Using theory of change to better address social and economic needs in mental health services

Introduction: Social and economic needs are greater in populations living with mental ill-health compared with the general population. However, services do not currently adequately assess these needs or offer appropriate interventions. A practical roadmap is required to work towards social and economic inclusion as a central component of mental health services. Methods: We used the participatory Theory of Change method to conduct two qualitative workshops with health care professionals, third sector workers, academics and lived experience experts (Workshop 1, n=16; Workshop 2, n=14) in the area served by the South London and Maudsley NHS Trust. We co-developed a Theory of Change model which aimed to outline the key steps needed to put social inclusion at the centre of mental health care services in relation to the largest mental health trust in the United Kingdom (South London and Maudsley), yet with generalisable elements for mental health services in the United Kingdom more broadly. Results: A shared goal for services was developed and agreed by participants of securing 'a consistent mental health system that enables individuals to feel loved, valued, and capable of thriving beyond their basic needs'. To progress from the current context to this shared goal, six objective pathways were co-produced to act as a roadmap: (1) Provision of person-centred culturally appropriate care; (2) Advocacy for funding for effective social inclusion services in line with need; (3) Advocacy for funding and support of social and peer programmes; (4) Co-located and localised community-based support hubs; (5) A shared feedback system with social inclusion Key Performance Indicators (KPIs) with an ability to include positive outcomes and drive accountability; and (6) A collaborative community service network. Conclusions: This Theory of Change model offers a tangible framework to put social inclusion at the centre of mental health services. This model can be adapted and translated to other services and settings that are aiming to make social inclusion a core feature of their provision, beyond those in which it was developed.