigates an innovative example of service user and carer involvement in designing and delivering mental health services in northeast Lincolnshire.
Making mental health services more responsive to the needs of local communities has been talked of for many years, but in northeast Lincolnshire it is now happening, thanks to a new form of provider.
Last year, NAViGO, a community interest company formed by service users and carers in partnership with mental health workers, took over the running of all mental health services in the area including inpatient wards.
This change came about as the culmination of two decades of service user and carer involvement to develop more humane and effective services. NAViGO emerged from the NHS and is a not-for-profit organisation.
NAViGO’s chief executive, Kevin Bond, who played a key role in this collaboration, says leaving the NHS has made it easier for meaningful service user and carer involvement to happen. “NAViGO can write its own rules, such as giving service users equal voting rights with staff in electing myself and the chair. This would not be allowed in the NHS.”
Now any staff or person from the local community can join NAViGO’s 700-strong membership, which currently includes 340 community members who are mostly service users or carers. These elect the membership board, which joins senior staff to hear issues that anyone wants to bring up in open meetings regarding the day-to-day operation and running of services.
There is also an external service user group, the North East Lincolnshire Independent User Forum, which senior staff “always go to in order to inform and be scrutinised,” according to Jacqui Ellis, who is head of workforce development and head of nursing and has responsibility for service user experience.
What difference has involvement made?
Some of the changes brought about through dialogue with service users and carers since NAViGO came into being include planning and redesigning wards, policy development and staff selection.
Staff training has also been reformed with the use of a groundbreaking package called RESPECT. This trains mental health workers to defuse difficult situations without using control and restraint techniques [see end of article].
As a result of these changes, aggression has declined and service user confidential national survey results for acute wards are well above the national average. Indeed, NAViGO’s acute inpatient sites at Harrison House, Pelham and Meridian Lodge were rated as ‘excellent’ by the Royal College of Psychiatry last year.
Service user involvement is not just restricted to scrutinising services but to directly delivering ancillary services through the Tukes’ Centre in Grimsby, which won the Guardian Public Service Award for inspiring public services in 2011, coming out top of 500 entries.
Forum member Philip explains that the Tukes Centre offers “work opportunities in catering, ground maintenance, property management and DIY, administration, reception and cleaning and laundry for NAViGO. It also renovated houses into flats last year, which will be let to NAViGO members”. This is in addition to having a public café, shop and conference centre. This initiative helps service users to gain confidence and training in preparation for employment, while being supported and advised by a support worker.
The benefits of this are that service users learn employment skills and develop social capital, while staff are exposed to people as rounded individuals rather than simply mental health patients.
The Centre was also mentioned for the excellence of the ancillary services it provides in The Public Sector Employee-Led Mutual Organisation (ELMO) Award.
A staff perspective
Staff also feel engaged with NAViGO, as indicated by the staff survey response rate of 72%, which was the highest for any social enterprise or NHS organisation in the country.
Even staff in backroom jobs like finance, HR and communications are encouraged to understand service user perspectives by spending time on inpatient wards or with care co-ordinators. “This helps them to realise that there is a human being behind the payment by results score that is increasingly becoming a mainstay of healthcare allocation, and get to see and meet people with mental health problems,” says Ellis.
“The most important thing to ask of staff is always ‘Was it good enough for a member of your family?’ For example, if a care co-ordinator is too busy to ring a service user back, this is not good enough.”
The message seems to be hitting home: 75% of staff said they would be happy for their family to use NAViGO services, as opposed to a national average of 60%.
The keys to NAViGO’s success
One of the keys to NAViGO’s success is its small size, which makes it easier for senior staff to respond to service users’ wants and needs than would be possible in a larger, more traditional mental health trust.
“As NAViGO, we can really prioritise mental health and tailor our services to our local community,” Ellis says.
Previously, the area was either geographically marginalised within a large trust or else mental health was not prioritised enough within a generic hospital.
But northeast Lincolnshire’s location – and relative isolation – can also have its advantages. “Geographical isolation also means that people from different organisations like Mind, Rethink Mental Illness and social services tend to know each other and to be less competitive and have worked in partnerships for quite some time now,” Ellis adds.
Although Ellis admits that she worries that this culture may be threatened by increasing privatisation and drive for profit maximisation within mental health services.
Nevertheless, Ellis is proud of what NAViGO has achieved so far and, while there is still work to be done on the attitudes of some professionals, she adds that working at NAViGO is very different to other organisations. “I am proud to work here. It belongs to us. Its success is all our responsibility. There are no managers in offices miles away telling us what to do. It is liberating but with freedom comes responsibility.”
Do you have an example of involvement you’d like to share or a query about National Involvement Partnership’s work? Please contact Raza Griffiths via firstname.lastname@example.org
One of the major changes brought about by NAViGO was the introduction of RESPECT training, which gives mental health professionals the skills to diffuse situations without having to resort to using methods of restraint.
Control and restraint uses ‘pain control’, says NAVIGO’s chief executive, Kevin Bond. For example, “pressing the thumb back against the wrist, or bending the hand back inwardly towards the wrist causing extreme pain if the service user does not comply by getting on their knees then being laid face down legs crossed up their back with one member of staff applying weight to these, whilst two hold the arms.
If service users struggle against any of these holds they may cause themselves extreme pain. “Deliberately inflicting pain to control people has no part in care in my view and such techniques widen the gap between people using the service and staff.”
The face-down ‘prone holding’ technique, as described above, was implicated in the death of Rocky Bennett and the subsequent inquiry into his death recommended limiting the time that such holding should be used for.
By involving service users in the training of RESPECT, staff are faced with the service user perspective on being restrained, which gives pause for thought.
In an emergency situation, a combination of gentle holding techniques, like those used on children and people with learning disabilities to manage aggression, are combined with a mixture of prevention techniques. Importantly, there is no face down holding.
NAViGO is now an accredited RESPECT trainer in Sheffield and Hertfordshire Mental Health Trusts, in Northern Ireland and even Antigua. NAViGO also supervises RESPECT training in schools and is campaigning for more ethical services which do not use control and restraint.