On 14th of April 2016, Mark Brown (@markoneinfour) ran a mental health minihack at Marmalade, the fringe of the Skoll World Forum in Oxford. In preparation he prepared three provocations to put to attendees for areas where it would be possible to innovate in mental health as actors coming from outside of the established publically funded system of mental health treatment and support.
Attendees were told to apply their knowledge and experience to addressing these presenting issues.
Below is the third of these provocations ( (The first ‘Payment by Results – outcome measures – getting data – arranging payment’ can be found here and the second ‘In mental health communication is flakey’ can be found here)
Provocation 3: Frugal innovation – making good stuff happen with eff all cash
According the Mental Health Taskforce report published in February 2016:
People with severe and prolonged mental illness are at risk of dying on average 15 to 20 years earlier than other people
Nearly two million adults were in contact with specialist mental health and learning disability services at some point in 2014/15
Nine out of ten adults with mental health problems are supported in primary care.
Of those adults with more severe mental health problems 90 per cent are supported by community services. However, within these services there are very long waits for some of the key interventions
Mental health accounts for 23 per cent of NHS activity but NHS spending on secondary mental health services is equivalent to just half of this. Years of low prioritisation have led to Clinical Commissioning Groups (CCGs) underinvesting in mental health services
While many objected to the Conservative Big Society idea; it did represent one answer to the emerging crisis which, depending on your viewpoint, was either caused by or resulted from austerity. At present there is little investment in mental health research and the available charitable funds for the actual provision of activity to support people with mental health difficulties has dwindled over time. The crunch on local government funds has also reduced greatly the available funds for mental health. Big Society suggested that frugal innovation might provide an answer to some of the unmet need in our communities.
Innovation has not been easy for organisations structured with business models developed in an era of public spending expansion. It’s possible to argue that larger organisations lack the agility and the entrepreneurial skills to be able to develop, prototype and test new ideas. It’s also possible to argue that this is not entirely a bad thing if we are talking about maintaining the welfare of people who are having a variety of challenging experiences and who rely on a consistent and reliable service. It’s more difficult to argue that the interests of a provider always align with the interests of a consumer when the consumer is a person with mental health difficulties who has funding allotted on their behalf by commissioners but is not a direct ‘consumer’ in the traditional sense.
The problem is that entry into the market is extremely difficult for smaller organisations who need to raise the funds to do before they can build they evidence that they can do. The bootstrap paradox is strong in mental health.
In a marketplace where funds are dwindling while need is rising, there has been much discussion of ways in which people with mental health difficulties might find solutions to their own problems with little discussion about ways in which that might be made a reality. As an area there has been much rhetoric but the reality has tended to be tiny amounts of funds mostly inaccessible to the kinds of small autonomous groups that form to solve particular problems. Government backed initiatives like Community Organisers, the DWP’s Developing Disabled People’s User-Led Organisations Programme and empowerment style organisations such as NHS CItizen have failed to touch much in mental health.
While many have ideas about what might be solved; the question of how such people might be resourced, supported, funded, matched with resources and how they might find some kind of sustainability still remains.
What financial devices might support small groups to deliver high quality mental health related services? How would investment in such groups be made possible, considering the considerable risk?
How might the knowledge gap around innovation, product development, design and management of human and other resources be bridged? How might innovation activity be focused on unmet need?
How could larger organisation find ways of working with a wider range of people to meet unmet need without requiring large amounts of additional investment?
How can innovation be fostered in low investment; low return areas such as mental health? How might we make mental health stuff happen when there is f*ck all money?
How might innovation serve the unmet needs of people with mental health difficulties rather than the provider interests of organisations? How might frugal innovation in mental health be supported?
Mark Brown is development director of Social Spider CIC. He is @markoneinfour on twitter.