The Life Rooms – Mersey Care NHS Foundation Trust

The building opened May 9th 2016 and now hosts a range of services including: An employment and enterprise hub to help Mersey Care service users get back to work, through employment support, volunteering opportunities and further education; Service users and carers will be able to get information about physical and mental wellbeing, advice on money, housing and community services, including sessions for Liverpool City Council and other agencies; A library for health and wellbeing, learning, literature and poetry operated by service user volunteers; A children's library area facilitating school and children centre use; Mersey Care Recovery College learning rooms for people who want to come and access a wide range of sessions and workshops; Meeting spaces for community group; A free IT suite for everyone to use; Interview areas for private confidential support; An open area for art exhibitions and cultural activities for everyone; A café run by a local social enterprise, North Perk.

Co-Production

  • From start: Yes
  • During process: Yes
  • In evaluation: Yes

Evaluation

  • Peer: Yes
  • Academic: Yes
  • PP Collaborative: Yes

Find out more

What We Did

Mersey Care’s People Participation Plan for 2014/15 was co-produced by service users and carers together with the People Participation Team. Within the plan service users and carers identified the need to develop a centre for recovery and social inclusion, designed to address the social determinants of mental distress. Scoping sessions were held involving service users to help support the development of the vision for a centre for recovery and social inclusion.

A key strategic priority for the organisation is supporting service users and carers to access employment. To date progress in supporting access to employment for our service users has been a flat-lining target. In the last six months we have seen some progress in this area but with 97% of service users on CPA unemployed the need to take innovative steps in order to fully address this area of social exclusion was identified as a key area of concern to the Service User and Carer Assembly. However, wider issues relating to housing, debt, benefits, social isolation and access to education were also identified as huge areas leading to inequality for mental health service users.

The work of the People Participation Team dedicated to supporting service user and carer voice was previously based within Trust Headquarters and not within a community context which service users and carers identified as an environment not conducive to inclusion.
The Trust’s Recovery College was launched in September 2013 and since that time its hub has been located within Rathbone Hospital. The work of the College has grown successively and the need to make the College more present within the community grew. At the same time the location of the College within a hospital setting was felt by service users and carers to contradict the philosophy that needs to underpin non-clinical models of care.

At the same time Liverpool City Council was forced to put the future of 9 of it’s libraries at risk due to reduced funding available. Service users expressed real fears at the possible loss of libraries. These are place that people can go to interact with other people, feel safe, access information and other resources as well as practical advice and support. This prompted Mersey Care to engage with the Council to explore whether a library could be developed as a centre for recovery and social inclusion.

One of the Libraries earmarked for closure was Walton Library. This building donated to the city by Andrew Carnegie 105 years ago was situated within an area of particular social need in the north of Liverpool. It is approximately 0.25 miles away from Mersey Care’s Clock View Hospital and Assessment Service. It has outstanding public transport links and is well located to be a place of outreach to mental health need within both north and central Liverpool as well as to Kirkby and south Sefton.

With the support of the Trust’s Service User and Carer Assembly a business case was put forward to the Mersey Care Board to acquire the building. This was approved and the building was acquired by the Trust in July 2015 and was vacated by the City Council in November 2016.

Service Users, Carers and Staff coproduced a design brief for the new centre for recovery and social inclusion and together awarded the design contract. A process of engagements sessions with the designers and service users, carers and staff then followed until the final design for the Life Rooms was approved.

The building opened May 9th 2016 and now hosts a range of services including:
• An employment and enterprise hub to help Mersey Care service users get back to work, through employment support, volunteering opportunities and further education
• Service users and carers will be able to get information about physical and mental wellbeing, advice on money, housing and community services, including sessions for Liverpool City Council and other agencies
• A library for health and wellbeing, learning, literature and poetry operated by service user volunteers.
• A children’s library area facilitating school and children centre use.
• Mersey Care Recovery College learning rooms for people who want to come and access a wide range of sessions and workshops
• Meeting spaces for community group.
• A free IT suite for everyone to use
• Interview areas for private confidential support
• An open area for art exhibitions and cultural activities for everyone
• A café run by a local social enterprise, North Perk

To learn more about the transformation and see the environment developed by service users, carers and staff working in partnership follow this link: https://www.youtube.com/watch?v=yYTaZNbAIXU

Full details of our range of activities and courses can be viewed on the newly developed website to accompany the service: http://www.liferooms.org/

Since opening in May 2016 there have been over 10,500 visits to the service. The three highest recorded reasons behind visiting are:
• Make use of free IT
• Just Spend time in the building or access social activity
• Access Recovery College Courses

35 partnerships developed involving the statutory, voluntary and private sector. Many of those partnerships cost nothing and represent the advent of a genuine social economy.

Over 40 GPs as well as IAPT services now provide referrals into this service and we seek to evaluate the impact of our non-clinical/ social prescribing models have not only on the outcomes for individuals but also impact volume and burden in primary care.

The Life Rooms Southport, replicating this model opened in Spring 2017 and we now seek to work with both primary and secondary mental health services in order to assess how innovative models of community mental health care can be developed around social models.

Wider Support

The Five Year Forward View for Mental Health document discusses the importance of creating ‘mentally healthy communities’ (Mental Health Task Force 2016:17). The Life Rooms contributes to this agenda by forming partnerships with external organisations in order to create more effective service provision. One example of this is the housing support sessions set up from the Life Rooms within our Professional Advice Area. Common mental health problems are over twice as high among people who are homeless compared with the general population, and psychosis is up to 15 times as high (Mental Health Task Force 2016:6). ‘Liverpool Floating Support’ and ‘Healthy Homes’ provide information and support to those who are at risk of homelessness or have difficulties in their current accommodation. Providing such opportunities contributes towards addressing the social determinants of mental distress, and therefore the prevention focus of much of the literature detailed earlier.

Moving forward, the Professional Advice Area is set to expand its remit to include offerings from organisations such as the Citizens Advice Bureau. Work needs to be done to both communicate and track the outcomes of these offers. This was a point specifically highlighted within the formative evaluation completed by Liverpool John Moore’s University of the Professional Advice Area (Cochrane et al. 2016)

The Life Rooms also provides resources for local community groups more generally. The library and computer access are examples of this, as well as hosting groups from the local Children’s Centre, local interest groups, craft and book clubs.

Additionally, since opening, the Life Rooms has hosted a number of events, offering wellbeing opportunities for those within Mersey Care, and the local community.

Working in this way is particularly significant. It is not about financial input, but a community focused, asset-based approach. The joining up of private, public and voluntary sectors has potential to improve outcomes for individuals, as shown by some of the indicative evidence presented so far. Remodelling community services in this way also presents opportunities in a broader sense, creating potentially less expensive, more effective ways of working.

Co-Production

As outlined above the concept for this service originated with service users and the business case, design brief and engagement process for the building were all co-produced.

Courses within our recovery college are co-designed, co-delivered and co-evaluated by service users, carers and staff.

We are currently in the process of undertaking 6 structured focus groups with service users, carers, staff, partners and members of the local community in order to learn from the first 9 months of operations so as to develop and grow the services offered as well as improve experience of them.

 

Looking Back/Challenges Faced

One of the key challenges has been in engaging the local community around our service and its presence within that community. There was clearly a greater need for more focused communications and indeed and engagement campaign around supporting mental health and well-being in a community/non-clinical setting. We have overcome this by having a dedicated campaigns and communications professional attached to our service and certainly this person played a key role in preparing and implementing the community engagement strategy around our second Life Rooms which opened in May 2017.

Another significant unforeseen challenge has been the scale of demand for our Life Rooms provision within primary care. Significant referrals are coming from GPs, Job Centres and other local community groups. Mersey Care is not commissioned for this and so whilst being responsive to the needs of those who come into this open door service we need to be careful that we do not do this at the expense of the impact we need to demonstrate in secondary mental health services. At the same time this challenge is also presents an opportunity to think differently around how primary and secondary mental health services might be more effectively and creatively co-commissioned in the future and this leads to the service evaluation about to be commissioned by the Trust.

 

Sustainability

As with all major project leadership and talent management is key. We have developed a strong senior leadership structure with clearly defined and complimentary portfolios of responsibility but one that also provides cross-management cover and support. A programme of talent management and succession planning is now underway around middle leadership roles. Clinical pathway.

Most critically of all is the embedding of the Life Rooms service within clinical care pathways. This ensures that we are firmly part of the accepted model of care for the Trust. Key to this is ensuring mechanisms for referral, pulling people through to the service are safely and effectively established. Essentially, such embedding ensures that Life Rooms is part of what we are and what we do as an organisation rather than an initiative sitting at the edges. Such embedding is the only way that the project becomes truly independent of people and personalities.

Evaluation (Peer or Academic)

An internal evaluation has been undertaken by our own staff and the Trust is about to commission a two phase service evaluation that will assess the impact of the Life Rooms on clinical/recovery progression as well as on patient experiences and indeed seek to measure any economic impact in terms of switching off costs both in secondary and primary care areas.
Liverpool John Moores University have undertaken SROI evaluation around the Recovery College provision and the professional Advice Area. They continue to undertake this work this year.
Tony Ryan Associates have been commissioned to do a service evaluation demonstrating economic, recovery and satisfaction impact. This will report in September 2017.

 

Outcomes

We have developed six primary aims for the Life Rooms and some initial evaluation around these are included below:

Aim 1: Raise the profile of mental wellbeing, empower service users within the community, and contribute towards ending the stigma surrounding mental health

“Here is sanctuary, peace and calm.” (Focus group participant)

The focus group participant quoted above articulates beautifully one of the objectives identified within aim 1 is to ‘provide a safe and welcoming environment where visitors feel valued’. The qualitative data from the initial survey of Life Rooms usage, as well as many of the comments left in the visitor’s book also provide positive reflections on the Life Rooms environment:

“Very welcoming. This is such a much needed resource, I am so glad I heard about the Life Rooms – I am really looking forward to using the things on offer.”
“The building is light, airy and very comfortable. I will certainly use the facilities and encourage others to do so.”
“As a service user I am so impressed with the new building, it is warm, welcoming and a place with loads of potential in mental health.”
“A joy to come in – even if it just for a coffee and a chat! Love it and proud to be a part of this exciting innovation in the heart of the community where I grew up and live.”

At a basic level, the footfall data for the Life Rooms also contributes towards the above aim. In the first nine months of opening, the Life Rooms has had over 10,500 visits.

“The Life Rooms has had a massive impact on me, you can’t put a price on that. I feel engaged by what it represents as a service. The focus is on what people want, it’s not putting people into a box. I like the way it engages the general public because everybody needs support at some point. I feel like the Life Rooms is moving things in the right direction. I tell everyone about it!” (User of the Life Rooms)

The quote above talks about ‘engaging the general public’. As the Life Rooms is open to the ‘general public’ as well as Mersey Care service users, it offers lots of potential for inclusion, raising the profile of mental wellbeing and challenging stigma. As one focus group participant succinctly put it:

“It would help with the stigma if they could see we’re not chained to walls”.

Usage of resources such as the IT facilities, library or café would be examples of potential for creating awareness around mental health as these facilities are offered within a mental health setting. Within the first three months of opening, an initial survey was undertaken in relation to what people were using the building for. The highest responding answer was ‘IT facilities’ In particular, it has been highlighted that this approach is supported when facilities are made available in ways that are inclusive and accessible.
The Five Year Forward View For Mental Health states that ‘the Department of Health and Public Health England should continue to help local communities build a grass roots social movement to raise awareness of good physical and mental health and support people to seek help when they need it.’ (Mental Health Task Force 2016:17). Engaging with the local community via the offering of a community space and resources offers a route for creating awareness of other services offered within the Life Rooms. A particularly good example of this was a community focused Christmas event held at the Life Rooms on 10th December 2016. On this day, several hundred people visited to take part in a Christmas celebration, during which they were introduced to the Life Rooms and the support it offers.

Aim 2: Promote mental well-being through non-clinical opportunities

“I’m always looking at opportunities to ‘switch myself on naturally’; I feel like the Life Rooms offers a space to facilitate these opportunities.” (User of the Life Rooms)

This quote comes from a lady who was encouraged to access the Life Rooms by her GP. Local CCG visions and strategies for mental health describe services that are more integrated with primary care (Mersey Care NHS Foundation Trust 2016:3). With nine out of ten adults with mental health problems being supported in primary care (Mental Health Task Force 2016:8), providing opportunities for patients to engage with non-clinical opportunities as part of tackling their mental distress offers potential for this integration.
Links between the Life Rooms and primary care have been made in recognition of the transformational aspirations of the local area commissioning intentions (Mersey Care NHS Foundation Trust 2016:3). ‘Referral cards’ have been created for GPs to give to patients who may benefit from the Life Rooms. Cards have been distributed to over 40 GPs. By promoting access to non-clinical opportunities for those presenting at their GP with mental distress, the Life Rooms aspires to evidence reduction in GP face-to-face time in the local area and avoid potentially inappropriate clinical referrals. The intention for evaluation of this process will involve collection of outcome data for users of the Life Rooms, specifically those who have come via their GP. It will also involve some level of data sharing between GP practices and the Life Rooms; this is being pursued at present.
However, as of December 2016, we do know that 20 people have enrolled at the Recovery College through signposting from their GP. The Recovery College is a non-clinical Mersey Care service, based within the Life Rooms, which provides free courses on a range of wellbeing topics. Courses are facilitated by those with lived experience of mental distress; they provide recovery learning opportunities and a chance to share experiences in a safe environment.

“The value of lived experience needs to be heard. No matter how good a nurse you are and how academic you are and fantastic you are, people who are unwell want to speak to a person who’s been unwell themselves.” (Focus group participant)

The Recovery College has a base within the Life Rooms, however courses are delivered across the Mersey Care footprint. Liverpool John Moore’s University has begun to conduct a Social Return on Investment (SROI) analysis of the Recovery College. Some initial data analysis has been done of attendance and course evaluation forms over the past academic year (September 2015-August 2016) Notably, within all three courses analysed (Confidence Building, Raising Your Self-Esteem, Living with Anxiety), 100% of respondents answered agree or strongly agree to the following:
• As a result of this course, I feel hopeful for the future
• As a result of this course, I have more ambition to do things
Participants also commented positively on the learning environment created by the tutors and were able to gain a lot from the sessions:

“Very helpful and informal/casual atmosphere allowed me to feel comfortable using some of my own examples. I have learned a lot” (Recovery College Student)
“Discussions about personal experiences of coping techniques as I have started using some suggestions that I had not previously thought about. Truthful and honest, not biased” (Recovery College Student)

Looking ahead, data collection within the Recovery College will be improved to obtain a more substantial data set. Work on the Social Return on Investment (SROI) analysis began in January 2017.

“A local little hub for staff, volunteers, and for advice… Being able to touch base, lean on someone. Can come to lots of events.” (Focus group participants)

Non-clinical opportunities are also provided via the resources, advice and event opportunities that the Life Rooms offers. This is brought out in more detail within the discussion of aims 3 and 4.

Aim 3: Improve access to meaningful occupation or employment opportunities

The employment rate for adults with mental health problems remains unacceptably low: 43 per cent of all people with mental health problems are in employment, compared to 74 per cent of the general population and 65 per cent of people with other health conditions (Mental Health Task Force 2016:16).
There are opportunities to receive employment support in the Life Rooms. Two ‘Vocational Pathways Advisors’ have very recently started in post at the Life Rooms (December 2016). Part of their role is to support individuals into meaningful activity or employment where appropriate. Since January 2017 they have received over 150 referrals, out of which many have attended ‘Employability Skills’ workshop, ‘Interview Technique’ Training, enrolled in Recovery College course, or accessed external employment support from other organisations and two individuals have commenced in employment.

There are a number of different partner organisations providing employment support from the Life Rooms. This includes CV support, help with job searches, mock interview sessions
Feedback from partner organisations is still being collected, however, ‘Liverpool in Work’, who provide a weekly employment support session from the Life Rooms, reported the following on 8th December 2016:

“Re: Liverpool in work clients seen from October to date, there are 40 new registrations. Out of these there are 7 new job starts with a further 4 awaiting outcomes on job interviews.
I’m on average seeing 8 new people per week with a further 3 appointments kept for reviews/funding totalling 11 just on a Wednesday alone.
I have funded clients for work clothes, travel a taxi badge, reach licence and various tools and health and safety clothes.”

Volunteer services are positioned within the Life Rooms. Support is available to anyone interested in exploring volunteering opportunities within Mersey Care and beyond. There are a number of volunteers who work within the Life Rooms. There is a focus on volunteering opportunities for service users within Mersey Care. All volunteers within the Life Rooms are service user volunteers. One ‘meeter and greeter’ volunteer explains:

“Being a meeter and greeter is good for my mental health.” (Focus group participant)

The recognition that meaningful activity is a key factor to recovery, as well as a strengthening factor for a community informs one of the key aims for the Life Rooms. Employment is not appropriate for many people, but everybody should have the opportunity to explore what is meaningful activity for them. Volunteering is an example of this.

Aim 4: Contribute to a stronger community through partnerships

The Five Year Forward View for Mental Health document discusses the importance of creating ‘mentally healthy communities’ (Mental Health Task Force 2016:17). The Life Rooms contributes to this agenda by forming partnerships with external organisations in order to create more effective service provision. One example of this is the housing support sessions set up from the Life Rooms within the Professional Advice Area. Common mental health problems are over twice as high among people who are homeless compared with the general population, and psychosis is up to 15 times as high (Mental Health Task Force 2016:6). ‘Liverpool Floating Support’ and ‘Healthy Homes’ provide information and support to those who are at risk of homelessness or have difficulties in their current accommodation. Providing such opportunities contributes towards addressing the social determinants of mental distress, and therefore the prevention focus of much of the literature detailed earlier.
Moving forward, the Professional Advice Area is set to expand its remit to include offerings from organisations such as the Citizens Advice Bureau. Work needs to be done to both communicate and track the outcomes of these offers. This was a point specifically highlighted within the formative evaluation completed by Liverpool John Moore’s University of the Professional Advice Area (Cochrane et al. 2016)
The Life Rooms also provides resources for local community groups more generally. The library and computer access are examples of this, as well as hosting groups from the local Children’s Centre, local interest groups, craft and book clubs.

Additionally, since opening, the Life Rooms has hosted a number of events, offering wellbeing opportunities for those within Mersey Care, and the local community.

Working in this way is particularly significant. It is not about financial input, but a community focused, asset-based approach. The joining up of private, public and voluntary sectors has potential to improve outcomes for individuals, as shown by some of the indicative evidence presented so far. Remodelling community services in this way also presents opportunities in a broader sense, creating potentially less expensive, more effective ways of working.
A challenge of working in this community focused way is communicating what is on offer. This was acknowledged within the focus groups:

“It’s not known in the community.” (Focus group participant)
“Given people aren’t clear about the purpose of the Life Rooms is, we need to work harder to communicate these.” (Focus group participant)

Events such as the above are helpful ways to engage with the community and offer opportunity to come into the Life Rooms and see what is on offer, but certainly, moving forward, pursuing opportunity to engage with the community further is necessary. Driving change presents difficulties in terms of communication; it also has the potential to create existence amongst organisations and individuals that are used to working in a certain way.

Aim 5: Promote diversity and access to mental health support for marginalised groups

Currently, demographic data in terms of users of the Life Rooms is not available. However, plans are in place to undergo demographic sampling of users in January 2017. The Life Rooms sits in the Warbreck Ward of Liverpool. The most recent census data demonstrates the proportion of BME residents in Warbreck is 5.9%, half that of the citywide average of 13.7% (Liverpool City Council, 2016b:4). People in marginalised groups are at greater risk of mental distress (Mental Health Task Force 2016:7). A strategy is currently being devised with local community development workers as to how best we can support BME residents to access the Life Rooms.
Mersey Care is one of only three providers of High Secure forensic mental health services in the country. As such we are acutely aware that one particular marginalised group in society is the patient population within forensic inpatient settings. Over a period of four years we have developed Recovery College approaches within these settings and moving forward we seek to develop the broader Life Rooms model within a forensic setting. This sets a clear vision that supports patients aspire to, and prepare for, a life beyond not only services but also beyond the criminal justice system.

Aim 6: Contribute to the development of mental health services, prioritising a community model

This piece of work, and the recommendations from it, will contribute towards a robust analysis of the Life Rooms model moving forward. The development of the previous five aims all contribute to this. The Life Rooms explores the contributions that Mersey Care can make towards supporting the recovery journey of those moving out of its services. It also aspires to strengthen the opportunities for support at a primary care level, thereby reducing the time spent with GPs. Furthermore, the opportunities available at the Life Rooms aspire to work preventatively with those who may not yet have sought formalised help for their distress.
Current economic challenges faced by the UK Health system present mental health services with a considerable challenge. It is increasingly apparent that previously accepted models of community care are becoming unsustainable. It is also increasingly apparent that demand for mental health services within our a Trust is growing by between 4 and 5 per cent each year. This reality challenges us to think differently around how we provide community care. The Life Rooms model seeks to respond to this challenge by taking a community assets based approach involving cohesion between statutory, voluntary and commercial sectors. Our aspiration is to develop an holistic social model that not only results in better outcomes for individuals and communities, but one that also enables us to switch off costs relating to traditional clinical models of care. A full econometric study will be required to robustly build the case in support of this aspiration.  Looking ahead, a second Life Rooms site has been identified in Southport. This represents the start of the process of replicating the Life Rooms model across the Mersey Care footprint.
 

Sharing

We have already hosted a range of fact finding visits from other groups and individuals seeking to learn more about the model. This includes clinical leaders, other trusts, CCGs, NHS England, local councillors, third sector organisations and we continue to welcome such visits.

An article describing the project will feature within the International Journal of Recovery Ontario Shores – University of Toronto in the Spring of 2017. A further article will appear in the same journal later in the year looking at some of the initial outcomes from our service evaluation.

 

Is There Any Other Information You Would Like to Add?

An interesting development occurring almost organically has been a take up on Life Rooms’ services from the local community and particularly within primary care. Over 40 GPs now provide referrals into this service and we seek to evaluate the impact of our non-clinical/ social prescribing models have not only on the outcomes for individuals but also how they impact volume and burden in a primary care setting as well as within the secondary care services for which we are directly commissioned.

This poses a real challenge to our thinking around how we creatively commission primary and secondary community mental health services in a joined up way. The Life Rooms model was developed in order to raise our ambition for those within secondary mental healthcare, ensuring that we don’t simply stabilise health conditions but rather we give people the hope, control and opportunity that leads them to a meaningful life of their own choosing and so provide a better chance not to bounce back into services. The impact of the Life Rooms on primary care settings suggests that we can be still more ambitious. By providing socially focussed interventions as early as possible we can potentially halt the deterioration in mental health and so reduce the need for expensive clinical intervention and admission to secondary services. In evaluating this model we have real potential to demonstrate not only savings to the public purse but also real and substantial life outcomes for individuals and wider society.

The Life Rooms as a vehicle to achieve both primary and secondary objectives is an exciting and intriguing proposition. We now seek to work with both primary and secondary mental health services in order to evaluate how this innovative model of community mental health care can be developed in such a way as to enhance individual life outcomes as well as reduce clinical costs.
 

 

 

 

 

 

 

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