Evaluating Your Way - a model of personalised community mental health support

This report is the result of a three-year independent evaluation of the impact of Together for Mental Wellbeing's personalised mental health services based in the community. The project was funded by the Department of Health.

Download the full report here

Download the executive summary here

What was the purpose of this evaluation?

As part of Together's commitment to continual assessment and improvement of our services, we applied for and were awarded funds from the Department of Health in 2012 to undertake an independent evaluation of Your Way, our model of personalised community mental health support.

The Mental Health Foundation undertook the three-year evaluation using data collected from 16 sites, with the aim of measuring the impact of Your Way services on those using them, and to provide evidence of the benefits of personalised services more widely.

What are the principles behind Your Way?

In 2010, we worked alongside the London Borough of Wandsworth to transform our day services in the area. We consulted extensively with those receiving support to ensure that future provision would meet their needs. The existing Day Centre was closed the following year to pave the way for support that would instead be provided entirely in community locations. Support workers took advantage of smart phone and netbook technology to ensure that they could work flexibly and adapt their approach to the individuals using the service. This new way of working came to be called Your Way.

Since then, Together has transformed over twenty community support services into Your Way services, providing support to over a thousand people across England each month.

Your Way provides goal-focused, flexible support with a key focus on ensuring that people who use the service are in control of their support.

There are five key elements underpinning the Your Way approach - please select the icons to explore the principles behind Your Way

Meaningful personalisation Open minded approach and excellent customer service Peer support Healthy living in the community Service user leadership

Meaningful personalisation

Personalised services put each individual at the centre of their support. People using Your Way control how and when they are supported. They identify goals that are important to them and Your Way staff work alongside them towards achieving these goals. Your Way services focus on building people's resilience and supporting them to move towards greater independence, so minimising the likelihood of them experiencing crisis.

Open minded approach and excellent customer service

Every Your Way relationship starts with a conversation and a blank piece of paper. Nothing is pre-determined, no-one is judged, and nothing is off-limits. Everyone's experience of using the service will be unique to them as they set their targets and decide how they are supported. Your Way staff teams must therefore be adaptable and work flexibly to meet people's needs.

Peer support

Peer support takes place when people with experience of mental distress support each other towards better wellbeing, as people of equal value and on a reciprocal basis, using their own lived experience as a tool for support. It is an integral part of the Your Way service, and Together offers training (accredited by Middlesex University) to anyone wishing to offer peer support to others. Peer support may be given in one to one settings or as part of a group.

Healthy living in the community

Social isolation and feelings of loneliness can be a major factor in people's mental health problems deteriorating. Your Way services focus on helping people identify and access solutions within their own community and aims to help them find ways to stay well without formal support. If people feel a strong connection to their community, this builds their resilience and goes a long way to preventing them experiencing crisis.

Service user leadership

In addition to people leading their own support, it is important that they can contribute to the development of their service. Your Way services focus on ensuring there are opportunities for people to have a say in how the service is run.

What is personalisation and why is it important in mental health services?

Personalisation is about people shaping the support they receive and being in control as they progress towards increased independence. It is about recognising that each individual is the expert in what works best for them.

A personalised service works alongside people to identify the goals that are important to them and how they will achieve these. It gives them the tools and support necessary to use their own skills, experiences and networks to lead their journey towards improved mental wellbeing. It tailors support to each individual, recognising that they have unique strengths and preferences.

An important element of personalisation is Personal Budgets, whereby people needing support are given a dedicated budget to spend on services and activities that can help them. They control this budget themselves and choose what to spend it on.

Many people who have been in touch with mental health services for some time may not be used to choosing and directing their own support. This makes personalisation all the more important in a mental health setting. However, progress towards personalisation has been slower in the area of mental health compared to physical health. Some people find it difficult to lead their own support at first, particularly if they are not used to this approach. It is important that this change is not imposed on them but rather achieved with them and that the pace is set by the person receiving support.

It's really important that the benefits of personalisation in mental health settings are evaluated and understood so that the approach can be effectively adopted in even more services.

What is wellbeing and how do we measure it?

One of the measures the researchers used to assess the impact of Your Way support was people's wellbeing. By focusing on wellbeing, we avoid relying on more traditional measures of mental health such as symptoms of illness. These measures are considered by many people who use mental health services to be outdated and not in line with how they see their own wellbeing.

What matters to us is how people are 'in themselves', how well they feel they are coping with everyday life and how hopeful and confident they are about achieving their personal goals. These are the things we work alongside people to improve, so it's important we measure these to see how well we're doing.

So what are the different factors at play when we measure wellbeing?

Please select the icons to find out how we measured wellbeing

Tools for measuring wellbeing

There are several established tools for measuring wellbeing, with the most widely-used being the Warwick-Edinburgh Mental Well-Being Scale (WEMWBS) developed by researchers at the universities of Warwick and Edinburgh. This is a scale of 14 positively worded items, each with five response categories. The end result is a score between 14 and 70, with a higher score indicating better wellbeing.

So what did we find?

Improved wellbeing

For people who took part in the evaluation within a month of first using Your Way:

Their wellbeing had improved within three months of first using the service.

There were significant improvements in relation to the following areas:

  • social support and relationships
  • finding a sense of meaning
  • relationships with health professionals

Achievement of goals

The researchers also observed a trend that may suggest that, as participants acquired more experience of setting and working towards goals, they got better at achieving them.

Qualitative themes

The following themes arose from the in-depth interviews:

  • People using Your Way saw it as a community rather than simply a service. It helped them to expand their networks of social support and brought people out of isolation.
  • Your Way empowers people and builds their confidence so they can manage on their own in the community.
  • Your Way is based on an open-minded approach and lets people be who they are.
  • Your Way offers a strengths-based, person-centred approach, where users of the service are able to direct the support they receive.
  • People value the peer support elements of Your Way and saw this as 'strength in numbers'.

Recommendations

On the basis of their findings, The Mental Health Foundation recommended the following:

  • That Together continues to learn from the development of the five essential elements of Your Way.
  • That Together continues to embed the Your Way approach in ways that reflect funding streams and local differences within each site.
  • That Together and other service providers continue to develop evaluation approaches to personalised community mental health provision.
  • That the Department of Health invests in the independent development of a Cost Benefit Analysis approach for innovative voluntary sector provision in mental health.
  • That the UK Government, service providers, research and representative organisations review the roll out of personal budgets across the country for people with mental health problems, including how the implementation of this policy impacts on the development of innovative self-directed support models and services.

Hear from some people that have used Your Way

To read more please select one of the images

Anneka

Donald & Sally

Rob

Sean

William

Maxine

To hear from more people you can download all of our case studies.

What does a Your Way service look like in practice?

Please select a case study below

Transforming day centre provision in Wandsworth

Putting people at the centre of their support in Warwickshire

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Your Way service
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