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Outcome measures (DIALOG and HoNOS)

Measuring outcomes provide a way for patients, clinicians and the health and care systems to understand the impact of the care provided. Outcome measures can be used to identify patient needs and understand the effectiveness of any care or treatment. They can also be used to measure health outcomes for a local population through ‘system process’ outcome measures.

In London, we are supporting the implementation of DIALOG as the London patient reported outcome measure (PROM) which is an assessment of health status and health-related quality of life that comes directly from the patient.

What is DIALOG?

DIALOG is a set of 11 questions where service users are asked to rate their satisfaction and needs for care across different parts of their life and treatment. It helps to guide a structured conversation between a health professional and service user that is patient centred with a focus on change.

Why does DIALOG exist?

DIALOG is simple to use and it enables proactive, personalised conversations at an individual level, supporting self-management and helping service users move forward with their journey of recovery. It has also been used to help inform the redesign of care planning processes within mental health services.

Capturing this information also gives a powerful indicator of patient satisfaction levels where health and social care services need to focus for improvement.

How to use DIALOG

Service users are asked by health professionals to complete this survey using pen and paper, or on a computer, iPAD or phone.

Who is DIALOG for?

This survey was initially rolled out for people within early intervention services and for those receiving a Care Programme Approach (CPA) package of care. The use of DIALOG can be extended to other mental health services including adolescents, older adults and primary care.

How often should DIALOG be used?

As a minimum, it is recommended that DIALOG is completed at the start of an episode of treatment, at review and at the end of an episode.

What is DIALOG+?

DIALOG is the tool and DIALOG+ is a specific intervention that uses the DIALOG scale and a 4- step approach based on solution-focused therapy.

DIALOG+ helps the person and the clinician to structure a conversation to explore their needs and wishes, support their care plan and help service users to actively problem-solve to support their recovery.

DIALOG resources


New Models of Community Mental Health programme

What is the New Models of Community Mental Health programme?

 The New Models of Community MH Programme is a London-wide programme that supports all of London’s Integrated Care Systems (ICSs) to change the way that mental health services are delivered in the community so that it is more joined-up, uses whole-population approaches and supports care that is more personalised to a person’s mental health needs.

The programme has an overarching aim to support London ICSs to develop ‘robust models of community MH transformation’

Policy and background context

This programme of work has come from the Community MH Framework for Adults and Older Adults that was developed by NHS England that aims to support people with serious mental illness or complex MH conditions in the community. London Integrated Care Systems (ICSs) are committed to transforming the way community MH services are delivered to ensure that people with complex MH needs are supported well in the community.

To find out more read the NHS Long Term Plan

Overview of governance structures

The London MH Transformation Board agreed to establish this programme in July 2020. This Board has oversight and accountability for the delivery of this work.

As part of this programme, we have established a Community of Practice (CoP) to bring together London’s mental health leaders across different sectors and organisations including mental health providers, commissioners, ICS transformation leads, voluntary care sector and people with lived experience.

We will use this network to share learning on approaches, challenges, different expertise and experiences across all London ICSs.

Programme workstreams

There are a number of workstreams based on key themes. Click on the tabs below to find out more information about our work.


New funding and support programme for London’s Social Prescribing Innovators

  • Healthy London Partnership is launching a new pilot programme to support London’s Social Prescribing Link Workers to improve the delivery of social prescribing services in primary care.
  • Successful applicants will receive up to £10,000 in grant funding and six months of dedicated support to tackle a challenge they face through the delivery of a specific social prescribing project.
  • Applications opened on 22 June 2022 and closed on 20 July 2022 – 12 projects across London have been successful and will make up the first cohort of SP Innovators.

Twelve projects from across London will make up the first cohort of Healthy London Partnership’s new Social Prescribing Innovators Programme, which was set up in the Summer to support SP services to tackle some of the biggest health inequalities challenges Londoners face.

The successful applicants, as judged by some of London’s most expert social prescribing professionals, academics, and clinicians, will be supported to deliver a specific project targeting a particular implementation issue, for six months from October 2022. This will include QI training, coaching and support, as well as up to £10,000 in grant funding for each project.

Dr Jagan John, Clinical Director for Personalised Care in London, and Chair of the North East London Clinical Commissioning Group says the programme will unleash powerful ideas from London’s vibrant social prescribing workforce to help overcome some of the implementation challenges of expanding delivery into London’s primary care networks.

“Social prescribing link workers, when based as part of the multi-disciplinary team in primary care networks, can really tackle the health inequalities many Londoners face. Yet time and again we hear how difficult it is to recruit and retain people with the right skills, set up hubs in the right locations, or link to appropriate services in communities outside the health service. This programme will give talented individuals and teams the opportunity to have the support they need to test out new ideas for making sure we can rollout social prescribing right across London, taking a holistic approach to even more people’s health and wellbeing while easing the pressure on the NHS.”

The results of the pilot programme will be shared in March next year. The innovative solutions developed by those who take part in the programme will be shared with all those interested in mainstreaming social prescribing across London’s primary care services and beyond.

To find out more, including a programme brochure and information about the projects teams, visit our Personalised Care project page.


FAQs, Resources and Stories

On this page, you’ll find more information about perinatal mental health services in London, with answers to key questions about the service.

Frequently asked questions

A wide range of mental health conditions can occur during this time, most commonly depression and anxiety. There are some conditions specific to this time in a woman’s life such as tokophobia – a severe fear of childbirth, and post-partum psychosis – a severe but treatable illness that occurs after having a baby.

It is not always possible to predict whether or not a woman is likely to experience perinatal mental health problems. However, some groups of women are at much higher risk, for example, 1 in 4 women with bipolar affective disorder experience post-partum psychosis.

It is vital that women receive treatment and support as early as possible. If left untreated, mental illness can have a significant and long-lasting impact on women and their families.

Getting appropriate treatment and support for perinatal mental health problems can help prevent avoidable suffering and isolation, strengthen families, ensure children have a healthy start and help prevent suicide – which is a leading cause of maternal death in the UK.

Here you will find a wide range of information and resources on perinatal mental health support available across London.

This toolkit offers best practice guidance about identifying and treating tokophobia. It draws on the current evidence and recommendations of a group of experts in the field.

We would like to thank all the many people who have contributed to this toolkit in order that it can reflect the voices of women with lived experience and the realities of working in Maternity and Mental Health Services. In particular, Rebecca Webb and Susan Ayers at City, University of London, conducted systematic reviews of the literature.

Download the Tokophobia toolkit

Resources

This toolkit provides guidance for health care professionals involved in planning the care of women at high risk of severe postnatal illness.

A pre-birth planning meeting is key to ensuring everyone has a clear understanding of the care the woman will receive in the weeks surrounding the birth of her baby, so everyone knows what to do and whom to contact if there are concerns.

Download the pre-birth planning toolkit

 

This toolkit is designed to offer advice to doctors and informs the multi-disciplinary team of best practice in providing preconception/family planning advice to women with a mental illness.

The document contains both information and resources and also recommendations that shift the clinical approach towards a collaborative model of care, using a strengths-based formulation.

Download the pre-conception toolkit

This document is to provide guidance for health care professionals involved in the care of babies born to women who have taken medication for mental disorders (psychotropic medication) during pregnancy.

Its aim is to optimise and standardise the care of exposed babies and to provide guidance to health professionals (in particular neonatologists, paediatricians and midwives) on the appropriate assessment and management of the risks and needs of the newborn baby.

Any psychotropic medication that has been taken by the mother during her pregnancy and / or delivery should be documented in the baby’s notes. Babies who have been exposed to such medication should undergo a relevant assessment as set out in this document. This assessment will take place in the hospital, birthing unit or home (if home birth). Information on this process should be given to mothers during their pregnancy and at the time of the post-birth assessment, so they can feel confident about their baby’s wellbeing.

Download the newborn assessment guidance

Stories

Chelsea’s story

Chelsea is mother of two young girls, a military wife, worked as Midwife for three years and now works as a Lived Experience Practitioner at Healthy London Partnership.

Shavarnah’s story

Shavarnah wanted to share her truths, the struggles she faced with her mental health as a young mum and how she created MumStyleLDN, which was her first step to healing.

Lynette’s story

Lynette shares her experiences, as both a member of the public and as a professional within maternity services. Her experiences extend across nearly thee decades.


Improving Access to Psychological Therapies programme in perinatal mental health

Having a baby can be joyful, exciting, and rewarding.  However, it is also common for pregnant women/birthing people and new mothers or fathers/partners to experience anxiety, depression, or emotional distress.

As many as one in five women/birthing people experience emotional difficulties during pregnancy and in the first year after their baby’s birth. This can happen to anyone.

Every London borough has an IAPT service which offers free, confidential talking therapy for people who have symptoms of anxiety or depression. IAPT stands for ‘Improving Access to Psychological Therapy’. They give priority to pregnant women/birthing people and fathers/partners.  This leaflet explains more about the service and the help we can offer you if you need it. For more information click here to access the “Help and emotional support during pregnancy and the first year after having a baby” leaflet.

Support across London

Below you’ll find a list of services available across London.


Mother and baby units in London

Mother and baby units (MBUs) provide specialist care and treatment when a mother is suffering from a mental illness and needs an admission to hospital.

These services allow for the mother and her baby to remain together, supporting their attachment and bonding, while the mother receives the care and treatment she needs to recover from mental illness.

Contact details for London Mother and Baby Units

A range of family focussed interventions are on offer, with staff including psychiatrists, nurses, psychologists, nursery nurses and occupational therapists. Women can be admitted from 30 weeks of pregnancy until the end of the first postnatal year.

There are three Mother and Baby Units that cater to the needs of all women and birthing people across London, regardless of where they live.


Community perinatal mental health teams

Community perinatal mental health teams support mothers who are experiencing moderate to severe mental health problems in the perinatal period to recover in the community. They also offer pre-conception advice to women with existing mental health problems who are planning a pregnancy.

They are staffed by a range of professionals and offer family-focused interventions, and work closely with maternity services, health visitors, IAPT, GPs, other community services and third sector organisations.

Support across London

Below you’ll find a list of services available across London.


Perinatal mental health in London

What is perinatal mental health?

The perinatal period is usually defined as the time between conceiving a baby and one to two years after giving birth. About one in every five women experience mental health problems during this time, making this a relatively common experience. Women may experience mental health problems prior to pregnancy and/or develop mental health problems during pregnancy or in the postnatal period.


Care Coordinators and Managers

If you are a Care Coordinator or Care Coordinator Manager, we have a wide range of information, resources and support available to you.

Care Coordinators and Managers’ pages


London’s movement for better mental health has helped 1.3 million Londoners to thrive as it turns five

  • More than 1.3 million people have participated in events and activities to improve mental health and tackle inequalities as part of the Thrive LDN movement since 2017.
  • Highlights positive results of meaningful relationships and interventions developed at a London, multi-borough and community or local level.
  • ‘We can’t overlook the huge challenges in recent years which makes the public mental health agenda even more important’ says Thrive LDN’s leadership.

London’s public mental health partnership, Thrive LDN, today marks its fifth anniversary.

Since launching on 4 July 2017, more than 1.3 million people have participated in events and activities to improve mental health and tackle inequalities as part of the Thrive LDN partnership. The participatory approach to supporting the mental health and wellbeing of Londoners has demonstrably had a positive impact, say Thrive LDN leadership.

Two million Londoners experience some form of poor mental health every year. Suicide is the leading cause of death for people between the ages of 10 and 34 and every week around 12 Londoners take their own lives. There are many communities in London who are at higher risk of unfair treatment based on their identity, beliefs, or social class, and in some cases a combination of these.

These shocking and sad statistics were the reason the Mayor of London, Sadiq Khan, and the London Health Board partners launched Thrive LDN, to work alongside Londoners to improve awareness and encourage more action around mental health and health inequalities.

Commenting on Thrive LDN reaching five years, the Mayor of London, Sadiq Khan, said: “When we launched Thrive LDN in 2017, no one could have foreseen the scale of the strains and pressures Londoners would have to face in the coming years. The pandemic and the ongoing cost of living crisis have had an unprecedented impact on the mental health and wellbeing of people across the capital. I want to pay tribute to Thrive LDN for the vital support they continue to provide to so many Londoners as we recover from the pandemic and work to build a better London for everyone – a happier, healthier and fairer city for all.”

Since Thrive LDN launched, the movement has grown and spread across the city. The Youth Mental Health First Aid (MHFA) programme has trained more than 100 new Youth MHFA Instructors and delivered Youth MHFA training to more than 4,000 education and youth sector staff citywide. Schools and colleges are working with Thrive LDN to play a role in the prevention of poor mental health and promotion of wellbeing for this and future generations.

The Thrive LDN Suicide Prevention Group is made up of 36 organisations and 48 members who are undertaking several citywide projects. This includes the development of Thrive LDN’s Suicide Prevention Information Sharing Hub which allows vital information to be securely shared to enable effective bereavement support and helps increase understanding and knowledge for agencies involved when a person takes their own life.

The Right to Thrive initiative has created a broad range of partnerships and grant funded nearly £300,000 to 36 grassroot projects which collectively aim to support those communities and groups most likely to experience poor mental health to amplify their voices, share power and leadership, and address some of the health equity issues they are facing.

The citywide #ZeroSuicideLDN campaign has seen more than 300,000 Londoners take the Zero Suicide Alliance’s free, online suicide prevention training to break the stigma of talking about suicide, suicidal thoughts and suicide bereavement. The campaign continues to be supported by the London FA, Metropolitan and British Transport Police, the NHS, all London Councils, London Fire Brigade and many more.

Earlier this year, on Friday 28 January, London hosted the first ever Great Mental Health Day across the region. The day saw Londoners and community groups sharing ideas and ways in which they are supporting their own wellbeing or others in their community or neighbourhoods. Close to 10,000 people accessed the interactive map of London on Thrive LDN’s website to find out what is going on in their area. Thrive LDN will facilitate the next Great Mental Health Day on behalf of regional partners in January 2023.

Councillor Kaya Comer-Schwartz, Leader of Islington Borough Council, was recently appointed as Thrive LDN Co-Lead, succeeding Mayor Philip Glanville. Cllr Comer-Schwartz said: “Thrive LDN is one of the capital’s flagship health initiatives. As we mark five years, thank you to everyone who has been part of this movement so far.

“I’m excited to join the Thrive LDN leadership team at this crucial stage when the public mental health agenda has never been more important. I’m conscious of the task ahead of us, we are only at the beginning of this journey.

“There is substantial evidence that the coronavirus pandemic has simultaneously widened pre-existing inequalities whilst creating new ones, such as problem debt, rising unemployment or structural inequalities. We can’t overlook the many other huge challenges and pressures on Londoners which makes this even more important.

“By working together and supporting each other, I’m confident we can build a city where every Londoner feels supported to thrive.”

Commenting on the fifth anniversary, Thrive LDN director, Dan Barrett, who supported the launch of the partnership in July 2017 said: “In 2017, things began with a series of open discussions with Londoners – to encourage everyone to think, talk and act more when it comes to mental wellbeing. Five years on from these initial community conversations, there has been real progress, demonstrating that we can achieve great things when we work together. Of course, there is still much more for us to learn and do but we believe our foundations and purpose are stronger than ever.

“Thrive LDN exists to drive and facilitate change. As we emerge from the coronavirus crisis, we must continue to put people and communities in the lead, allowing us to develop meaningful and trusted relationships at a London, multi-borough and community level. Doing so will allow us to support the wellbeing and resilience of all Londoners who need help and support now and beyond the pandemic.

“We look forward to continuing to work with partners inside and outside of health and care systems to find new ways of reaching, involving, and supporting Londoners to improve mental health and prevent a decline in wellbeing.”

Thrive LDN is one of many initiatives to improve mental health across the globe. Cities such as New York, Toronto, Edinburgh, Barcelona and many more have been leading new ways of improving the wellbeing of citizens and to tackle the inequalities and challenges that can lead to poor mental health. Explore Thrive LDN’s activities and events at www.thiveldn.co.uk.

ENDS

  • For further media enquiries, please contact ludley@nhs.net / 020 8148 5123

NOTES TO EDITORS:

  • Thrive LDN is a citywide public mental health partnership to ensure all Londoners have an equal opportunity for good mental health and wellbeing. Launched publicly by the Mayor of London and the London Health Board partners in 2017, Thrive LDN has evolved and grown significantly in the past five years. More information can be found at thriveldn.co.uk.
  • Councillor Kaya Comer-Schwartz, Leader of Islington Borough Council, is also London Councils’ Thrive LDN lead. She succeeded Philip Glanville, Mayor of Hackney at the end of June 2022. London Councils is a cross-party organisation representing all 32 London boroughs and the City of London Corporation.
  • Two million Londoners experience some form of poor mental health every year and Londoners’ life satisfaction and feelings of self-worth are lower than the national average. Thrive LDN was established in response to this, with the aim of reducing the number of Londoners affected by poor mental health.
  • In July 2017, Thrive LDN launched Thrive LDN: towards happier, healthier lives (2017), a summary of work engaging with hundreds of experts by profession and by experience across London’s public, charitable and business sectors to identify what would make a difference to Londoners’ mental health and wellbeing.
  • Thrive LDN’s campaign, Are we OK London?, started an open conversation with Londoners about mental health and wellbeing. As a result, it generated over 420,000 interactions and are now working with partners on several citywide and local projects across London. Thrive LDN also held community workshops, in partnership with the Mental Health Foundation, in 17 of the 32 London boroughs to start conversations on a community level.
  • Thrive LDN’s 2018 campaign engaged with a more diverse audience, grew our followers and subscribers and increased discussion and action around how inequality and discrimination can affect Londoners’ mental health and wellbeing, with a potential reach of over 23 million people. The campaign culminated with a festival of cultural activity organised by young Londoners.
  • In 2019, more than 200,000 people took part in events and activities to improve mental health and tackle inequalities as part of the Thrive LDN movement. Read more about our campaigning in 2019 here.
  • Also in 2019, Thrive LDN began leading the #ZeroSuicideLDN campaign with support from the Mayor, the NHS in London, London Councils, London’s police forces, Transport for London, and other emergency services, such as London Fire Brigade and the Maritime and Coastguard Agency, alongside voluntary and community groups, such as Mind in Haringey, and many others. For more information visit thriveldn.co.uk/zerosuicideldn.
  • Since 2020, Thrive LDN has awarded nearly £300,000 to 36 community and grassroot projects across London to help support the mental health and wellbeing of those who are experiencing higher levels of unfair treatment and discrimination through its Right to Thrive initiative.
  • In March 2020, Thrive LDN was asked to lead the regional coordination of the public mental health response to and recovery from the COVID-19 pandemic. Thrive LDN developed a response plan and agreed business cases with health and social care partners. Between April 2020 and March 2021 more than 685,000 people took part in projects, events, and activities on which Thrive LDN has led or collaborated on.
  • In May 2021, the London Health and Care Leaders’ Group commissioned the Thrive LDN Advisory Group to undertake a comprehensive review of regional public mental health across three main areas:
    • Review available public mental health research and insights.
    • Review the strategic and policy landscape to identify opportunities and levers for collective action around public mental health.
    • Review the public mental health literature to define how we can collectively approach and achieve change.
  • Most importantly, in response to the above, Thrive LDN developed a series of actions where opportunities could be maximised in the short, medium and long term. Subsequently, the Towards Happier, Healthier Lives (2021) report was endorsed by the London Health Board in November 2021.
  • On Friday, 28 January 2022, Thrive LDN supported the facilitation of London’s first ever Great Mental Health Day. On the whole, Great Mental Health Day was a huge success and provides a strong platform for us to collectively build upon:
    • Close to 10,000 people accessed the interactive map of London on Thrive LDN’s website to find out what is going on in their area.
    • On the day, there were more than 750 individual tweets using #GreatMentalHealth and more than 20,000 video views on Thrive LDN channels alone.
    • More than 60 events took place across almost every borough in London, many of which were held in person, involving local walks, coffee mornings and workshops.
  • More recently, Thrive LDN has supported the public mental health response to emerging crises on behalf of the region, from the pandemic to the climate emergency, to the current cost-of-living crisis, to geopolitical crises in Afghanistan, Hong Kong, and Ukraine. All these crises are putting pressure on Londoners and creating devastating mental health consequences of wider inequalities, disproportionately affecting Londoners with lived experiences of marginalisation and disadvantage.