Third sector mental health approach post covid-19

Covid-19 has caused many individuals, organisations and systems to pause, take a step back and consider what they should and could do to ‘flip the script’ and think about things in new ways.

Like others, the voluntary, community and social enterprise (VCSE) sector for mental health has done just this. Working with GGI this year we have launched a joint paper exploring how the system and accompanying mindset could look different' in months and years to come.

The VCSE sector is an important partner for health and social care agencies and makes up a significant part of the UK economy, with 153,000 registered charities and £53B of income.

Alongside this, mental health provision has become more important than ever as people have struggled to cope with the pandemic – all at a time when the sector has had to cope with considerable change.

Today we explore some of the key findings and potential solutions as outlined in the paper – including a shift in mindset.

Inception - impact on demand and funding

The impact on the sector throughout covid-19 has been exponential. Ultimately, as well as the pandemic affecting people physically, there has been a huge impact on people’s mental health and wellbeing too. A mixture of the following has been incredibly difficult:

• after-effects from the illness itself

• increased challenges in accessing support for those with existing mental health conditions and

• burnout from people working either too much or seeing their jobs and income disappear

The NHS and social care systems face unprecedented demands and impact on capacity. It will worsen particularly during the third wave of the pandemic. In this context the value of the Voluntary, Community and Social Enterprise (VCSE) sector becomes more evident. More and more this sector acts as a frontline responder to our population’s health and social care needs

At the same time, funding was put under pressure. Cuts continued in stretched funders such as local authorities. The NHS, alongside fundraising bodies, saw a reduction in the amount they were able to gain from public interest. And it won’t stop here – a recent report from Demos suggests that 83% of charities now forecast a decline in their income over the next 12 months, and 69% think it will take more than a year to return to pre-crisis income levels.

So, what can be done to support the sector in meeting the increase in demand and impact on funding? Collaboration can be seen as a key approach to this. At the moment the sector often competes with itself, chasing the same money. Instead, they should collaborate and learn from each other to improve outcomes for individuals.

The health and social care White Paper states that “the NHS and local authorities will be given a duty to collaborate with each other.” So, should the VCSE mental health sector be calling for a statutory duty to be included in collaboration within the sector to deliver the best results?

We should take a strategic and pragmatic approach to increasing participation of VCSE beneficiaries to amplify their voice. Enabling the voluntary sector in this, not just being around the table but with an aim, could bring huge benefits.

Culture change – diversity

The government and the NHS are prioritising equality, diversity and inclusion across public services and this has become more apparent in the past year. The importance of having both lived experience in and diversity of board members has been shown to improve results in both the private and public sectors. A principal concern during the pandemic is that trustees could be less engaged as they have been unable to visit services and meet staff.

Most boards would acknowledge they are not as diverse as they should be – whether in terms of gender, race, age, or any other protected characteristic. This also means they are unlikely to reflect the communities they serve. Research shows that charity boards are more likely to be filled by men than women, with fewer younger people applying for roles. Only 8% of charity trustees are from black and minority-ethnic communities but these communities represent 14% of the population.

The lack of diversity on charity boards needs to be an absolute priority for the sector. Evidence shows that a wide range of experiences and backgrounds is key for boards. It helps to broaden thinking and respond to key challenges.

Systems – time for regulatory reform?

The VCSE mental health sector is regulated by a broad range of bodies. The two main national bodies, the Charity Commission and the Care Quality Commission (CQC), have taken different approaches during the pandemic.

Some of the VCSE organisations we engaged with questioned whether the Charity Commission has the breadth of power and understanding needed to sufficiently understand the complexities of the mental health and wellbeing sector - and provide the best regulatory support and oversight. Many of the organisations the Charity Commission regulates (overall, excellently) are larger fundraising organisations with less approach to the delivery of services.

In these circumstances the CQC often seems like it is in a strong position to provide regulatory guidance and insight, as many of the services delivered by the VCSE mental health sector are commissioned by or alongside NHS services – the bread and butter of the CQC.

The paper therefore asks whether now is the time to take a step back and look at regulation differently in the sector. A change may be needed to encourage services to run in the best and most appropriate ways for patients and their families.

Illuminations

• Collaboration between Voluntary, Charity and Social Enterprise (VCSE) mental health sector providers would ensure success and the best possible outcomes for service users

• Diversity must be at the centre of everything that is done. Boards must take action now to include and encourage a range of voices when developing and delivering services.

• Engaging in conversations about the future of regulating the sector would be beneficial both for VCSE organisations themselves and the people they are supporting.

If you have any questions or comments about this briefing, please call us on 07732 681120 or email advice@good-governance.org.uk.