Mental health care in the UK is a complex area involving a number of systemic and intersecting challenges. Community, primary and secondary health services are under a great deal of pressure, with little spare capacity amongst clinical staff to engage in preventative care work. This means that the non-clinical needs of people affected by mental illness have often gone unmet, leading to deterioration in well-being and quality of life and potentially readmittance to care services and crisis centers.
In this challenging context, Mental Health UK proposed the Mental Health Navigation model as a beneficial, cost-effective and person-centered approach to mental health care. The model offers a blueprint to deliver mental health services within communities—improving the patient’s health outcomes as well as the cost-effectiveness and use of primary and secondary healthcare resources. Mental Health Navigation is a model that provides people experiencing mental illness with support to address their unmet non-clinical needs and navigate their journey towards personal recovery.
Within the model, the Mental Health Navigator role provides seamless support to service users, by connecting them with both health services and the community. While the focus is on mental and physical health, wider support includes (but is not limited to) help with benefits, housing, employment, social connections and finances.
Launching the Community Mental Health Navigation Pilot
“The Mental Health Navigation model has the merit to approach health delivery more holistically and generating evidence of the cost effectiveness of a community centered model that emphasizes the need to invest in individual resilience,” says Marion Birnstill, Senior Manager Global Community Impact EMEA, Johnson & Johnson. “Given the burden placed on the healthcare system and the increasing number of mental health patients, this model holds promise for our understanding of humanizing health and new community health models of the future.”
With support from Johnson & Johnson UK and the Johnson & Johnson Foundation, Mental Health UK launched the Community Mental Health Navigator pilot program in June 2020. The pilot had two main aims across its two-year run: to support the non-clinical needs of people experiencing mental illness and to reduce demands on the capacity of general practitioners (GPs), mental health nurses and other frontline health and care professionals.
Mental Health UK is a partnership of four charities: Rethink Mental Illness (England); Adferiad Recovery (Wales); Mindwise (Northern Ireland); and Change Mental Health (Scotland). Therefore, the pilot established four new Community Mental Health Navigator (CMHN) posts, one in each region, to work within one local Primary Care Network (PCN).
The pilot was intended to act as an early intervention by attracting and accepting referrals, primarily from local primary care services (such as GP surgeries), within which navigators would be based. Patients referred to CMHNs would be supported to, for example, get help from local housing teams, engage with community activities, receive financial support or access training or work. CMHNs would adapt to the needs of individual patients, visiting them in their homes or signposting them to relevant local and national services. The process was designed to help prevent escalations into crisis and the need for emergency care, thereby freeing clinicians to focus on the clinical needs of their patients.
“If you are experiencing a serious mental health problem, you may not have the confidence, capacity or knowledge to obtain the variety of complex support that you need during a moment of crisis,” says Brian Dow, Chief Executive at Mental Health UK. “The role of our Community Mental Health Navigators is to be that vital link between the patient and the healthcare professional who provides that structure and guidance.”
Personalized support creating better health outcomes
Across the two years the pilot ran, The Tavistock Institute of Human Relations consistently evaluated its success, including conducting extensive interviews with stakeholders. According to Tavistock’s findings, 647 referrals were logged by CMHNs between April 2021 to September 2022, a 270% overperformance on the anticipated numbers. During the same period there were almost 6000 appointments offered, of which 85% were attended.
Interviewees reported that the CMHN model was effective in helping people address non-clinical issues or access further help, with patients reporting improvements in confidence, self-worth, purpose and physical health. People also shared that they felt better and less isolated because of CMHN support, joining in on more community activities.
The proactive nature of the support seemed to be of particular benefit to people experiencing mental illness, as people reported decreased anxiety and/or exacerbation of health or mental health conditions as a result. People supported by navigators also adhered better to both clinical and non-clinical treatments and were more likely to engage in and maintain positive health behaviors.
One participant in the pilot stated that the CMHN model “probably saved my life. If not for [navigator] I don’t know what I would have done or where I would be.”
Expanding the Mental Health Navigation model
The CMHN pilot has been continued and expanded within two of the sites, allowing navigators to continue to support users and contribute to improved mental health outcomes for a larger population of people. This includes plans by Rethink Mental Illness for the navigator role to be extended across England, with aspirations to embed a navigator in each of its 1250 PCNs.
“We are proud of the holistic approach to community-based care that the program models,” adds Dow. “Moreover, we are delighted by the findings of the report by the Tavistock Institute of Human Resources, which evidence that our person-centered approach not only leads to better health outcomes for people living with mental illness, but also reduces pressures on the healthcare sector and its staff. We look forward to taking forward these learnings when expanding on the great groundwork of this pilot.”
The launch of the Community Mental Health Navigators pilot in 2020 aligned with the Johnson & Johnson Center for Health Worker Innovation’s strategy to transform health systems by supporting frontline health workers responding to emerging healthcare needs, says Rhoda Steel, Social Impact Lead, Johnson & Johnson UK. “The program is a pragmatic, solution-focused, community-based approach to deliver care and support to people living with severe mental illness and improve their quality of life. We hope to see this human-centered approach to healthcare replicated and expanded in the years to come.”
The Community Mental Health Navigator Pilot Programme is supported by a grant from Johnson & Johnson in the UK and the Johnson & Johnson Foundation.