Introduction
The Life Rooms, Mersey Care NHS Foundation trust
Methods
Ethical approval
Recruitment and participants
Topic guide
Data analysis
Results
Referral categories | Number of referrals |
---|---|
Life Rooms learning provision | 2201 (57.0%) |
Social support in relation to debt and benefits | 217 (6.0%) |
Social isolation | 214 (5.0%) |
Physical health | 174 (4.5%) |
Employment | 117 (3.0%) |
Housing | 95 (2.4%) |
Volunteering | 40 (1.0%) |
Family/caring role | 29 (0.7%) |
Other | 845 (22.0%) |
Total | 3894 |
Themes | Subthemes |
---|---|
Quality of partnerships | Shared values: holistic approach, stigma reduction and co-production |
Mutual trust and reciprocity | |
Regular communication and face-to-face contact | |
Benefits of partnership working | A cost-effective and sustainable way of working |
Broadening opportunities | |
The promotion of psychological wellbeing | |
Facilitators | ‘Under one roof’ |
Staff with a shared vision | |
Professional input | |
Challenges within the Life Rooms model | Equality in partnerships |
Capacity to communicate effectively | |
Inappropriate referrals | |
Insufficient resources | |
Threat from Mersey Care expansion | |
Making things even better | Mechanisms for regular feedback |
Key contacts | |
Variety of courses |
Quality of partnerships
Shared values: holistic approach, stigma reduction and co-production
We look at the organisations and their values and whether those fit with our values and what we believe the Life Rooms is doing or the Trust is trying to do (LRs 4).
The environment they’ve created is about this holistic approach, which I think is fantastic… One of the reasons we were interested working with the Life Rooms specifically was because that was an approach that they were looking to take. They wanted to bring in an expert for each particular area and an organisation that could add value to what they were doing (Partner 5).
The fact that they are so effective is because they look at the whole person (Partner 13).
It helps us in attracting more people to the building… I don’t think we would be anywhere near as successful as we are without our partners. They really are vital to us. I think it helps us to get away from the stigma of that’s a mental health building (LRs 6).
I hope the value of our brand also helps Mersey Care to again encourage people to use the Life Rooms because it is a place where they can start to access music activities that are provided by Royal Liverpool Philharmonic (Partner 7i).
We very much asked the makers when they were designing the activities, and they were all bespoke to the Life Rooms participants and working with the staff there to make sure that what we were delivering was pitched right for the people taking part… The sessions are written particularly for these groups and I think all of that is absolutely the key (Partner 12).
Involving the service users is also about creating ownership and value and it’s like in anything if people feel that this is something, that the course that they are part of and that they have a say in the direction of it and the output from it, hopefully that will increase their motivation for not only turning up week in week out but actually wanting to then create the best possible result not just individually but as part of the team and seeing the whole group as part of a team because hopefully that’s when a lot of the skills and the positive outcomes will flow (Partner 7i).
Mutual trust and reciprocity
I think it’s that longevity of relationships. Partnerships don’t just happen in five minutes; they come over time of working with each other... I think all partnerships have to work both ways. It’s about mutual respect and good communication. It’s about trust (Partner 8).
We’ve built a relationship that is based on developing a shared understanding of one another, a real respect for one another and also which, even in the test of any difficult times, we know at some point particularly over twelve years, things won’t always be perfect, things happen but we’ve got a real level of trust and honesty (Partner 7i).
We absolutely see ourselves as a partner organisation because it’s a reciprocal relationship. It’s not just us providing a service and having a service level agreement. We are responsive to each other and learn from each other (Partner 7ii).
The relationship goes beyond the actual activity we deliver in Mersey Care settings into other activities that Mersey Care have supported us to design at Philharmonic hall and also we’ve become part of supporting other initiatives such as the campaigns Mersey Care have led on Zero Suicide Alliance or the Big Brew and other things where we involve our artists. We are an employment partner as well where we guarantee interviews for Mersey Care service users in job applications and things like that. We’ve developed from a very small ‘we will provide a music service to you’ into a real sense of collaborative relationship over the years (Partner 7i).
We agreed that on a monthly basis, we would let them know where we were up to with the customers, we would let them know any progress that was made, we would let them know about the engagement levels... It’s been that sharing of information, which I think has gone really well (Partner 5).
I would say that the strong working relationship with them has been due to the fact that we know them really well and they know us really well but also there’s that reciprocation of us sharing information with them and them sharing information with us (LRs 8).
Regular communication and face-to-face contact
Regular communication is absolutely critical and we are very open and transparent with Mersey Care because it’s been that long-term partnership so we can be really open and reciprocal and honest with each other (Partner 7ii)
They’ve been very clear in explaining how we communicate with them. That’s been a very important aspect of the relationship and a pretty successful one (Partner 5)
I think having them in the building makes a massive difference. I think them seeing us every week, getting to know our names and faces, I think that in itself really helps (LRs 8).
I think the key workers who operate in there have got very good relationships with the staff on a personal level, they’ve got a very good professional relationship, and they are able to refer across to each other a lot easier. When I go to visit staff in there, very often the pathways advisors at the Life Rooms will be coming over and talking to me about ‘I’ve got a potential referral here for you, what do you think about them’? Really trying to gain an understanding of our programme (Partner 5).
Benefits of partnership working
A cost-effective and sustainable way of working
Keeping the cost down for both sides. Say we are referring someone to get support with a benefit application, well that individual is already in existence so we don’t have to train an individual within our own service. Likewise for them, if they’re working with someone who is struggling with their mental wellbeing, then they know they can refer straight into the Life Rooms, they don’t have to do anything or train anyone else or waste their resources when those assets are already in the community so it’s time saving, it’s cost efficient, it’s beneficial (LRs 3).
There are also benefits of partnership working for the NHS as it may reduce pressure on clinical services:Third sector organisations might not have the money for meeting space so we can work together and maybe give them a space for free in one of our Life Rooms to help their organisation keep running (LRs 3).
If the social issues were addressed, it would take a lot of strain off the mental health sector/the clinical sector so hospitals and clinical services (LRs 7).
In light of this, some partners suggested that the Life Rooms model should be implemented on a national scale, as other NHS trusts across the country would benefit from the introduction of this approach in the longer term:The benefit for Mersey Care is if you can intervene earlier and prevent or provide effective early support for people, hopefully it will either get rid of the need for them to go into some of the more clinical NHS settings or it will keep people who have recovered and come out of inpatient settings, actually will keep them supported living in the community and independently as well (Partner 7i).
If every NHS trust could have something like the Life Rooms to try and alleviate problems before they happened, I think it would be a real positive… If that could be the strategy countrywide, I feel like there would be an investment there in the short-term but I feel that in the long-term, there would be money saved there because you would have alleviated a lot of these issues (Partner 9).
We work with other NHS organisations in different parts of Liverpool City Region… Wow how life would be so much more straightforward if they had Life Rooms. You can see many of them are talking about similar types of things but I always just say to them ‘just phone [name] and ask him for the blueprint’ because clearly Mersey Care have got a really good model going. Surely it will have some sort of benefit for the NHS (Partner 7i).
Broadening opportunities
The creative work with the Playhouse or the music with the Liverpool Philharmonic, it opens up new avenues to people because they are quite rare opportunities for the majority of people, especially the people who use the Life Rooms who might be quite deprived in some ways and might not have those kinds of opportunities (LRs 9).
In terms of activating people moving on from the Life Rooms, that’s where partners come in. You want people to be accessing the community and using what they've learnt on your course [to] then go and live their life (LRs 9).
I think the Life Rooms really encourages partnerships because they see their members as being with them for a while but also they want their members to move on and be involved in community activities outside of the Life Rooms (Partner 8).
Clients of the Life Rooms then get referred to other courses that we run at Philharmonic hall, specifically for people experiencing mental illness (Partner 7i).
I think their attitude to their participants is brilliant… What they see is organisations doing other things enhances people’s experiences and actually it’s brilliant if someone moves on to do something else because it means that they have moved on and progressed and they are on a really good path (Partner 8).
Promotion of psychological wellbeing
Who would have thought I can sing? We are sounding harmonious. It’s incredible. Again it’s that ability of someone to bring out the best in you, to awaken something in yourself that either you never thought you had or you were convinced you didn’t have or you compared badly to someone else (SU4).
To go to the Playhouse and to be in that that atmosphere doing a performance instead of in the Life Rooms gives it more atmosphere (SU7).
Every one of us felt that being part of a bigger organisation that was dedicated to this activity at the Philharmonic and there is a little bit of prestige about it as well to say I stood on the stage at the Philharmonic (SU4).
It’s not always going to be the actual music itself that produces the outcomes, it might be just that shared experience of working as part of a team (Partner 7i).
I think for the participants, the service users, the benefits would be that a lot of them have made friends with each other now and they go out shooting photography together (Partner 9).
Life Rooms has been life changing but the thing that changed our lives was having people [referring to partners] not focus on our depression but focus on our new interests and focus on them with people [partners] who really have a passion for those interests (SU4).
In the past, my experience with Mersey Care was being a patient in hospitals and occupational therapy and this [referring to a poetry course] is like a therapy outside the hospital (SU5).
Facilitators
‘Under one roof’
Partners provide us with services as well so they come into our buildings and facilitate sessions or provide services from our buildings. It's part of linking the community together because it puts everybody in one place. It’s easily accessible for everyone (LRs 9).
Ordinarily somebody might come to you for an appointment if they’ve got problems with their benefits, if they’ve got problems with their housing or they might want to get into employment, and traditionally you would be passing them from pillar to post… We’re saying to them if you come into our service, as best as we possibly can, we will meet your needs in this space if you can get to us our partners are there (LRs 3).
[The Life Rooms are] able to organise those kinds of meetings for you to have on the premises with somebody who comes in from outside, and that was also very useful and supportive at a time when… my mental health at that stage was not managing to cope with much in the way of decision making or trying to actually navigate my way around… I couldn't have envisaged going to a class where I went to find it myself and I went along. That would have been far too daunting (SU1).
I think it’s because Mersey Care have done an amazing job in creating a place that’s a safe space that doesn’t feel like a hospital setting but equally it’s got that wraparound care and support of the NHS and I think it’s remarkable what they’ve done and how they’ve set up the spaces is fantastic. It makes it therefore an environment that’s conducive to people not being on edge and to feeling comfortable, to feeling ok to have fun and to make a bit of noise and to sort of feel safe but equally to just relax and throw themselves into an activity as well (Partner 7i).
Staff with a shared vision
It’s also a safety net for some people should something come up in my sessions, and sometimes it does, it triggers something for somebody or someone discloses something, there is help at hand… I think it’s really important that working within that space, that’s all on hand (Partner 8).
There’s always a member of Life Rooms supporting and sometimes it’s their mentoring staff so people who have previously been service users and have now started to volunteer and help support some of the activities that the Life Rooms delivers. We feel like we pass skills on to them (Partner 12).
Having that member of the team in [name] who’s in Mersey Care, who understands how it all works, knows all the people, is incredibly well respected and is such a lovely person to work with, actually that just saves so much time and energy and effort… It means we’ve got access to that expertise that we can just run things by, talk through things, test ideas out, get an opinion on, which is really effective (Partner 7i).
It just makes the world of difference when you’ve got somebody who you know you can just reach out to and get advice from or ask for some information with regard to Life Rooms. It definitely helps to have a key contact (Partner 14).
There’s a real, it just jumps out at us about the value the Life Rooms teams place on the work that we do as well as the service users. That’s so important to us because we like to be in long-term partnerships that can develop together where the other partner actually wants us to be there… I think the enthusiastic and the commitment of the Mersey Care staff that work with our musicians is fantastic and a real willingness to get stuck in and to get involved and to understand it and to work with the musicians. That real sense of professional respect and collaboration between musicians and Mersey Care staff is absolutely at the heart of it (Partner 7i).
Professional input
With regard to the learning provision, courses are delivered by highly skilled professionals such as musicians from Liverpool Philharmonic hall or professional craft makers from Bluecoat. As delivery from a highly experienced team results in high quality delivery, the added value of professionals delivering courses within the Life Rooms community hubs was highlighted:I just think our job is so much more enriched for being able to offer so many different organisations and the scope of help is just massive and the fact that each partner will be a specialist in their own field so they know exactly what they’re talking about (LRs 5).
I think the key to our whole outreach programme is that we use professional working makers... It’s a high quality delivery. I absolutely believe that is the key to success. It’s something that’s very carefully considered and the sessions are written particularly for these groups (Partner 12).
I think the thing that was most prominent for me was the quality of the external involvement. It far surpassed anything I was expecting… There’s a difference between going with somebody who is just interested in it and having somebody whose life interest is to work in that area and to share their passion and share their interest. It’s wholly different. There’s quite a difference in what you can get out of it (SU4).
The musicians then respond quickly to the mood and the discussion that’s happening as well. They might completely change the piece of music they were about to play in 30 seconds based on a conversation that’s happening between the service users in the session (Partner 7i).
She seemed to think that myself and another participant were a little bit beyond the maybe beginner level of what the course was aimed at, and so because there was really only myself and this other guy attending, she really tailored it to us. It was just wonderful. It was a real gift on a plate for me given what I was going through at the time emotionally (SU3).
They're probably quite traditional writing workshops but the actual design of them could change according to what people would like to do so I’m flexible in that sense. I don't stick to a rigid way of doing this. Say for example, someone brought a photograph in or they brought something in of interest that could change the nature of the workshop… And I might then design the next one to be slightly different. It's really about keeping people engaged, interested and very involved really as it’s for them (Partner 15).
I think our musicians certainly respond to service users, they involve them in the development of the courses as they are progressing and we get their feedback to make sure that it’s feeding into what we do (Partner 7i).
Challenges within the life rooms model
Equality in partnerships
There is not that kind of equality really between the partners and the organisation. To develop a culture of that would be great (Partner 15).
One of my staff was approached by a pathways advisor to sign a partnership agreement which I had a look over and it was very one-sided weighted in the favour of Mersey Care… It was very much a large service provider’s partnership agreement. It didn’t really think through from a charity’s perspective or a partner’s perspective. It’s all very from a Mersey Care angle (Partner 6).
Rather than a disembodied referral, that we actually have a physical relationship where we meet each other as equals and we meet around the table and we get a common understanding of what we are doing and why we are doing it (Partner 1).
Capacity to communicate effectively
When you’ve got a lot of partnerships that you’re working with, mental wellbeing, physical wellbeing, housing, employment but within each of those categories there are numerous partner organisations and signpost organisations that we use and actually trying to keep in touch with all of those organisations is extremely difficult (LRs 8).
I think the only barriers were just knowledge or information. I suppose like not knowing the full range of the services offered. I think that’s been our only barrier so we wouldn’t have referred in for vocational training or employment support necessarily because we didn’t know that they offered that (Partner 2).
According to the SLA [service level agreement], we were meant to have regular catch-ups, quarterly meetings, they tended not to happen. There were communication issues (Partner 6).
No one comes in and says ‘how’s it going?’ It’s all very busy… There is no debrief or I get no feedback from the Life Rooms (Partner 10).
I think for communication just to be a bit quicker and a bit slicker between the two would really enhance things... I suppose it's communication at the administrative level that perhaps could help, could be improved and that would help to really kind of streamline experience for everybody (SU3).
Inappropriate referrals
A lot of partners can send inappropriate referrals through. One of the main difficulties is when people are quite unwell, quite poorly, who actually need more secondary care intervention and they get sent through to us before they have been sent through to secondary mental health care. With that, it gives us quite a lot of work to do (LRs 3).
We do sometimes get what we might term as inappropriate referrals so maybe people with multiple barriers that need sorting before they are work ready (Partner 16).
A small third sector organisation that we might think is amazing and offers great support for our clients, they might only have three staff. If we are shooting referrals at them, it might take them a while to pick that person up and that’s not any fault of their own. It’s just because they haven’t got the capacity so we have to be really careful not to inundate the third sector organisations as well and make sure we aren’t being detrimental to their service by the types of people we’re sending through, the issues that people might have (LRs 3).
There’s always challenges around because of areas so depending on what postcode they’re in, that can provide some challenges in that they may not be able to access certain support because they are not in the catchment area. There may be challenges around whether they are on benefits or not. Some of the offers that we have are open to people who are on benefits (LRs 8).
They put me in contact with them but Sefton at Work obviously can't help me because I was with them three years ago and they only have an amount of funding for each individual (SU2).
Insufficient resources
When I first went there, they put me in a classroom upstairs. I had three people who couldn’t be evacuated plus two carers as well. I said that room is not suitable. It’s upstairs and there’s not enough room for everybody to sit round. One lady had a panic attack. There was nowhere to teach. There was no board in the room (Partner 10).
Sometimes people talk about wanting to hurt themselves or want to talk about things that have happened in their lives and some people might come in and be very vulnerable and out of that vulnerability comes issues that I think hang on a second, I think that needs to just be flagged up with somebody here (Partner 8).
For some partners, teaching in this environment was unfamiliar, and as there was no formal induction process, they encountered difficulties during the first few weeks:There have been some issues that Life Rooms are aware of with some of our sessions running on Life Rooms sites in terms of appropriate staffing. That’s something we are working with Mersey Care on so making sure that there is the appropriate staffing to support any sessions, particularly if there is somebody there who begins to feel distressed or upset, being able to have someone there who can support them appropriately (Partner 7ii).
There’s not a clear induction process if somebody just stepped in to do something. In my experience, that hasn’t happened (Partner 15).
I would have really benefited from a real induction. I was sort of parachuted into something that I wasn’t expecting. I think if they are looking to other people providing the service, most definitely I think that’s really a responsibility of the Life Rooms to say these are our clients... You need to do a proper induction… Maybe a little pack or something: ‘If this happens, this is what you need to do and these are the people you need to speak to if you’ve got any concerns’ (Partner 10).
Funding to enable some partners to continue delivering their provision from the Life Rooms has been lost, and resource implications have filtered into service users’ experiences:There are no guarantees that [name] and I will continue to work with the Trust. With NHS funding and the way things are, it’s reviewed every year (Partner 15).
It [referring to yoga] really made a big difference to me, and very sadly, the Life Rooms had to make the decision, a funding decision, and she [yoga teacher] couldn't continue. Which was a great shame… I know for everybody else that did those classes, how desperately we missed that and how upset we were when they had to end and that was a funding issue (SU1).
One of the difficulties when we talked to the staff at Life Rooms about why they haven’t brought the fabulous florist back and they said it’s all down to finances. If their finances are such that another £1 an hour makes such a material difference, then they are spending their pounds quite wrongly. You have to address what’s good. Instead of having them for six weeks, you have them for five consecutive weeks. That’s far better than having somebody do six weeks and the quality of what you walk away with is much poorer (SU4).
Threat from Mersey care expansion
When they cross over into the community and voluntary sector, into the third sector, I have an issue because that’s the world that I listen to and that’s what I’m hearing back at me, genuine fears of people who have run small little organisations for years saying they are going to do it for us now (Partner 1).
There are lots of small organisations and community groups who are doing really good work that are struggling for funding and I think that they are a little bit fearful that Mersey Care are growing up that community offer very very wide and that could be detrimental to a lot of community groups that maybe they could be helping to fund, to support work that they do (Partner 4).
There is a danger that if we focus too much on these monolithic providers, we will lose this rich tapestry that Liverpool has. That would be one of my fears anyway. It’s about acknowledging and respecting small voluntary organisations. There are things that are being done in our community that are best done in our community… The Life Rooms in my judgement is the part of Mersey Care that is setting itself up as in competition to the voluntary and community sector (Partner 1).
It’s very similar to PSS. PSS have their wellbeing centres and how does the model of the Life Rooms compare to the PSS wellbeing centres? I’d be fascinated to see how that worked (Partner 15).
PSS has done fabulous work around art therapies and gardening and different things and the Life Rooms does them now but they do them in a beautiful building, better resources, better this, better everything but they haven’t got the years of experience working in the community that PSS has got (Partner 1).
I’ve been in groups that have been disparaging about Mersey Care in general. I thought to myself it’s the biggest mental health organisation on Merseyside so you’ve got to embrace what’s there as well as maybe campaign to get people to work better without someone taking away their service (SU5).
Making things even better
Mechanisms for regular feedback
Sometimes we don’t get information from the clients about a partner organisation… They could say yes that organisation really helped me or no I didn’t feel like I got the help that I needed from that organisation and therefore I need to go back or I need another organisation to help support me (LRs 8).
I think if we get more feedback from them [partners], then we can obviously continue to develop as a service to help support them as an organisation. I think that’s key (LRs 8).
Thus, it may be beneficial for the Life Rooms to hold more partner events in order to gather feedback from partners. This would enable partner organisations to network with one another:What I think would be great for our service is for the partners to have more of a say in how we are working in the Life Rooms (LRs 3).
What we have lacked so far due to capacity and time has been getting all the partners in the room and having a bit of a reflection. Let’s have some ideas. Let’s see how we can develop the service (LRs 3).
The problem is, creative partners don’t get many, well there aren’t any forums to talk to each other… It could be done in lots of different ways but I think twice a year would be good. Not necessarily pressure for everybody to get up and do a big presentation but just to share progress and some discussion of what’s worked really well because unless I look it up or find out about it, I’m not going to know what other partners are doing (Partner 15).
Key contacts
The only challenge I would say was that I’ve had three different people to deal with… That’s the only challenge I suppose having to explain myself every time. I suppose make sure we have a dedicated person. So you have the same person each time (Partner 3).
[name] who works at Walton with us, she’s basically been the point of contact for the best part of four years now so we’ve managed to keep that relationship consistent so that everyone knows who they are speaking to so I think that that has been a massive help as well (Partner 5).
It’s not always easy to communicate clearly between different organisations because you always start off with two or three people from each side involved but then it might escalate to we need to talk to finance or we need to talk to this person or that person so then before you know it there are quite a few people involved and you lose track of who is doing what… I think it is just about having some really clear communication with key people (LRs 10).
That in itself can be one of the challenges because for a lot of organisations, you don’t actually know who you are referring the person to and they don’t know who you are (LRs 8).
We don’t know who people are, they are less involved, they are less present. We receive referrals but there is no development of relationship (Partner 1).
Variety of courses
I’d just like to see a lot more of it really and more focus being given to maybe the creative side than the medical self management side. I’m not saying that doesn’t matter. It does. But I’d like to see an equality of approach in terms of creativity (Partner 15).
I felt very strongly was that there was a slight imbalance between the mind body connection and that there was a lot of more practical aspects about coping and management. So managing anxiety, managing your finances, these kinds of things… I did feel strongly, particularly after the funding that was lost for the person for yoga, that there wasn't many things like meditation, relaxation, yoga, all of the kinds of things that you do, which are mindful to improve your physical connection with mental state was not as well served (SU1).
I think that would be great especially if it linked up some people together. I did one workshop, only once, it was in Broadoak and [name] was there and it was just serendipitous. We actually worked together and we hadn’t planned anything but we did one workshop and I was doing some poetry work and [name] was there and she played in response to stuff and that was just I mean it was a one off but it would be fabulous (Partner 15).
I’ve spoke to [name] who runs a monthly writing class there and we had a small discussion about potentially rolling the writing class into the photography class one month because I think there is a bit of a cross-over between writing and photography (Partner 9).