The Life Rooms - Mersey Care NHS Foundation Trust - WINNERS #MHAwards18

Please briefly describe your project, group, team or service, outlining what you do and why it makes a difference.

The Life Rooms is a service run by Mersey Care NHS Foundation Trust, a mental health and community Trust. The Life Rooms attempts to improve mental wellbeing by providing community ‘hubs’ where people can be supported to access the opportunities that are right for them. The Life Rooms offer: • Recovery College: Free courses to support wellbeing • Pathways Advice: Support and guidance in relation to next steps, including support to into a number of different community partners who provide help in many different areas including housing, debt and employment • Volunteering: Support into volunteering opportunities • Peer support: 1:1 supportive conversations with a peer support worker (someone with lived experience of mental distress) An individual may access any number of these services. The Life Rooms also acts as a community resource, providing a safe environment and IT, cafe and library facilities. Anyone who visits the Life Rooms can use these resources. Anyone can access the Life Rooms. People that come to the Life Rooms include Mersey Care service users and carers, people being referred from primary care or public or third sector organisations, and the general public. The Life Rooms has six primary aims 1- Raise the profile of mental wellbeing, empower service users within the community, and contribute towards ending the stigma surrounding mental health. 2 – Promote mental wellbeing through non-clinical opportunities 3 – Improve access to meaningful occupation or employment opportunities. 4 – Contribute to a stronger community through partnerships. 5 – Promote diversity and access to mental health support for marginalised groups. 6 – Contribute to the development of mental health services, prioritising a community model. The entire Life Rooms model has been co-produced, is co-delivered and will be co-evaluated.

What makes your service stand out from others? Please provide an example of this.

Evidence indicates that much clinical time in both mental and physical health settings is occupied by attending to social needs rather than carrying out clinical care. The focus of the Life Rooms is on the self-management of health through learning and social resource empowerment using a community assets based approach. The model effectively draws together existing resources across Mersey Care and Liverpool and Sefton Community services that are already devoted to addressing social and educational need. It supports education, social prescribing and community development; promoting prevention and recovery. It lends itself to physical and mental health contexts as well as the transfer of care from secondary to primary settings. An example of this is the transfer of care from clusters 1-4 in secondary care to primary care, supported by a referral to the Life Rooms.

How do you ensure an effective, safe, compassionate and sustainable workforce?

As with all major projects, leadership and talent management is key. We have developed a strong senior leadership structure with clearly defined and complimentary portfolios of responsibility, yet providing cross-management cover and support. A programme of talent management has identified upcoming middle management champions who have formed the Wider Leadership Team and who operationalize the strategic decisions. All staff have annual PACE reviews at which objectives are formed and all have monthly 1:1s, team meetings and reflective practice. The job descriptions for many of the Life Rooms roles have ‘lived experience’ as a desirable; for example, the Recovery Learning Facilitators, Pathway Advisors and Life Rooms Support Workers. Our volunteering scheme is often the pathway into paid employment within the Trust. All staff have essential mandatory training updates, safeguarding and PREVENT training as well as the opportunity to enhance their professional development through objective-related courses.

Who is in your team?

Director of Inclusion and Participation 2 x Band 8A Head of Service roles 1 x Band 7 Operations Manager 1 x Band 6 Social Worker 4 x Band 4 Employment Advisors 4 x Band 4 Pathway Advisors 1 x Band 6 Chef Lecturer 1 x Band 5 Recovery College Manager 4 x Band 4 Recovery Learning Facilitators 4 x Band 3 Life Rooms Support Workers 4 x Admin roles 1 x Band 5 Project Manager

How do you work with the wider system?

All care exists within the wider society; the Life Rooms model acknowledges that the NHS cannot solve societal problems in isolation. Over 50 partnerships have been developed with statutory, private and voluntary sector organisations; many of whom deliver services out of the Life Rooms in order to provide support ‘under one roof’ for our clients. Many of our partnerships are cost neutral and represent the advent of a genuine social economy. The Five Year Forward View for Mental Health document discusses the importance of creating ‘mentally healthy communities’. The Life Rooms actively 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 delivered from the Life Rooms by our partners ‘Liverpool Floating Support Service’. Since we are aware that common mental health problems are over twice as high among people who are homeless or at risk of homelessness, our partners provide information and support to our clients thereby addressing the social detriments of their mental distress.

Do you use co-production approaches?

Mersey Care’s People Participation Plan was co-produced with service users and carers in 2014. Within that plan service users and carers identified the need to develop a centre for recovery and social inclusion, designed to address the social detriments of mental distress. With the support of the Trust’s Service User and Carer Assembly a business case was approved by the Trust Board and our first building was acquired in 2015. Service users and carers worked with staff to co-produce a design brief and to award the design contract. Staff and service users and carers evaluate the service and make recommendations and provide solutions for the growth and development of the Life Rooms model. One key challenge was to engage the local community around our service and its presence within their local community. We have overcome this by having dedicated campaigns and through communications professionals being attached to our service. We also hold regular community events such as ‘Big Brew’, Children’s Christmas Party, Children’s Easter Egg Hunt, and summer barbecues. This has been successful in that some people who initially were opposed to our service now volunteer their time and expertise at the Life Rooms. Life Rooms Advisory Group (LRAG):

The LRAG has been set up as a forum to work alongside users of the Life Rooms service. This group was set up from a series of five community engagement events that took place in the early stages of the development of the Life Rooms. These events were well attended by Mersey Care service users and carers, members of the community, Mersey Care staff, and partner organisations. During the events, the attendees worked alongside Life Rooms staff to explore the aims of the Life Rooms service. Attendees had the opportunity to respond to these aims and work with staff on how they may best be manifested within the service. After these events concluded, the feedback was collated and themed. Attendees were then offered the opportunity to continue their involvement with the Life Rooms by participating in an on-going Life Rooms Advisory Group. The outcomes from the engagement events were then picked up by this group, and continue to be explored and developed on an on-going basis. The group have worked with staff around Life Rooms development.

They have co-produced initiatives that respond to identified challenges. In particular, the group have focused on how they can raise awareness of the Life Rooms and have created marketing materials and have gone out to speak with organisations about the service. As well as these areas, the group have created a Life Rooms charter reflecting the ethos and vision for the Life Rooms service. It was important that the LRAG group had significant input into this charter as a reflection of the commitment of the Life Rooms to side by side working. Research and evaluation at the Life Rooms: Life Rooms users have worked consistently to support the research and evaluation aims of the service. Thus far, this has involved completing a service evaluation of the Life Rooms alongside Life Rooms staff and an external organisation. The Life Rooms users within the group supported the development of this piece of work by offering feedback to methodological approaches and undertaking data-collection and data-analysis work. This meant that users of the service were embedded into the research agenda of the Life Rooms, as well

Do you share your work with others? If so, please tell us how.

We have already hosted a range of fact finding visits from groups and individuals; CCGs, NHS England, local politicians, government ministers, clinical leaders, Local Authorities, overseas clinical groups, and voluntary sector organisations. We have presented to the King’s Fund and to NHS England. HRH the Duke of Cambridge expressed an interest in our work and officially opened one of our Life Rooms in 2017. We have also been published in the International Journal of Recovery Ontario Shores; university of Toronto. The Life Rooms will be presenting at the following upcoming conferences: • Royal College of Psychiatry Social Prescribing conference June 2019 • Link Worker conference July 2019 • Social Prescribing Network conference July 2019 • Refocus on Recovery Conference September 2019

What outcome measures are collected, how do you use them and how do they demonstrate improvement?

The Life Rooms evaluation report 2018 explored the impact of the Life Rooms in terms of impact on health systems, impact on individuals, and impact on community. We used a range of methodologies to explore these areas. Some of the main findings are shown below. A copy of the full evaluation report is available on request. Life Rooms usage: • Over 30000 visitors to the Life Rooms (April 17 – March 18) • Over 1000 new Recovery College students (April 17 – March 18) • Over 1000 new registrations with the Pathways Advice service – 61% of these new registrations were Mersey Care service users (April 17 – March 18) • Over 2000 referrals for onwards support were made by Pathways Advisors to over 100 sources of support (April 17 – March 18) • 45 volunteers successfully placed within Mersey Care (April 17 – March 18) Measuring value and impact: [Impact on the health and care system] • Early evaluation work illustrates that, after using the Life Rooms, Mersey Care service users evidence a reduction in clinical cost when compared with Mersey Care service users who did not use the Life Rooms. [Impact on the person, their carers and families] • Life Rooms people and environment are felt to be positive influences • The Life Rooms are felt as non-judgemental and a safe space to share experiences • Self-development and self-awareness are identified as significant outcomes for users of the Life Rooms • Social inclusion offers positive impact on the lives of individuals; the Life Rooms are seen as places to facilitate this • Development of personal goals is identified as a positive outcome of the Life Rooms on individuals • Initial SWEMWBS analysis indicates a medium effect in the context of improved wellbeing for Life Rooms users [Impact on community] •

Over 100 community partnerships have developed as part of the Life Rooms model. These present some favourable outcomes in terms of building effective working practices in community support. “I’ve always said it’s just such a safe place because, even if I’m not in a good mood, get out and at least go to the Life Rooms where I know other members of staff and students and service users… you know everybody understands, do you know what I mean?” “With the Life Rooms, you can actually, if you walked into a group that were in the Life Rooms you couldn’t go she’s staff and they’re users ‘cause you don’t know because it’s not dwelled on, is it?” “…and speaking to people, I’ve got more awareness of me and where I am in my head so I know now if I’m starting to fall down… so I know to try and get my coping strategies in place.” “On a few of the courses I met a, I met a girl there, I say girl she’s the same age, you know she’s a woman, I met someone there and we clicked and we had lunch in, in the little coffee shop there and it was like oh my god this is the first time in my adult life I have sat and had lunch with a friend” “It got me back on the ladder to go back to work… to feel confident to go back to work knowing that I could cope with work… I could… and I could cope with life”

Has your service been evaluated (by peer or academic review)?

Formative evaluation was initially completed by Liverpool John Moore’s University (Cochrane et al.2016). An internal evaluation was subsequently undertaken by our own staff. The Trust has commissioned a two-phase service evaluation that will assess the impact of the Life Rooms on clinical and recovery progression as well as on patient experiences. It will also seek to measure any economic impact in terms of switching off costs in secondary and primary care areas. Our Social Worker and Research Lead is being supported to complete a PhD around the evaluation of the Life Rooms model in the social prescribing arena.

How will you ensure that your service continues to deliver good mental health care?

Our six primary aims around the Life Rooms model will ensure the service continues to deliver good mental health care; these will be performance monitored through the Life Rooms Advisory Group in reports to the Trust Board. One of most critical outcomes in terms of good mental health care in the embedding of the model within clinical care pathways on entry and egress; thus ensuring that all service users and carers have access to the supporting services required to alleviate their mental distress and continue their recovery journey. Our success in involving the local community has gone some way to addressing the stigma attached to users of mental health services. We will continue to work with local commissioners to demonstrate the benefits of commissioning the model in primary care settings. Currently Mersey Care is only funded to work with service users and carers accessing secondary care services, however we have observed an organic take up from the local community and GP services. Over 40 GPs now provide referrals directly into the Life Rooms and Mersey Care supports this without the associated funding. The situation certainly poses a challenge to how we creatively commission optimum mental health services that join up preventative, primary, and secondary care services.

What aspects of your service would you share with people who want to learn from you?

The Life Rooms model was developed in order to raise our ambition for those within secondary services, ensuring that we do not simply stabilise mental health conditions but rather give individuals the hope, control and opportunity that leads them to a meaningful life of their own choosing and so provide an alternative to ‘bouncing back into services’. We realise that with the appropriate funding we could be more ambitious. By providing socially focussed interventions as early as possible we can both prevent and halt deterioration in mental distress and so reduce the need for expensive clinical interventions. Our challenge is to demonstrate through robust research and econometric studies not only savings to the public purse but real and substantial life outcomes for individuals and the wider society.

Additional Questions

The following questions are an opportunity for you to provide further details on how you implement positive practice in your service delivery and how you ensure your service is advancing access and equalities. Answers to these questions will not influence how your PPiMH awards application is assessed, however any responses received may contribute to the potential inclusion of your service/team as a positive practice example within published guidance developed by NCCMH and NHS England.

How many people do you see?

Over 30000 visitors to the Life Rooms between April 17 – March 18

How do people access the service?

Self-referral, GP referral, clinical referrals such as consultant, CPN, OT.

How long do people wait to start receiving care?

Pathways Advisors (the first port of call for everyone visiting the Life Rooms) see people on a ‘drop-in’ basis. There are therefore no waiting lists to access the service.

How do you ensure you provide timely access?

All of the above

Commissioner and providers

Commissioned by (e.g. name of local authority, CCG, NHS England):

Liverpool and Sefton CCGs

Provided by (e.g. name of NHS trust) or your organisation: Mersey Care NHS Foundation Trust

Population details

Brief description of population (e.g. urban, age, socioeconomic status):

The Life Rooms Walton, Southport and Bootle provide services to the people of both Sefton and Liverpool metropolitan boroughs. Sefton consists of a coastal strip of land on the Irish Sea extending from the primarily industrial area of Bootle to the traditional seaside resort of Southport whilst Liverpool is predominantly an urban conurbation also located the north west coast. Sefton in its entirety is in the most deprived quarter of English Local Authorities with 5 of its lower super output areas (LSOA) in the top 1%. However in other parts of the borough are some of the least deprived areas, with two LSOAs being in the least deprived 5% of areas nationally. 71% of Sefton residents aged between 16 and 64 were in employment between October 2015 and September 2016 (62% employees & 9% self employed). This is slightly lower than the North West (72%) and England as a whole (74%) Liverpool is ranked the 4th most deprived local authority with 26 LSOAs in the most deprived 1% nationally and 134 LSOAs in the most deprived 10% nationally which is 45% of the city’s total. Only 63% of Liverpool residents aged between 16 and 64 were in employment between October 15 and September 2016. This is significantly lower than both the North West (72%) and England (74%) figures.

Size of population and localities covered:

Sefton has a population of approximately 274,000 whilst Liverpool has a population of approximately 478,580. The Life Rooms at their three locations are available for access to the population of both Liverpool and Sefton metropolitan boroughs.

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The Life Rooms – Mersey Care NHS Foundation Trust – WINNERS #MHAwards18

Co-Production

Evaluation

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