The following is an out-take from our pamphlet ‘Better mental health in a bigger society? (published by Mental Health providers Forum in December 2011 and available for download for free here). It recognises and celebrates the role of fixers (or connectors) as the people who get things to happen in mental health.
Traditionally, the NHS has sat as a structure by itself. It has been a closed system only making contact with the community either through the provision of services or when it has invited involvement.
It has seemed to many that you were either working within the NHS or outside of it, either a patient or a professional.
Increasingly, as this paper discusses, the lines between these categories are becoming blurred. People may be both patients and professionals, people may be working in the community but employed by the NHS or local authorities. Projects may be collaborations between different services. Individuals may spend some of their time working in peer services, some of their time working in more traditional roles. Solutions to problems may begin from a medical analysis of prevention, recovery or wellbeing but end up being enacted by a local church, a branch of an employment advisor, a small community group or a social enterprise.
The landscape is not state services, surrounded by clusters of everything else. The landscape is already a complex network of different forms of organisations, services and groups all working in some way toward the better overall mental wellbeing of the communities.
What becomes clear is that for this mixture of different organisations to work together in a way that generates the greatest possible outcomes for all parties in a community, there must be something that stitches them together.
From the outside, the NHS can seem opaque and impossible to engage with. This is not just a complaint of people who use NHS services, though this is often levelled, but also a complaint of those wishing to engage with the NHS to make things happen. This may also be a complaint of those that are currently working within the NHS.
It can be difficult for anyone to find ways to get to the right person inside a complex organisation whilst on the outside of that complex organisation. It can be difficult for people within a complex organisation to get to the right person.
For many of the suggestions in this paper to take place, it is necessary to recognise that often it is people who make things happen as much as structures and procedures.
At present, too many good ideas are tied into inward looking projects and services, with huge amounts of knowledge, experience and expertise bundled up in people occupying particular roles or positions that do not allow them to make those ideas happen or to assist others in doing so.
In many areas, the difference between an effective and fertile relationship between these different groups, organisations and services and a dysfunctional or unproductive one is whether there are people in any of those organisations who make it their business to meet, discuss, support and network with others in the same area, regardless of what service they come from.
These are the people we refer to as fixers. They are the people that have both skills and experience themselves which they use to make change happen, but also the skill of seeing how other people might come together in new ways to make things happen. Regardless of where they are based, fixers move between different forms of organisation and different groups of people finding ways of taking positive change forward.
Because fixers feel confident in working with all forms of organisation, they provide valuable insight for all as to how they might work better together. They can smooth waters between organisations that have been traditionally antagonistic, they can transfer knowledge from one silo to another, they can provide the overview necessary of the overall picture while providing specific information to all parties in that picture.
Fixers can be catalysts around which new projects begin, or the glue that helps bond new and old together.
The defining characteristic of a fixer is that the focus upon making sure that things happen for the overall good rather than focusing on the interests of one particular service or group.
EXAMPLE: In some areas, such as the North East, a number of individuals have arisen who fulfil the role of fixers
In the North East a range of organisations and individuals have responded to the need for joined-up action between and understanding of roles of state and voluntary sector agencies.
At a regional level, Mental Health North East (MHNE) is a small umbrella organisation that was formed in 2005 to use the combined voice of voluntary sector organisations providing mental health services to represent the sector to government agencies.
MHNE works with locally based networks and forums to ensure that voluntary sector providers, including smaller user led organisations are not ignored by commissioners and policy makers.
At a local level, Newcastle-based Launchpad is an organisation that offers the chance for people who use services to have their voice by the people who run those services. An essential part of fulfilling that role is for Launchpad’s team to understand the landscape in which services are delivered.
That means attending all relevant meetings and committees with the local authority, local NHS agencies – knowing who is responsible for deciding what and on what basis – and creating opportunities for service users to make their voices heard to the right people in a way that is most likely to effect positive change.
As Launchpad say:
“People who use services are ‘experts by experience’, and our knowledge and insight are invaluable for improving the mental health system. We try to put across service user views to bodies as diverse as the Strategic Health Authority, the Primary Care Trust, the Northumberland, Tyne and Wear NHS Trust (NTW), the city council, social services, the police, voluntary organisations, charities, and MPs, to name just a few. There are as many service user points of view as there are service users, so we convey as wide a range of opinions and outlooks as possible.”
The work of Delivering Race Equality in Mental Health’s Community Development Workers is a good case study of the attempt to create fixers to improve outcomes in a particular area.
However a fixer arrives at their role, one of the primary things that they will make clear is that relationships and strategies that exist on paper are no substitute for the real-life problem solving that happens on the ground.
Fixers know that everything that should fit together does not always do so, because they make it their business to see how things a playing out in the real world. Fixers are also good at understanding and explaining how complex systems work to those outside of them.
Fixers also know that relationships and projects are made by people, not solely by policy.
Without fixers, the radical potential for new ways of working and new outcomes for people with mental health difficulties run the risk of becoming empty, instrumental exercises where things are put into action but people are left out.
- The NHS and local authorities must accept that increasingly the key to meeting desired outcomes in mental health will be based on networks of individuals and organisations, not hierarchies. NHS and local authority services will be some amongst many and will need to ‘open up’ to outsider influence and contact.
- Fixers link together organisations, ideas, individuals and events. They play an essential role in making the higgledy-piggledy real world of mental health services work. The NHS and local authorities need to recognise where fixers are evolving and support them.
- The NHS and local authorities should engage with the Community Organisers currently being trained as part of the government’s Big Society programme.
- The NHS and local authorities should review the lessons learned from the Delivering Race Equality in Mental Health Community Development Worker programme, as it represents a possible model for artificially creating fixers.
Our project ‘The New Mental Health’ is currently looking for funding from people like you. You can pledge as little as you like to help us to bring together a book on how organisations are changing the lives of people with mental health difficulties in new ways.