The story of Mental Health Helplines Partnership

Working together, helping others

Our story

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Our story

The story of the Mental Health Helplines Partnership

Our Story:

Sue Scott conducted the research and interviews.

The publication of this story is sponsored by the Department of Health.

The chapter titles are inspired by Sue’s extensive record collection.

Dick Frak wrote this story.


CONTENTS

FOREWORD: Phil Hope MP, Minister of State for Care Services 4

INTRODUCTION: The Future Looks Bright 6

1: Things Can Only Get Better 8The new context – Policy change – NSF – immediate access – Helplines – telecommunications technology – NHS Direct.

2: Don’t Leave Me Hanging on the Telephone 12Beginnings – Exploratory meetings – Tensions … and some positive glimmers – Fears about funding – A modest proposal and common interests – Chemistry.

3: Who You Gonna Call? 18Early outcomes – Public Survey – Quality Standards Handbook – First Conference.

4: It’s Going to Happen 23Major investment and responsibilities – PwC review – A loose coalition evolves new governance arrangements.

5: Changes 27Steering Group formed – Changing relationship with THA – Accredited Training – First Staff appointments – Beginning the Telecoms solution – Second conference.

6: State of Independence 34Company and charity incorporation – Chief Executive and Chair of Board of Trustees recruited – The work continues.

7 – Summary: Don’t Stop ’til You Get Enough 36Lessons learnt: A practical approach to Leadership – A new approach to Partnership – A different approach to Change. Looking ahead.

APPENDIXA. References 40B. Acknowledgements 41

Minister’s Foreword

The past ten years have seen great improvements in mental health services across the country. Effective services that are now part of the ordinary fabric of support for mental health simply didn’t exist a decade ago. However, more remains to be done to improve and protect the good mental health and well-being of everyone: individuals, families and communities.

New Horizons is the new national vision for mental health from 2010, developed with a wide range of people and organisations. My ambition for New Horizons is to create a dynamic programme that will both improve the quality of services and widely promote public mental health and well-being in the years to come. At listening events across the country, I’ve heard from service users and carers that easy access to information and services, through reliable and fl exible pathways, is crucial. So, mental health helplines clearly have a vital enabling role to play.

4 Our Story: Ministers Foreword

The history of the Mental Health Helplines Partnership refl ects a journey through the period of the National Service Framework and the development of NHS Direct. This valuable experience should help us prepare for the future. It has shown just what is possible in terms of agreeing quality standards, consistent training, and, more recently, single technology across a diverse group of organisations, as long as they share the same aim – of being there for the people who need them.

Some helplines, for example, have been quick to see the potential for improving access to psychological therapies – a major plank of our efforts to deliver modern and personalised mental health services. We want this programme to reach more people and communities now, helping to protect against the adverse effects of the economic recession. I am happy to learn that one current mhhp programme is directly engaging helplines on this very issue.

As you read this report, I would ask you to study the lessons learned here and think about how helplines can best contribute to a new era of mental health in England. I look forward to working in partnership with you, as we continue the transformation of specialist services and roll out a new approach to whole-population mental health and well-being.

Phil Hope MPMinister of State for Care Services

5Working together, helping others

Our Story: The Future Looks Bright6

The Future Looks Bright

A good story brings together interesting characters in a plot. This story is no exception. It’s the story of how the mental health helplines partnership (mhhp) began – and what happened next.

This story is one response made to the National Service Framework for Mental Health and the emergence of NHS Direct. It is also a response to the needs of users to access support, while avoiding the constraints of traditional mental health services. By telling the tale, we hope the lessons can be applied elsewhere.


The plot continues to unfold. With mhhp’s incorporation as an independent charity just over a year ago, a new chapter has begun. Now is a good time to tell the story, as the new Board and Chief Executive set a course to the future.

This partnership is one example of how mental health services have developed in England during the last decade. We draw on the recollections of those characters who were directly involved – the leaders of the process. We use the word in the same way Barrack Obama uses ‘leader’ in his story of working as a community organiser in south Chicago. The leaders in our story are the members who took up the initiative: who chose collaboration over competition, stayed involved and spurred it on.

The National Service Framework was launched as a ten-year strategy for mental health in 1999. As it draws to a close at the end this year, what’s on the horizon for mental health over the next ten years? One keyword featuring in much of the current debate about mental health and wellbeing is ‘enabling’. This story shows how the same technology that caught the attention of the commercial world also captured the imagination of independent helplines and a new government. We believe we’re only at the start of harnessing the truly enabling capacity of mental health helplines. Here’s some recent living history to help push it further.

8 Our Story: Things Can Only Get Better*

In Modernising Government, Prime Minister Tony Blair set out his vision:

“We must deliver services and programmes that are not only effi cient and effective but also joined up and responsive. People have grown used to services being available when they want them. The Government is committed to making public services available 24 hours a day, seven days a week, where there is a demand. In short, we want public services that respond to users’ needs and are not arranged for the provider’s convenience.”

In his introduction to the health white paper, The New NHS: Modern, Dependable (DH 1997) the Prime Minister set out the scope of this change in health in these terms:

“For the fi rst time the need to ensure that high quality care is spread throughout the service will be taken seriously. National standards of care will be guaranteed. There will be easier and swifter access to the NHS when you need it. Our approach combines effi ciency and quality with a belief in fairness and partnership … in a changing world no organisation, however great, can stand still. The NHS needs to modernise in order to meet the demands of today’s public … The NHS will start to provide new and better services to the public. For example, a nurse-led helpline to provide advice round the clock.”

The scope of change for mental health was set out in Modernising Mental Health Services: Safe, Sound and Supportive (DH 1998):

“… We must tackle the root causes of ill-health, ensure higher standards of health care and quicker treatment (while) … promoting independence, improving protection and raising standards and to do so by … NHS and Social Services (working) more in partnership to provide integrated services which will improve the quality of life for our people.”

1: Things Can Only Get Better*

The new government of 1997 came into power with widespread public support for change. It set about establishing a new policy context through instituting a large programme of change, including the modernisation of public services.


The National Service Framework for Mental Health

By the end of 1999 this policy was fl eshed out in The National Service Framework for Mental Health: Modern Standards and Service Models – which quickly became abbreviated to ‘NSF’. This document set out standards for mental health services around the country: what they must achieve, how they should be developed and delivered, and how performance would be measured.

The Framework’s Seven Standards were founded on a solid base of evidence and validated by an External Reference Group, consisting of health and social care professionals, service users and carers, health and social service managers and campaigning charities. The Reference Group used a set of guiding values and principles to inform service delivery:

• To offer choices which promote independence;

• To be well co-ordinated between all staff and agencies;

• To deliver continuity of care for as long as this is needed;

• To empower and support staff;

• To be properly accountable to the public, service users and carers.

People experiencing mental health problems could expect services to:

• Involve service users and their carers in planning and delivery of care;

• Deliver high quality treatment and care, known to be effective and acceptable;

• Be well-suited to those who use them and non-discriminatory;

• Be accessible so that help can be obtained when and where it is needed;

• Promote their safety and that of their carers, staff and the wider public.

Immediate access is the policy driver

NSF Standards two and three were to ensure consistent advice and help for people with mental health needs, including primary care services for individuals with severe mental illness:

‘Any individual with a common mental health problem should:

• Be able to make contact round the clock with local services necessary to meet their needs and receive adequate care;

• Be able to use NHS Direct as it develops for fi rst level advice and referral on to specialist helplines or local services.

This is the fi rst clear reference to the political agenda set out by the Prime Minister, combined with the expectation that telephone helplines would contribute to the development of new models of support.

The NSF stated that mental health problems were common problems. Primary care teams should provide most of the help individuals needed.

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10 Our Story: Things Can Only Get Better*

NHS Direct was envisaged as providing a new source of national fi rst-level advice that should also be able to provide a route to specialist mental health helplines.

Helplines

Telephone Helplines were already well established before the start of this modernisation. Many helplines were established as far back as the 1970s – even further back in the case of the Samaritans – which began operating in the 1950s. Helplines have increased in number and variety, but emerged during a time when the UK saw a huge increase in the take-up of domestic telephone use, together with major developments in telecommunications.

Many mental health helplines were independently established in the 1980s and 1990s. They often started life as informal lines of support provided by volunteers. Informal helplines still develop today, as recent research with black and minority ethnic (BME) communities shows (Kalar, 2008).

The number and diversity of helplines led to the establishment of the Telephones Helpline Association (THA) in 1996 as an umbrella organisation, to raise standards and promote training across the helpline sector. THA now has over 400 member helplines, ranging from national to regional and local organisations – including dedicated mental health helplines.

Samaritans still provides the most frequently adopted model across the voluntary helplines sector. Independent mental health helplines develop in response to listening to the specifi c needs of individuals experiencing mental health problems and their families, discovering gaps in provision and barriers to accessing services to meet needs, especially around supportive listening and specialist information on specifi c mental health conditions.

Telecommunications technology

Business was quick to see the commercial potential of telephony combined with information technology. This has had a dramatic impact on the delivery of consumer services and the growth of the service industry sector as part of the UK national economy. One example is provided by First Direct Bank, the telephone bank. This telephone bank’s call centre has never closed since 1st October 1989. It took it’s fi rst call at 12.01 am on 1st October 1989. With more than one thousand calls taken in its fi rst 24 hours of operation. By May 1991 the bank had 100,000 customers, and in less than two years this fi gure had climbed to 250,000. In April 1995 the bank gained its 500,000th customer. First Direct began limited trials of Internet banking in July 1997, launching a full service the following year. In May 1999 it launched text message banking, a service where the bank will alert customers by text message if the balance on their current account goes below a certain amount. This service can also send weekly statements by text.


NHS Direct

NHS Direct was announced in December 1997 as part of the NHS modernisation programme and a key element in providing the public with ‘easier and faster advice and information’. The name of this new service makes an explicit reference back to First Direct, reinforcing the notion of service and rapid access, at a time and place to suit callers. NHS Direct was described as the future single gateway into NHS services, a 24-hour nurse-led telephone service in which nurses, using computerised ‘decision support’ software, advise the public on all health matters. NHS Direct was rolled out across England between 1998 and 2000. With full coverage achieved by November 2000, the context changed signifi cantly for primary care and helplines.

NHS Direct shows how new technology enables better access to health services around-the-clock. But this innovation presented the further challenge of ensuring that people making calls about mental health to NHS Direct could be appropriately supported and, where necessary, referred on to specialist support. NHS Direct call centres reported that 4 to 6% of calls were directly concerned about mental health. However 40% of calls had some mental health component. NHS Direct calls typically lasted 10 minutes. Mental Health calls were longer – lasting 20 minutes on average – effectively using between 36% and 60% of NHS Direct’s helpline capacity. Nurse advisers expressed diffi culties coping with mental health calls, feeling less confi dent about providing advice on dealing with the caller’s needs.

In response NHS Direct established mental health leads at every Call Centre and embarked on mental health training for all staff. This training improved confi dence in dealing with mental health related calls (Payne, 2001). But there was also the NSF requirement that there should be a pathway on from NHS Direct to specialist mental health helplines or local services. This challenge is summarised by George Askoorum, then working on the development of NHS Direct in Wakefi eld:

“A caller phones NHS Direct … we think we need to refer this person onto a mental health helpline … who do we refer them to? How do you know which is a good helpline? What criteria do we use? What standards do they work to? What risks are involved? … We’re going to have to talk to helplines … we need to develop a pathway …”

12 Our Story: Don’t Leave Me Hanging on the Telephone*

Professor Carolyn Steele, then National Mental Health Lead for NHS Direct and Senior Policy Advisor for the Mental Health Branch at the Department of Health, recalls:

“The original idea for the mental health helplines partnership came about from work George Askoorum and I were commissioned to do for NHS Direct in 2000, on an information-sharing agreement between telephone helplines and NHS Direct. The NSF required NHS Direct to refer people with mental health concerns to appropriate helpline services in the community. George and I decided to meet some of the helplines already in contact with NHS Direct, thirteen helplines as I recall. We were interested in call volumes, quality, training, confi dentiality and accountability – how these issues were managed – and what support would be needed to improve outcomes.”

2: Don’t Leave Me Hanging on the Telephone*

In 2000, NHS Direct started work on a protocol to signpost and refer callers on to specialist mental health helplines, in line with NSF Standard Three. NHS Direct needed assurance that the helplines it offered to refer callers onto worked to satisfactory standards, with broadly compatible approaches to managing confi dential caller information.


When NHS Direct brought together this Mental Health Referral Protocol Consultative group the number of helplines actually operating across England started to be revealed. Here was the potential to deliver the NSF standard, in collaboration with NHS Direct. Government Ministers recognised this potential quickly. Professor Anthony Sheehan, then Joint Mental Health Lead at the Department of Health, was responsible for ensuring that the government’s policy of “effi ciency and quality, with a belief in fairness and partnership.” was enacted. Professor Sheehan saw his job as ensuring that:

“The political arena and the stakeholder arena were brought together … my role was primarily to help secure support for the initiative and oversee the commissioning of the work that would help achieve the partnership. At the time there was a real drive for access to services … that was very important. Access was a key indicator and … mental health helpline support would be a critical part of rapid access to advice and help … that was really the driving force for the partnership development – with an emphasis on early advice, early support and access as part of a wider range of initiatives to improve mental health care and support generally.”

Exploratory meetings

The Department of Health hosted an exploratory meeting consisting of mental health helpline organisations and NHS Direct in Leeds on 27th February 2001. In proposing to develop a partnership at this meeting, Professor Sheehan insisted that the project would start with “a blank sheet of paper” and develop over time to “take forward a managed and strategic approach to helpline provision

to support and underpin the NSF.” Professor Sheehan set out the Department’s position in relation to supporting the development of the infrastructure of mental health helplines, so that they could take up a full role in the implementation of the NSF. A summary position statement was subsequently circulated to a larger group of helplines. George Askoorum recalls this meeting:

“That fi rst meeting was a bit of a battle in itself. The helplines started by saying ‘No ... this is nothing to do with us … NHS Direct gets funded for that … We don’t get funded … Why should we work for you? You’re going to increase calls levels to our helplines but not give us any funding … why should we work for you?’ That was the starting point …”

A second meeting on 13th March 2001 in London brought together the same helpline representatives again – this time with the addition of the Telephone Helplines Association (THA). Carolyn Steele engaged representatives in a discussion about how mental health helplines intended to respond to the Department of Health position statement. The meeting agreed to a proposal that THA facilitate this process. It was at this meeting that the name ‘mental health helpline partnership’ fi rst emerged. Carolyn Steele was aware of tensions right from the start:

“The fi rst London meeting was not an easy meeting as I have noted many times.

No helpline was really prepared at that point to share much information with us – and certainly not with each other! Trust was a critical factor. The only issue we all agreed on was that training was important and was an area we could all work on together.”

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Tensions, differences, rivalry … and some promising glimmers

The issue of trust is confirmed by Liz Rowlands, who was present at the London meeting and went on to play a key role through chairing the partnership meetings and leading the THA facilitation:

“There was open conflict between local organisations and national services. Saneline was very active in the early partnership meetings, and as a single national helpline service that was part of the tension for the smaller helplines. There was a great deal of worry in these early meetings about NHS Direct taking over. There was also conflict in meetings between locally-based organisations and national services, who they saw as potentially displacing them.”

At the same time as these tensions started to surface, there also emerged some recognition of the promise and potential from the helpline side. This was articulated by Kathy Mulville, then THA Chief Executive, who stated that – for the first time – a major funder had asked the helpline movement for its view, which she celebrated as recognition of the work of helplines and the diversity of helpline sector. Jacky Hammond, then representing Rethink, remembers:

“There was lots of enthusiasm as well as anxiety at the first London meeting from all parties involved. Everyone agreed that it would be great to work together … but how the heck do you do it? And we all got sent away and told to come back in a couple of weeks to address the issue.”

George Askoorum recalled the distance between the helplines and NHS Direct:

“We acknowledged there were different issues for both sides. For the helplines there were issues of capacity, issues around funding and all sorts of issues concerning service provision. For NHS Direct there were issues in terms of quality of care, quality of call response, consent, confidentiality, staff training, and duplication.”

Jonathan Clarke, responsible for the Premier Christian Media Trust’s helpline Premier Lifeline, and a member of the partnership from the start, recognised the value of sharing experiences, information and good helpline practice in the partnership meetings. He was also:

“ … Aware of an innate rivalry – there was a market place in mental health service provision – with competition for funding. There was also a suspicion among the helplines that they could be taken over by the NHS.”

With the suggestion that money may be set aside to develop a 24/7 national mental health helpline:

“ … Would someone break ranks and tender for that funding? There were question-marks, although it was not clear that the Department of Health knew where it was going to go.”

Fears about funding

Helpline funding mainly came from health or local authority sources, was local in origin, short-term and patchy. There was no consistency in funding helplines across the country. Some areas provided no funds at all. Jacky Hammond picks up this point:


“The fear was that if mental health commissioners across the country knew the Department of Health were going to fund and support one national helpline service, then they would withdraw funding from their locally-commissioned helplines.”

Professor Sheehan was also aware of the tension between helpline partners:

“I was not convinced the bigger organisations were motivated to take over … there was a genuine recognition that what was needed was plurality and that it was important to maintain this … most people agreed that improved access to mental health support by telephone was a good thing. This agreement should not be taken for granted: people could have said everything was alright as it was, and that there was no need for change – but that was not the case.”

In spite of tensions and anxieties during these early meetings, helplines representatives kept attending. With their support, the Department of Health commissioned THA to carry out a four-month Partnership Development Project from June 2001, with the objective of formulating proposals to establish a longer-term partnership. Jacky Hammond noticed a sea change in the quality of partnership and debate as a consensus emerged on common areas of interest:

“At fi rst, the task was to ensure you got the interests of your organisation on the table. We also had to deal with some interesting challenges, for example, a written proposal tabled by Saneline that any new fi nancial resources from the Department of Health should be invested in delivering a single national mental health helpline. Because the majority of

the partners in the room represented small local helplines – who would no longer exist if this happened – this was very threatening to them. Sharing and trust didn’t exist at fi rst because we were in a competitive world.

But once we started talking about quality and training – we got excited about the potential. We knew from our experience in taking calls what worked well from the feedback we got from callers.”

A modest proposal, defi nitions and common interests

At the meeting in September 2001, THA tabled a set of ‘proposals’ to clarify where helplines were positioned on important matters – to elicit who agreed, disagreed or were neutral on the following points:

1. There is a publicly advertised out-of-hours mental health helpline available throughout the country;

2. That it should be delivered from local centres, rather than one national centre;

3. That it should have one national telephone number, delivered to local centres;

4. That commissioning helplines should be based on clear quality criteria;

5. That local commissioning should offer diversity in staffi ng, volunteering, and medical and non-medical;

6. That the service should have clear information about other helplines, as well as information on statutory services, that they can use to signpost callers.


The third proposition was contested at the meeting and not well supported. But having to come to an understanding about similarity and differences, the group turned its attention to what constituted a mental health helpline. Jonathan Clarke remembers this debate:

“There were organisations such as Saneline and the Rethink and Mind helplines which were specifi cally ‘badged’ as mental health services, and there were others which provided some element of mental health information and advice and support within a broader remit, such as Premier Lifeline, Samaritans and the Muslim Women’s helpline.”

Agreement was reached about partnership helplines being those that took a signifi cant number of calls about mental health issues and offered listening support. This was set out in a defi ning statement:

“A communication resource to support people experiencing distress (be it in need of support, or in crisis) that provides listening support, information and signposting. This support may be made available by telephone, e-mail, text or another equivalent means and often acts as a resource for not only for those directly experiencing mental distress but also families and carers, health care professionals and the general public.”

Responses to THA questionnaires made it clear that there were three board categories of helpline dealing with mental health calls:

• National organisations – providing either a national helpline or a set of helplines across particular localities of England;

• Local or regional helplines – providing helpline support to a particular region or locality in England;

• Specialist/Special Conditions helplines – providing specialist support on a particular mental health issue.

These categories made concrete the plurality and diversity of interests Professor Sheehan, Kathy Mulville and others recognised. They kept in focus these contrasting interests as partners worked together. The Development Project also confi rmed a set of interests helpline partners could sign up to work on together:

• The need to develop a common set of quality mental health helpline standards;

• The development of specialist mental health helpline training resources – ideally accredited by a nationally recognised organisation;

• The need to infl uence the commissioning of helplines and the development of this market;

• The use of information and communication technology (ICT) to develop closer working relationship between helpline providers, where appropriate, and use it to generate call information for planning, performance management, quality and training purposes.


The fi rst phase of the Partnership was completed with the publication of The Mental Health Helplines Partnership Development Project Report in October 2001 which incorporated the proposals and defi nitions arrived at through THA’s facilitation. 61 helplines were contracted during this fi rst phase and 42 responded.

Personal chemistry

At fi rst, the prospects for partnership did not look promising. The Department of Health and NHS Direct could not protect helpline partners from the market, nor allay concerns over decisions being taken independently by mental health commissioners. Some helplines perceived NHS Direct as a strong rival and threat. Smaller local helplines were wary of larger national organisations. However it became clear that the diversity of the helpline sector was its strength: it could reach people that others could not. The early stage of partnership shows how collaboration overcame competitive rivalry.

THA was regarded as a trusted facilitator. The early research conducted by questionnaire between meetings was helpful in drawing up common defi nitions and future project aims that the majority of the helpline partners could sign up to. The chemistry of being together also helped. According to Liz Rowlands, the fact that the helpline group came together on a frequent basis:

“ … Got people talking and working things out for themselves. It helped them make closer links to NHS Direct, for example about training on dealing with ‘repeat’ callers. And although Saneline was the source of some tension – they also did contribute a great deal.”

Carolyn Steele summarises these efforts:

“Part of the challenge was to ensure that all the helplines – no matter what size, whether they were a national organisation like Rethink, or someone operating from their front room … that they were listened to and involved ... because it was about ensuring that there was access and choice … as well as standards.”

18 Our Story: Who You Gonna Call?*

Helplines faced many challenges, including poor supporting infrastructure, uncertainty over funding and poor recognition of their potential. Where daily effort was focused on sustainability, there was frequently little awareness of what other mental health helplines were doing. Many helplines were members of THA – but there was still a good deal of competitive tension. In spite of these challenges, helplines actively engaged in the partnership development project. Mapping helpline provision across England, defi ning the principles for a quality helpline service, recognising the importance of staff and volunteer training, and setting out proposals for future work were tackled. This chapter summarises the early outcomes of partnership work presented at the fi rst national conference in May 2003.

3: Who You Gonna Call?*

Early outcomes

The origin of the partnership was based on awareness that there was a problem in realising one of the NSF key objectives. The solution lay outside the usual space of health and social care provision, through NHS Direct and the Department of Health working with independently established helplines. On the face of it, the answer seemed very simple: transfer NHS Direct callers onto specialist mental health helplines. However, as Carolyn Steele and George Askoorum discovered, it was not going to be that quick or easy. There were issues concerning confi dentiality, accountability and quality, among many other areas.


Liz Rowlands notes that:

“This next stage took longer … there was a massive amount of work. That was when the public survey was done and the IT upgrade started. But the feeling in the group was very different and very co-operating … the worry about what was going to happen at the meetings … would there be loads of confl ict? … had gone.”

Features of a quality helpline service

By July 2001, partnership members had achieved a level of trust that allowed them to defi ne certain standards together. There was support for a closer defi nition of quality. It was agreed that, for a quality helpline service to be delivered, the following elements were necessary:

• Policies and procedures in place

• Consistency in approach

• Clear complaints procedure – accessible by the caller

• Training, support and supervision for helpline workers

• Clear confi dentiality policy that staff, callers and other agencies are aware of

• Clarity in helpline offers, accurately set out, so callers’ expectations were met

• Monitoring

• Evaluation using feedback from callers, with service user input into helplines.

An important background to this discussion had been THA’s Quality Standards for helplines, together with THA team’s experience in developing these generic helpline standards. However it was generally agreed specifi c standards were necessary for the operation of mental health helplines.

Carolyn Steele recalls these discussions:

“The proposal was around investigating the potential to establish a quality standard across mental health helplines to improve access … the reason I pushed on quality through standards and training was because it was the only thing I could get everyone to agree on ... it was the point of least resistance.

“From there on the focus was around the training and establishing the quality standard. We commissioned THA for that, and we used their generic standard as a reference and adapted that for mental health helplines. It took a lot of time to do it. People have criticised me for taking the time to get through this and have said ‘well why didn’t you just tell the helplines what had to be done?’ and I said ‘well they wouldn’t do it … they needed to own it.”

“One of the early things was actually language … for people to be clear about what they meant, because people would say ‘we provide counselling’ or ‘we provide advice’ and when you asked them what that meant we got lots of different responses.

The language of the day was ‘me’ ‘mine’ ‘them’ and the establishment of Quality Standards … working together on something that everyone agreed was needed, gave a platform to look at other issues. There were lots of stages to get through to getting the Quality Standards.”

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The public survey

A second strand of work, running in parallel to the development of these Quality Standards, was research into public awareness of helplines and the attitude of users and potential users towards mental health helplines, using public survey methods. This was independently commissioned through THA on behalf of the partnership and the Department of Health. George Askoorum recalls:

“We commissioned an independent survey of the public about what people do when they need help – will they use a helpline? We then asked the research company to follow up and interview people who had used helplines, and from that we collected objective survey data that demystifi ed a lot of our existing thinking. For instance, it became clear that callers did not particularly care who was on the other end of the line, as long as they received good advice and information … For NHS Direct the main concern was: is it safe? And so this took us back again to the development of the quality standard. We needed to be able to say that we are able to offer a safe service and in order to be able to do that we needed agreed standards. The challenge once we had standards was ensuring compliance.”

Information technology review

Investment in the ability of helplines to connect to one another and to use the benefi ts of information and communication technology (IT) for helpline delivery started in July 2002. An assessment of IT capacity was carried across the partnership. 17 mental health helplines with low levels of infrastructure were initially identifi ed and provided with IT equipment, support and access to training during this

phase of partnership development (a second wave of IT investment brought the number of helplines receiving support up to 30). One direct impact of this investment was that helplines could more easily be included in consultations between partnership meetings – which were now were held every two months. As the work on developing the mental health helpline quality standards intensifi ed, consultation between meetings was carried out by THA using e-mail. This IT development was also intended to prepare helpline partners to be in a ready state to receive and use information resources, through having access to the information database being developed by NHS Direct at this time.

Accredited training

A continuing theme during partnership meetings was training. It became clear that Helpline organisations invested at different levels in training and approached training according to differing organisation priorities. There was agreement that the quality standards being developed should be supported by managerial procedures and a skilled workforce. The development of training would come latter, starting with a consultation on accredited training during Autumn 2003. But some agreement around what should be included as learning content started to be develop through the quality standards work. Communication skills and mental health awareness training were considered important priorities. There was general agreement that any training would benefi t from being subject to independent assessment and external accreditation.


As Jacky Hammond put it:

“An accredited training programme could set the bar higher for how our own teams responded to calls.”

Infl uencing funders and commissioners

Another continuing theme was fi nding an approach to infl uence helpline commissioning. It remains the basis for much anxiety for many helpline organisations. Some of the work in other areas would start to bring infl uence, as Jacky Hammond noted:

“If we had a common set of standards (and some of us were already using the THA general standards) we could have confi dence in working with other helpline partners. We could also show our commissioners a set of standards, backed by the Department of Health, which they should use when reviewing our contracts – or tendering for new helpline services.”

Tony Barker, then manager of Crisispoint – the fi rst helpline to gain the Mental Health Helpline Quality Standard – makes a similar point:

“We wanted to raise awareness of our service in the outside world. The Standard shows we are providing a quality service for callers on a par with larger helplines across the country.”

In addition it was felt that guidance for commissioners and funders on the advantages of helplines in the context of reaching their targets against NSF must also be developed.

First Conference

On 15th May 2003 the Mental Health Helplines Partnership held its fi rst national conference at the Old Vic Theatre in Blackfriars, London. An audience of around 150 people attended, consisting of commissioners of mental health services, users and carers, helpline staff and partnership representatives as well as NHS Direct, the National Institute for Mental Health in England (NIMHE) and the Department of Health.

The audience heard a presentation summarising the fi ndings of the public survey into mental health helplines, revealing that 20% of the public were aware of the existence of mental health helplines. 30% of the public said they would use a mental health helpline if the need arose. Of the 5% of the public who had used a mental health helpline, many would recommend it to a family or friend. The convenience and immediacy of using a helpline, availability 24 hours a day and confi dentiality were regarded by the public as important.

The Mental Health Helplines Quality Standard Workbook was presented.

Twelve linked standards developed through the partnership between THA and mental health helpline covered many aspects of the management of the helpline and the delivery of the helpline service, including: fi nding out about the helpline; getting through to the helpline; establishing and maintaining interaction during the call; offering information, advice, signposting and referral during the call; handling complaints; confi dentiality; ending the call and follow-up work; monitoring and evaluation; staff recruitment, and staff training.


Jacqui Smith, then Minister of State for Health with responsibility for Mental Health, delivered the conference keynote speech. The Minister noted how partnership Helplines received 5.5 million calls each year. She spoke of the level of cooperation between partnership members and how this sustained partnership approach acted as an example of the model government wished to see taken up in other areas. The Minister launched the Mental Health Helplines Quality Standard Workbook, noting that promoting diversity did not mean losing sight of quality. The Minister also launched the funding guidance, encouraging commissioners to consider helplines in the delivery of local mental health services, saying:

“The more I become aware of the potential of telephone helplines, the more I am convinced that they can offer a unique source of help and support … for many people with mental health problems, telephone helplines provide an important way to access support and information.”

Jacqui Smith turned her attention towards the future. Much had been achieved, but there was more still to be done. To do this £5 million was being allocated from the mental health budget as an investment to support the further development of the partnership.


Carolyn Steele recalls:

“We had enormous support from the minister, Jacqui Smith … and later, Rosie Winterton … they were brilliant. From the work that was developed we were able ... to go through the bidding processes and secure £5 million, which the Minister announced at the conference, and which we were thrilled about … in order to establish the partnership, to look at all these other areas of work and to establish the programme board … that was a major, major thing.

“When we got the £5 million we had our three phases mapped out and it was our task to try and bring everyone along with us … and that was quite a challenge as well.”

George Askoorum remembers that:

“The work becomes more specific now … £5 million to develop an infrastructure to enable and support access, quality, choice and governance. By now we have a partnership of between forty and fifty helplines working together. What was clear and what the helplines did not want was to simply divide up the money among them – because next year we would be back to square one.

“When we got the money we agreed about what we shouldn’t be doing - but we were still not clear about exactly what we should be doing. This was when we commissioned PricewaterhouseCoopers (PwC) to consult with partnership members and make recommendations. We received some criticism at the time because they were perceived to be expensive. But we picked them because they were credible … The work they were tasked to do was to consult with the partnership and come up with the best ways of delivering on access, choice, quality and governance and after nine months they came up with a report which laid out how to get there.

4: It’s Going to Happen*

The first national conference was successful in engaging key stakeholders. It culminated in the announcement of a significant financial investment. It also set the scene for the next stage in the development of the partnership. The hard work was just about to begin.

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24 Our Story: It’s Going to Happen*

“Right from the beginning of this work it was always understood that the problem was sustainability. The activity had to deliver sustainability. If helplines have a sustainable product to market to commissioners that is where the money in future will come from – and at the same time the caller will be assured of a quality service. Part of the sustainability initiative was to be able to put structures in place to enable helplines to develop the capacity to be funded in future.”

Carolyn Steele recalls:

“We commissioned PwC to do a national review of mental health helplines and from that to make recommendations ... which refl ected the phases of the work we were doing … to make recommendations about how to take that work forward … this very strongly underpinned us getting the £5 million as well.

“The survey had also showed us lots of interesting things about what callers want as well … where they wanted to be referred to …. what was important for them and … we fed all that back into the system as well.

“PwC went out and talked to every single organisation … and that was great … and yes, some helplines may not all have liked their approach, because the harsh reality was that if the Department was investing money, there had to be some criteria to work to. So, apart from creating a framework, it was also a bit of a reality check for helplines.

“While this work was going on … and it was a large piece of work ... some of the organisations were going under ... and I said at the time ‘it doesn’t look good that while we are doing a review of national provision some of the services are closing’ … we actually gave some small grants to keep them going.”

Attention at partnership meetings was about to focus on engaging with PwC for nine months from July 2003. But it should also be remembered that the partnership and THA were working through arrangements to enable the quality auditing of helplines to begin, as well as starting to look at consultation over helpline worker training. The conference had also drawn some new members into the partnership, including Rebecca Tang of Wah Sum, the Chinese Mental Health Association:

“I went along to THA for training and met Liz Rowlands, who put me in contact with the Mental Health Helplines Partnership … and I attended the conference in 2003.

I was so impressed by the conference and by what was going on with the partnership that I wanted to get involved. And we had received lottery funding to set up a helpline.

“George Askoorum was very helpful and supportive and gave lots of advice and … we were able to develop the helpline because of our involvement with the mental health helplines partnership … I began attending partnership meetings and they were so useful … We were at the beginning of setting up the helpline and … because our knowledge was very limited my experience of the partnership was very positive ... we got lots of help and advice from the other helplines … it really widened my eyes ... we went on to receive between 200 and 300 callers a month.”

Other new members were also joining the partnership, and partnership meeting attendance numbers grew. This brought some challenges to decision-making, as the thread of important previous discussions were sometimes lost. Questions that had previously been seemingly settled were returned to


again. Steps were taken by THA to brief new participants. But the challenge of managing change, while keeping continuity of purpose, revealed that the decision-making capability of a ‘loose coalition’ of partners meetings was reaching its limit. New governance arrangements would be necessary to ensure that the funding announced by the Minister could be properly invested and accounted for. During this period the Department established a Project Management Board (PMB) as the Minister had indicated at the Conference, to support a wider range of voluntary sector partnerships.

PwC published their fi ndings in February 2004, following extensive direct consultation with telephone helpline organisations, with THA, in workshop sessions at partnership meetings and with the newly formed PMB. PwC then presented its recommendations to the Minister in April 2004.

PwC Recommendations

The PwC Report made recommendations in a number of areas that collectively provided an ‘investment model’ for Mental Health Helplines, through which the new resources would be applied over three years, to develop an infrastructure intended to sustain helplines over the longer term and deliver improved access to mental health helpline callers.

The recommendations were:

• To establish a new governance framework, providing clarity over decision-making about investments. The framework consisted of three ‘tiers’ – PMB holding an executive review function, a Steering Group exercising a decision-making function on investment,

and the Helplines Partnership Forum meetings forming the consultative body for mental health helpline partner organisations.

• To commission the development of telecommunications infrastructure, capable of routing calls to mental health helplines so that, for the caller, there would be the means to access helpline support 24 hours per day, seven days per week. This became known as the ‘telecoms solution’. The solution must reduce costs to helplines and improve the quality of management information. These advantages would be important in persuading commissioners about the cost-effectiveness of helplines over the longer term.

• To invest a signifi cant allocation of the total resource in ‘Targeted Investments’ – capped at £40,000 per organisation, and intended to enable struggling helplines to continue operating while these structures were being put into place. Targeted investment were also to be used to stimulate the development of ‘shared services’ – intended to reduce helpline overhead costs by contracting out services that could be provided for a fee by another helpline partner.

Forming the Steering Group

PwC’s recommendations had signifi cant implications for relationships between all of the stakeholders in the partnership. The complex arrangements around the commissioning of the ‘telecoms solution’ went beyond the remit of the consultants and would be worked out through the next phase of the partnership. While PwC had captured the issues and brought an objective perspective to the complex issues and conditions helplines operated in, there is also a sense

26 Our Story: It’s Going to Happen*

that the proposals were worked out against a background of continuing anxieties. Bridget O’Connell recalls:

“I joined Mind Infoline in 2003. I became involved with the partnership at the early stages of the PwC consultation … Because the members felt that PwC consultation was so mechanistic, everyone united against them and that was something of a breakthrough … PwC tried hard, but people felt that they did not understand what helplines were doing … when PwC asked ‘why don’t you answer calls in a particular way?’ people said – ‘well that’s not how we do things’. It made us see that we were all quite tolerant of our differences and that people should be given the choice about what service they wanted at the end of the line … it became clear that these differences were not a problem for us, but they were for PwC. It was a breakthrough … rather than these dry long meetings with people glowering at each other ... people began to open up and meetings began to be more productive and a better experience … people began to realise that they hadn’t lost their funding because they talked about how they did things with potential competitors.”

Pam Blackwood also became a helpline representative at this time:

“I have been with Samaritans since 2003 which was when the partnership was already going into the PwC process … my predecessor at the Samaritans was also involved with the partnership and when they moved on, I took over. There were still concerns that we were all going to become a government department … things were very fraught early on and I

wondered what I had got myself into! There was a feeling that the proposals from PwC were being put upon them … that they were not the partnership’s decisions.”

In reaction to the external review, and perhaps to reassert a sense of ownership, partnership members took the initiative of developing the terms of reference for the Steering Group. Increasing membership had made partnership meetings unwieldy. It was agreed to elect a Steering Group, drawing representatives proportionately from the different types of helplines making up the partnership. The Steering Group would become the decision-making body for the new investment.

The Steering Group would be elected by the partnership and be accountable for its decisions on investment to the Project Management Board. In addition to elected Steering Group members, two non-partner representatives with voting rights were also to be added to the Steering Group. Co-opted members were permitted, to strengthen the Steering Group by providing particular expertise and focus, for example, in enhancing the focus on BME use of helplines.

The extent of the initiative partnership members showed in wrestling back power from the PwC recommendations was in the partnership’s insistence that the Steering Group should have an appointed independent Chair without any direct interest in operating a mental health telephone helpline. The Steering Group Chair would also sit on the Project Management Board. It reiterated the importance helplines placed on being independent, and “not become part of a government department.” It recommitted members to the next phase of development.


Pam Blackwood, elected as a national helpline representative to the Steering Group, recalls:

“The Steering Group was very important ... things began to move faster after that formed … the group met monthly and things happened between meetings.”

Bridget O’Connell, also elected as a national helpline representative, remembers:

“The Steering Group had a crucial role to play in helping to move things forward, but it was a blessing and a curse, because the rest of the partnership began to see it as our responsibility … saying ‘well you make the decisions’. There was a lot of time spent on consultation … and sometimes when decisions were taken people said ‘well that’s your decision – not ours’. Funding for helplines in crisis and for development was a big thing for the Steering Group. It caused a lot of excitement as well as tensions about who should get it, and why. The partnership spent a lot of time discussing issues around this.”

5: Changes*

Elections to the partnership Steering Group took place during September 2004, with the results announced at the partnership meeting on 30th September 2004. Two Steering Group members where elected for a three year term to each of the Helpline Categories (national/generic helplines, specialist helplines and regional/local helplines). A co-opted User Representative and a BME Representative, both with voting rights, followed. Gil Hitchon, then Chief Executive of MACA (now Together: Working for Wellbeing) was appointed as an interim Independent Chair and steered the group through its fi rst nine months.

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28 Our Story: Changes*

Darren Bottrill, elected as a local helpline representative, recalls the work the Steering Group undertook in awarding Targeted Investment funding:

“For me one of the key events in partnership story is the formation of the Steering Group. We knew there was going to be a large pot of money coming down from the Department of Health and the Steering Group was going to help decide how to spend that money. Targeted Investment was where helplines could apply for funding … it was a initially for helplines in fi nancial diffi culty … and funds left over were allocated towards development … for Nightlink, this meant getting out to people who were rurally isolated … letting them know about the service and how to use it.

“The Steering Group was effectively a management team, making all the decisions about how money was spent and how objectives were realised … we had to prioritise some work and not others. The idea of ‘shared services’ got put to the back … for instance I would have liked to be able to ask a partner organisation to carry out some research for us on mental health service users in Cornwall … we could have seconded someone to do that work … also sharing expertise and resources … shared services was a very complex piece of work, which never really kicked off, and still hasn’t.”

A new Chair

Gordon Boxall was appointed as Chair of the Steering Group and took up this role in September 2005:

“I responded to an advert asking for a Chair for the Steering Group … as someone who was a leader in the fi eld, but not directly involved in helplines … someone qualifi ed and competent to have a leading role ... but with no direct interest. I didn’t know quite what I was walking into. I spoke to Gil Hitchon who had taken on the position as an interim arrangement for nine months to a year, with a view to then handing it over. I was recruited and my organisation was remunerated for my time and the other members of the Steering Group were compensated in a different way … in recognition that, in particular, smaller organisations would be put under pressure ... how would they be able to afford this? … it wasn’t just about the bigger organisations and people who had the time … it was really about including everybody … There was a really sound value base and philosophy all the way through …

“I came in and took over chairing the Steering Group looking to ensure that, as well as membership representation, there was service user representation … which hadn’t worked as well as it could have done up to that point. There was real determination to ensure that the service user voice was heard and was around the table … it was diffi cult but we worked and worked and worked to get it right ... working with the National Service User Network … and also around race equality … getting representation from a specialist BME organisation.


“The early days were about process and systems and making sure we had them in place … partly that was to do with me and my wanting to ensure a structure, but also a consensus for decision-making, and making sure that everyone understood that. We had some storming as you would expect – but we got through that, broadly with the same people … so it wasn’t that people were unhappy about it …but a case that we were all shifting and developing as part of the roles we had … to what became a very strong group.

“I was reporting up to Programme Management Board that was headed up by Kathryn Tyson, which included Carolyn Steele and other people from the Department, as well as Commissioning representation … so they were the ultimate governors as it were ... setting milestones and ensuring that we were working towards these.

“Members of the Steering Group put in a huge amount of time and effort – Darren, Emma, Bridget, Amo, Fran, Pam, Sheila and Rebecca … people took their roles very seriously … sometimes we would spend a lot of time in discussion … not just being parochial … but thinking strategically … it was a big learning curve.

“There is no doubt that the targeted investment we made helped keep helplines going … but it did not necessarily make them sustainable.”

Changing relationship with THA

With the Steering Group established, the working relationship between the partners and THA changes. The emphasis of THA’s involvement shifts from the facilitative and communicative support function partner members had known since July 2001 at

partnership meetings, to THA working with member organisations on auditing the Quality Standards for Mental Health Helplines and the design and delivery of the helpline worker accredited training programme. During this period THA was also commissioned to produced the ‘Guidelines on Confi dentiality’.

Accredited training

Sarah Teevan took up the role of Accredited Training Coordinator, a post funded by the Department of Health and hosted by THA. Sarah worked closely with Partnership members on the design of fi ve learning units for mental health helpline workers, consisting of: mental health awareness; services and routes to help; telephone boundaries; telephone helpline skills; and, working on a mental health helpline. The units of this programme were accredited by the Open College Network (OCN) at Level 2 NVQ in November 2005.

The learner’s time commitment for the whole programme was estimated at 180 hours, made up of private study, workplace learning, tutor-led study days and tutorials. To facilitate the cascade of the training programme through helplines, 66 potential trainers attended ‘training for trainers’ courses from 27 helpline partner organisations. The plan was for the people undertaking this training to form the group who would run the programme for their organisations. However, a year after accreditation, only fi ve organisations were actively involved in the accredited training programme. 22 other organisations did not go on to run the programme. The cascading effect did not happen. At December 2006, only 41 learners were actively involved in the programme.


Rebecca Tang, Steering Group representative, recalls:

“Accreditation is very important. The partnership developed a basic but very useful programme ... although I suggested that the programme could include more specialist content ... by the time the programme was ready for roll out we were in the process of winding up our helpline, so I did not attend the training.”

Bridget O’Connell remembers:

“Training was very important. THA had been commissioned to develop a training programme, which generated a lot of interest as well as challenge from within the partnership. There was a lot of commitment among many of the partners to the training programme, and as a partner it was frustrating when it was suspended, pending review. As a Steering Group Member I understood why it was suspended – I could acknowledge the strategic decision – but operationally it was very frustrating.”

Thurstine Bassett, who conducted the fitness for purpose review of the training programme, recalls:

“ … The training programme was quite good and people liked it – which ran contrary to the feeling within the Steering Group. This pleasantly surprised them – that the training programme was better than they thought. They had consulted very widely in the first instance and produced materials that were very full and then there was a plan to ‘train trainers’ across the partnership. The training programme had been very thoroughly set up – getting information, preparing and getting ready. Where it fell down was in delivery where – although it

rolled out quite widely – very few people were trained. The finding in the review report was that while it hadn’t caught on fully, it was well respected and could be built on. Some people really didn’t like the training programme, so carrying out the survey in the review did throw up surprises and silence.”

Quality Standards

The scale of the work involved to prepare the first 30 helpline organisations to undertake an assessment against the standards in the Quality Standards for Mental Health Helplines Handbook was underestimated. At the first national conference in May 2003 it was expected that 30 helplines would be audited during the course of the following year, but one helpline was assessed and accredited in 2003/04 (Crisispoint). Of 30 helplines assessed during 2004/05 only, 12 were accredited (6 on first assessment, 6 on reassessment) while 18 did not achieve the quality standard during that year. The cost of the support provided through THA to helplines was considerable, and while the programme continues, and there has been a comprehensive sign up by partners over time, it operates on a smaller scale. Darren Bottrill first got involved in the partnership because of an interest in quality issues:

“The Quality Standard was already in place before the partnership through THA … all that happened was that it was developed with a warp towards mental health. THA were involved in getting that together.”


Bridget O’Connell recalls:

“THA had already been involved in producing quality standards for helplines and were commissioned to develop the mental health perspective within the standard. Quality did not have such a big impact.”

First staff appointments

As the Steering Group started to take decisions about new priorities on behalf of the partnership, including the allocation of Targeted Investment and the detailed work of shaping what became known as ‘the telecoms solution’, it became clearer that they needed direct access to dedicated staff.

Lilian Owens (previously representing the helpline organisation No Panic in the partnership) was appointed to NIMHE East Midlands, with a remit to support voluntary sector development – including fostering stronger links to commissioners of mental health services. The engagement with commissioners started in earnest with her appointment.

Rethink successfully bid to host the post of Project Manager and Administrator, on behalf of the partnership. Peter Chidwick was appointed in September 2005 and Nicola James joined shortly afterwards. The fi rst partnership offi ce was opened in Dover. Darren Bottrill and other Steering Group members cites the appointment of the Project Manager as one of the key events in the partnership story:

“ … There was someone to drive the work forward … Peter Chidwick was playing a key role ... we had lots of great ideas but we all had our day jobs and needed someone to do that work … and that was Peter … that role was instrumental in getting all the helplines attending

the meetings, keeping the communication alive. He also acted as an executive offi cer … the main communication between the Steering Group and the members, supported by Nicola James and then Mirelle Frost.”

Bridget O’Connell remembers:

“Recruitment of paid staff was a massive move forward. Things did improve when Peter Chidwick came into post. At his fi rst partnership meeting, Peter came in with a PowerPoint presentation and timetables and so on, and when people began to go off on a tangent, he was very adept at keeping things on track … and there was an upsurge of interest in the meetings and attendance improved.”

Beginning the Telecoms Solution

A major plank of the PwC Investment Framework accepted by the Minister was the procurement of a telecommunication system to achieve 24/7 access to mental health telephone support. This system should enable callers to be routed to partnership helplines that were open and ready to take their call.

Advances in digital communications technology allowed separate partner organisations to share this system without the need to invest in new equipment or to lose their individual identity or methods of delivery. The cost of building such a system was becoming affordable, if a single large contract over several years could be established with suitable suppliers. The partnership was able to learn from the experience of organisations which already had ‘intelligent platforms’ in place, e.g. Samaritans, NHS Direct and Rethink. The system needed to be fl exible, so that different partner members could establish their own call plans. The


benefi ts should also include lower call costs and the delivery of enhanced management information.

The partnership took professional advice from Colin Sweeney on this matter. Colin had previously worked with the partnership on telecoms issues. He produced an options appraisal and subsequently prepared a requirements specifi cation used in the Invitation to Tender. The Department of Health’s new procurement arm – PASA – was extremely helpful in steering a course through the tender process.

Call Handling Services Ltd and ntl:Telewest Business won the Telecoms contract in a joint bid. Peter Chidwick has been working closely with the supplier and helplines who came into the fi rst wave to pilot the system. At December 2008, 12 partner helpline organisations are part of the Virtual Call Centre, handling 6,000 weekly calls through the system. Steering Group members believe the telecoms platform has been a signifi cant development. Daren Bottrill notices similarities to earlier breakthroughs when helplines got Freephone numbers:

“For me a really important development was the telephony platform … lots of members became part of Freephone network incurring local rates … the partnership was then able to negotiate particularly good deals on incoming call costs … this was funded and developed for the benefi t of all helplines partners.”

For George Askoorum, the telecoms solution has been at the top of the priority list:

“We needed to develop a telecom solution and infrastructure that would enable round-the-clock access without helplines losing their individuality and keeping to their own remit.

Not all helplines operate 24 hours a day – but help should be easily accessed 24/7. It’s also important to be able to collect and collate signifi cant management information that helplines could use to improve their services – which would also make the case to commissioners. The bigger helplines may have had these tools – but smaller helplines did not have them.”

As chair of the Steering Group, Gordon Boxall is convinced a good investment has been made:

“The most signifi cant success has been the development of the telephone platform … that will test out people’s ability and determination to work together in partnership … From the caller’s point of view, if I’m calling your helpline and you are engaged or not open I can have the choice to be transferred to another helpline without having to hang up or without getting a message saying sorry we’re closed … It could be that I need a specialist helpline dealing with eating disorders or anxiety or a local service … if you are calling from Bristol area you may want another helpline in the area … I can now press a button and be patched through to another service … which is fantastic ... for a caller that is wonderful … and for the DH they can happily say they are offering 24/7 service … for the partnership we can say they are working for the interests of the caller rather than the individual organisations involved … that’s brilliant … it gives organisations a much, much better service and access for callers and for much less money ….. the unit cost is wonderful … it’s a great deal and, of course, with the investment coming from the Department of Health, the helplines weren’t having to lay out money to get it.”


Second conference

The second national conference: ‘Working together, helping others’, was held in May 2006 to celebrate the achievements to date: 48 partner member organisations providing helplines from over 230 locations across England and receiving almost 7 million calls every year. The conference began with a short video address from Rosie Winterton, MP, Minister of State for Health, a keynote speech from Kathryn Tyson, Head of Mental Health Programme at the Department of Health, and with a question and answer session hosted by Niall Dixon, Chief Executive of the King’s Fund. In her keynote speech, Kathryn Tyson spoke about the progress made in many areas since the fi rst conference. She also looked ahead to consider the sustainability of the partnership:

“This is perhaps the most important area of work to be undertaken now, so that we can be advised as to the most effective way of sustaining the partnership in the long term. Consultation with our key stakeholders is extremely important here, particularly commissioners, and I would encourage you to support this consultation through your participation in the conference today. I know that the partnership is actively engaged in addressing this and I expect to see their recommendations in due course.”

34 Our Story: State of Independence*

In autumn 2006, the partnership commissioned a sustainability review, co-ordinated by Jacky Hammond. She consulted helpline organisations and took advice from other stakeholders on the best approach to ensure the partnership continued to exist and pursue its objectives into the future. Her fi nal report to the Steering Group and the Programme Management Board set out the options (MCCH, 2007). It recommended that the partnership become constituted as an independent legal entity, ideally as a charitable company in its own right, while continuing to pursue the original objectives of the partnership. In June 2007 the Steering Group took legal advice and approved the proposal that the partnership should seek status as an independent Charity and Company Limited by Guarantee.

The Steering Group envisaged that, once the new company was established, a Chief Executive would be recruited, and staff hosted in other organisations working on partnership objectives would transfer over to form the new staff team. To be incorporated as a charity, the new company had to satisfy the Charity Commission that it’s purpose was entirely charitable and for Public Benefi t. A Board of Trustees would be established to secure this. The new company, Mental Health Helplines Partnership, was registered at Companies House on Friday, 25th January 2008. The company was incorporated as a Charity on Thursday, 11th September 2008. The objectives of the company are:

“To advance health and particularly mental health, in particular by improving the quality of services to people suffering from ill health and those caring for or treating them

andTo undertake any other charitable purpose.”

6: State of Independence*

The investment of £5 million for the development for mental health helpline infrastructure across England was committed for three years from April 2004. As Kathryn Tyson noted in her speech at the second conference, attention now needed to turn to the sustainability of the partnership.


Fiona Kerr was appointed as the fi rst Chief Executive of the Mental Health Helplines Partnership and came into post on Monday, 7th July 2008 in new offi ces in Peterborough. Peter Chidwick, Lilian Owens, Nicola James and Mirelle Frost transferred over to the new company as employees soon afterwards.

In the midst of change, the work continues. To date, 60% of partner organisations have achieved the mental health helpline quality standard. Clare Marshall has been appointed as the new training manager, and Paula Ojok is PA to the Chief Executive. The partnership commissioned the fi rst-ever substantive research into black and minority ethnic (BME) mental health helplines. This provided evidence and mapped the extent to which BME communities use ‘unoffi cial’ means of support, including informal helplines (Kalar, 2008). This has a strong resonance to the origins of many of the partnership organisations.

The second conference launched the partnership website (www.mhhp.org.uk) as well as confi rming the logo and name by which the mental health helplines partnership is increasingly recognised and referred to:

mhhp

The work to engage commissioners on the value of helplines continues, with a podcast on the website and, in February 2009, the launch of a Commissioning Guide (also available on the website). In their joint introduction, Bob Niven, recently appointed Chair of the Board, Kathryn Tyson and Fiona Kerr write:

“Telephone communication combined with information technology continues to shape and change all our lives. But it’s only recently that the capacity of helplines as enabling technology has started to be fully realised – including how it can respond innovatively to changing mental health needs … Helplines allow individuals to get support and advice quickly when they need it, without the delays that can occur where services require professional referral. There’s good evidence to suggest the public will use helplines as a fi rst resort, and that helplines are not inhibited by stigma in the way some mental health services are.”

This echoes the speech Ivan Lewis, Parliamentary Under Secretary of State for Care Services, gave to the House of Lords event in March last year, launching the mhhp telecoms network and the Race Equality Mapping Report:

“Helplines are often the fi rst call for help that people make when they are in a mental health crisis. If they can’t get the support they need in that call, there isn’t a second call. That’s how important helpline services are. Consequently, mental health helplines need to be at the heart of all commissioning strategies for integrated community mental health services.”

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36 Our Story: Don’t Stop ‘till You Get Enough*

Lesson One: A practical approach to Leadership

In his NHS review last year, Lord Darzi of Denham summarised the development of his ten year plan for reforming health, and identifi ed the importance of staff input at all levels of the NHS, especially those working at the point of service delivery:

“ … through the review process we have developed a shared diagnosis of where we currently are, a unifi ed vision of where we want to be, and a common language framework to help us get there … leadership makes this change happen … frontline staff have … shown themselves to be leaders by having the courage to step up and make a case for change.”

This echoes a point made by Carolyn Steele on the challenges at the outset of the partnership:

“Part of the challenge was to ensure that all the helplines – no matter what size, whether they were a national organisation like Rethink, or someone operating from their front room … that they were listened to and involved ... because it was about ensuring that there was access and choice … as well as standards.”

Lord Darzi would have been served well by this example. Leadership at the outset of the partnership clarifi ed where mental health helplines stood in relation to meeting the NSF standards around access to people needing support. It identifi ed what was missing and what could be improved – and what needed to be stuck at – with a plan, resources and determination.

Lord Darzi refers to leadership as being:

“ … the neglected element of the reforms of recent years.”

This will come as a surprise to many managers, where every NHS conference and presentation is full of exhortations about leadership. But we argue here that it is practical leadership, close to the point of service delivery – perhaps in their front room running an ‘unoffi cial’ helpline – that makes the difference.

7: Don’t Stop ’til You Get Enough*

What lessons can be learnt from this story? How does it connect to the larger mental health agenda? This chapter suggests there are three lessons. It concludes by looking ahead to the new era.


Lesson Two: A new approach to Partnership – mutual ownership

When Gordon Boxall refl ects on his experience of the partnership, he cites vision and team work as important ingredients of partnership:

“It’s always a team that does it ... the Department didn’t need to create another organisation to set this up ... the Third Sector does this … just give it to the Third Sector … yes, create a framework in terms of governance to ensure there’s accountability and that the money can’t just be spent in any area … that had to be agreed with the Programme Management Board. But I’ve never had any diffi culty with them ... there’s never been a time when they’ve said: ‘Oh no you can’t do that, because that’s not in our interest’.

In the early meetings between the helplines, the Department of Health and NHS Direct, Jacky Hammond recalls that:

“… basically, two options were emerging: (1). an ‘NHS Direct for Mental Health’ or (2). bring together, if we wanted, all the various helplines in existence around the country. It was decided then that there needed to be a consortium approach under the auspices of THA …”

This particular partnership approach illustrates some of the demands on the style of leadership required, which has been studied by Robin Ryde (2007):

“While some leaders may understand exactly where things need to get to, and how to get there … others take a more exploratory path … it may take longer and may be an ongoing process of course review and correction … which the leader will accept, as long as they feel overall progress is being made … The route

forward may not always be obvious and may not always be plotted in detail … but with a clear vision, the direction will always be known … these leaders are people-orientated and understand that change comes fi rst and last through deep and sustained commitment.”

Ryde’s insight into the type of leadership approach necessary to bring about a productive partnership connects to Carolyn Steele’s views about establishing ownership:

“… the reason I pushed on quality through the standard and training was because they were the only things I could get everyone to agree on ... it was the point of least resistance. From there on the focus was around the training and establishing the quality standard. We commissioned THA for that, and we used their generic standard as a reference point and adapted that for mental health helplines. It took a lot of time to do it. People have criticised me for taking the time to get through this and have said ‘well why didn’t you just tell the helplines what had to be done?’ and I said ‘well they wouldn’t do it … they needed to own it’.

What is interesting in this story is that trust did not arrive easily. Yet the partnership did not dissolve. There was no single ‘tipping point’ that established common trust. The recollections of Darren Bottrill, Bridget O’Connell and Pam Blackwood show how competition continued to inhibit trust. Yet the partnership endured. We contend this happened because a strong sense of ownership emerged. When it was perceived to be threatened (for example by PwC’s review) ownership rights were strongly defended.

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38 Our Story: Don’t Stop ‘till You Get Enough*

Lesson Three: A different approach to Change

While fostering ownership was critical in the formative stages of the partnership, there’s also a sense that the task Carolyn Steele and George Askoorum set out to tackle demanded continuing adaptation – but without giving up the original vision about the objectives.

‘Pathway’ is the keyword George Askoorum uses frequently to describe this work. He uses the word when reflecting upon what’s necessary for the partnership to flourish now:

“mhhp is an independent organisation now and needs to embark on a new and different pathway … and in terms of the wider world – see what impact it can have. The words to describe where the partnership is now are – commitment, ownership, passion and interest – to see the outcomes succeed. The formation of the partnership was about people prepared to voice their differences – but not let that interfere with the development of the partnership ... and they own that development … not the Department of Health.”

Carolyn Steele makes the point that these lessons are transferable to a broader field:

“I suppose the icing on the cake for me is that these methods are entirely transferable. We have gone through all the pain of doing it … you still have to go through it – but you could fast-track … you could take out mental health and put in older people, for instance, or children ... actually the methods are the same. Because we have been through this process we know it works ... and my hope is that this will continue … that others will be able to take what we have learned and use it in other ways … the underpinning knowledge is specific, but

the process is exactly the same. People said ‘why didn’t you include other helplines like Childline or Victim Support?’ … and I would say that most of these helplines do have a huge mental health component and could use these methods. But it was such a big task that if we made it any wider we would have failed. I said ‘let’s do this mental health bit and then when we have that in place maybe we can use it there and there’.

“The partnership is in a good position now to ensure that in the future they can collectively provide for the whole of the market … that helplines come to be seen as a valuable part of the mental health service provision. A lot of change and innovation is down to individuals. But it is important that if you take that individual away things don’t fall down. I have been a champion of the partnership and hopefully now the partnership will be its own champion.”

Looking ahead

The final words of the story (so far!) are given to Fiona Kerr, Chief Executive of mhhp and Bob Niven, chair of the Board of Trustees of the charity. They bring the story right up to date and look ahead. First, Fiona’s insights since picking up the reins:

“Since mhhp gained it’s independent status, the span of work is widening – not least working with other government departments – including the Ministry of Justice and the Department of Work & Pensions. Partnership meetings are well attended and participation is strong. In recent months there’s a sense of people revisiting the value of helplines, in the light of the economic crisis and trying to meet the growing need for advice and support.


“Helplines could have fallen off the radar – but in fact they are back on the agenda. We hope to contribute and influence the development of the New Horizons strategy – to become a force for change and champion innovation across services. We don’t assume we simply have a right to that status – we will continue to work hard to earn it. It’s great to have a dedicated and energetic team, who feel motivated by members – and hopefully members feel galvanised by the commitment the team put in! We have the independently accredited training programme and a virtual call system – products we will constantly review and improve in response to what members say they want them to do better.”

“Looking ahead … the weight of our efforts will be directed at Commissioners … because it’s about drawing more resources into this sector. That critically depends on raising awareness of helplines and what they can do to respond to the changing organisation of mental health services and users’ needs. We must keep service users at the heart of our strategy – for example, looking at demand and caller feedback, and where the gaps are out there.”

Bob Niven adds:

“Deep down, why did I want to become mhhp Chair? Put simply, it’s because I want to live in a society where disadvantaged groups secure the support and opportunities they need. That is, for me, one of the hallmarks of a worthwhile, progressive society.

“It’s quite an exciting time for mental health. The message is getting through that the traditional methods have limits. The idea of a supportive and a responsive environment for mental health is key. Part of that is about

being able to get advice and services early and easily. The implementation of improving access to psychological therapies programme (IAPT) is one such opportunity … it’s important for helplines to get in on the act. mhhp can support them in doing this both by publicising helplines to IAPT teams – and by exploring ways of working within the IAPT model. A large number of mhhp partner organisations are in the voluntary sector and are nimble on their feet. They are able to respond flexibly to changing demands. This will be an advantage in terms of staying competitive.

“I want to enable mhhp to make a success of this new era. We now have a more independent mhhp, through being less closely tied to the Department of Health. mhhp is now a charitable company in its own right. To that extent mhhp is more on its on its own and that – in theory – brings some risks. But I believe the opportunities provided by that greater independence – the resulting room for manoeuvre to help bring about progress – far outweigh the risks.

“My goal is, over time, for coverage of all conditions, all communities and all localities. For everyone who could benefit from a helpline service to have access to an appropriate helpline, to know about it and to have the confidence to call – whatever their mental health circumstances, wherever they live and whatever their culture or identity. I want mhhp to build a powerful, shared strategy for this new era. We must spread the word about what the helpline sector and mhhp does and what it can contribute – about our value to people with mental health difficulties and the other key stakeholders across the field of mental health.”

40 Our Story: Appendix

Bassett T (2007) Independent Review of mhhp Training Programme. Thurstine Basset Consultancy.

Cabinet Offi ce (1999) Modernising Government. London: Stationary Offi ce.

DH: Department of Health (2008) High Quality Care for All: NHS Next Stage Review. Professor Lord Darzi.

DH (1999) The National Service Framework for Mental Health: Modern Standards & Service Models. London: Department of Health Publications.

DH (1998) Modernising Mental Health Services: safe, sound and supportive services. London: Department of Health Publications.

DH (1997) The new NHS: Modern, Dependable. London: Stationary Offi ce.

Hammond J (2007) Future of mhhp. PowerPoint presentation to Mental Health Helpline Partnership Forum.

Kalar A et al (2008) Mapping Race Equality in UK mental health helplines. Commissioned by the Mental Health Helpline Partnership.

Lank E (2006) Collaborative Advantage: How Organizations Win by Working Together. London: Palgrave Macmillan.

MCCH (2006) Sustainability Review. Report commissioned by the Department of Health.

MCCH (2007) Final Report on the Future of the Mental Health Helplines Partnership. Prepared by Jacky Hammond and submitted on 30th April 2007.

Middleton J (2007) Beyond Authority: Leadership in a Changing World. London: Palgrave Macmillan.

Munro J et al (2001) Evaluation of NHS Direct fi rst wave sites: Final Report of phase one research. Medical Care Research Unit, University of Sheffi eld.

NHS Direct (2002) NHS Direct Information-Sharing Agreement. G. Askoorum and R. Fairhurst.

Obama B (2004) Dreams From My Father: A Story of Race and Inheritance. Edinburgh: Canongate Books.

Payne F et al (2001) Evaluation of the National NHS Direct Mental Health Project. Immediate Access Project, Institute of Psychiatry, King’s College London.

PwC: PricewaterhouseCoopers (2004) Developing an Investment Framework for Mental Health Helplines. Report to the Department of Health.

Rethink (2004) Do Helplines Help? – Summary Report. Commissioned by NIMHE.

Ryde R (2007) Thought Leadership: Moving Hearts and Minds. London: Macmillan.

THA: Telephone Helpline Association (2005) Confi dentiality: Good Practice Guidelines.

THA (2003) Quality Standard Workbook for Mental Health Helplines.

THA Help On The Line … What commissioners and funders need to know about Mental Health helplines. Commissioned by NIMHE.

TNS: Taylor Nelson Sofres Consumer (2002) Usage and attitudes towards Mental Health Helplines. Report prepared for the mental health helplines partnership.

APPENDIXA. REFERENCES


Anthony Sheehan, DH

Carolyn Steele, DH

George Askoorum, DH

Charles Perry, DH

Kathryn Tyson, DH

Gil Hitchon, MACA

Gordon Boxall, mcch

Chris O’Gorman, Manchester Joint Commissioning

Karen Beasant, WAND (Working Advocacy in North Devon)

Stella Ansell, WAND

Sarah Teevan, Mind Infoline, then THA

Lilian Owens, No Panic, then CSIP/mhhp

Jacqui Jedrzejewski, NHS Direct

Sarah MacGillivray, NHS Direct

Sarah Thomson, NHS Direct

Rebecca Downes, NHS Direct

Liz Rowlands, THA

Kit Wilby, THA

Priya Shah, THA

Babs Evans, THA

Kathy Mulville, THA

Jan Williams, THA

Linda Thomson, THA

Deirdre Rusling, Depression Alliance

Sherry Clark, Depression Alliance

John Davis, Eating Disorders Association

Adeela Rashid, Muslim Womens Helpline

Judith Claudett, National Phobics Society

Sue Morris, National Phobics Society

Cat O’Neill, National Phobics Society

Jonathan Clarke, Premier Lifeline

Marjorie Wallace, SANELINE

Helen Hyslop, SANELINE

Val Hughes, SANELINE

Pippa Sargent, CALM

Jane Powell, CALM

Mabel Whittaker, CrisisCall

Jean Fardoe, CrisisCall

Peter Hopkins, CrisisCall

Andy St. John, Greenwich Out of Hours

Kerry L’Anson, Mental Health Matters

Vici Williams, Nightlink

Darren Bottrill, Nightlink (now Re-Gain)

Isabel Cornet, First Steps To Freedom

Keith Carter, First Steps To Freedom

Melanie Waller, First Steps To Freedom

Lorraine Wade, Mental Health Helpline Blackpool

Angela Winter, Mental Health Helpline Blackpool

Sarah Foxton, Mental Health Helpline Blackpool

Menazir Begum, Mental Health Matters

Tom Hodgeson,Mental Health Matters

Sheila Maugham, Mental Health Matters

Carol Holland, Mental Health Matters

Georgina Bond, Young Minds

Su Ray, Samaritans

Jackie Wilkinson, Samaritans

Pam Blackwood, Samaritans

Jane van Zyl, Samaritans

Roger Male, Solace

Julia Langrish, Tasha Foundation

Keith Williams, Tasha Foundation

Sal Ball, Bristol Crisis Service For Women

Jenny Smith, Bristol Crisis Service For Women

Viv Peake-Payne, Bristol Mind

Sheila Chesney, Basildon Mind

Megan Brown, Rochdale & District Mind

Tony Barker, Crisispoint (Turning Point)

Rebecca Tang, Chinese Mental Health Association

Amo Kalar, East in West Consultancy

Judi Barker, Young Minds Parents Information

Daphne Joseph, Young Minds Parents Information

Kat Williams, Women & Mental Health Infoline

Sarah Johnson, Women & Mental Health Infoline

Jacky Hammond, Rethink

Mike Hartley, Rethink

Mark Smith, Rethink

Pete Fry, Rethink

Sharon Curtis, Rethink

Phil Bosworth, ASSIST Trauma Care

Joy Bright, ASSIST

Sheila Marston, ASSIST

John Hodgson, Barnsley Mental Health Helpline

Sue Wardell, Stockport Mind Infoline

Andy Carr, Stockport Mind Infoline

Sheila Hammer, Eating Disorder Association

Emma Healey, B-eat (beating eating disorders)

Mark Reilly, B-eat

Andy Gaines, B-eat

Peter Booth, NAPAC

Gill Thomas, NAPAC

Carole Morgan, Lifeline Cambridgeshire

Pippa May, Lifeline Cambridgeshire

Julie Downs, Hearing Voices Network

Natalie Smith, HARP Helpline

Andy Pritchard, Mindline Somerset

Annabel King, Crossline, Plymouth

John Pither, Crossline Coventry

Pamela Drinnan, Crossline Hull

Muriel King, Crossline Scunthorpe & District

Deirdre McLellan, Doctors’ Supportline

Ian Glover, Staffordshire Mental Health Helpline

Sharon Godwin, Staffordshire MH Helpline

Gillian Sanderson, SOLACE

Pam Roberts, Womankind

Helen Stockwell-Cook, Womankind

Peter Kilgariff, Mental Health Helpline – Lancashire

Keith Carter, Anxiety Alliance

Sheila Harris, Anxiety Alliance

Lynn Hiltz, WITNESS

Nicky Lidbetter, Anxiety UK

Sandra Dennis, Agoraphobics United

Sue Shinman, The Line to What Now?

Alison Barnard, Guide-Line

Hanif Bobat, Manchester mental health helplines

Sarah Yiannoullou, Dream Team

Fran Witherden, Dream Team

Janet Roberts, Shropshire, Telford & Wrekin MH Helpline

Lisa Dando, Threshold

Thurstine Bassett

Colin Sweeney.

B. CONTRIBUTORS TO THE PARTNERSHIP – Thank you everyone!


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