Joint Experinces and Local Mental Health Systems

Joint Experinces and Local Mental Health Systems:


A Collaborative Project involving


Florence & Prato (Italy) and Lanarkshire (Scotland)






With the development of community based mental health services in Scotland over the last 20 years, considerable work has taken place to develop good partnership working between the statutory agencies; NHS and the local authorities (primarily social work). This joint working has been accompanied by changes in structure and processes at all levels, with the aim of improving the care available for people with mental health problems. To date, less importance has been given to joint working with the intermediary organisations, primarily NGOs, that also work with service users to provide support and facilitate social inclusion.


The term ‘intermediate area’ refers to the realm of mental health and well-being activities outside the statutory mental health services. It is the interface between the service and the local community, where most of the joint experiences or interactions between different service providers and community agencies are located. For many service users these intermediaries act as a bridge to mainstream activities. For others, the organisations provide ongoing support.


Traditionally this voluntary or not-for-profit sector has been seen as ‘user-friendly’, but undervalued. The relatively large number of smaller NGOs, sometimes in competition with each other, plus the role of statutory organisations in granting them short-term funding, means that they often have limited involvement and influence in decision-making at an individual or corporate level.


The development of joint working between the statutory agencies is no longer enough: the whole system requires re-engineering and re-adaptation from the perspective of service users and carers. It is therefore important to identify the elements of the intermediate area in order that the mental health system as a whole will become more effective and more responsive to the needs of the local service users, their families and the community at large. The ‘Joint Futures’ agenda that aligned Health and Social Work in Scotland needs to be complemented by developing a ‘Joint Experiences’ model recognising the reality of multiple working relationships between independent organisations.


An action research approach can facilitate this by sharing and reflecting on experiences in different settings. This model has been established in Italy and it is now proposed that it be extended and adapted to joint working in Scotland.




The Joint Experiences and Local Mental Health Systems Project was established in 2001 in Florence and Prato, in the Tuscany region in Italy. This arose from previous work that identified the need to integrate service user views and preferences in planning and delivering mental health services in Italy and elsewhere. The proactive position of mental health service users over the last three decades and the move towards community based mental health services made collaboration between services and sharing of experiences timely and useful. The initial project, established in Tuscan region by AiSME (a self help mental health NGO based in Florence) and the mental health services and the municipalities of Prato and Florence was supported by Mental Health Europe. The success of this project provided the basis for a strong collaborative partnership between the statutory agencies and community based mental health organisations locally. As a result, the capacity and capability of the local mental health system were enhanced considerably.



The subsequent series of Local Mental Health Systems seminars held in Italy and in other countries as part of this project, in collaboration with Mental Health Europe (MHE) and the European Network of Users and Survivors of Psychiatry (ENUSP), identified the advantages of the Joint Experiences model in ensuring active collaboration between service providers and local NGOs, particularly user and relatives/carer associations. The model has been used to ensure collaboration between services and different local organisations, particularly user and relative associations in different localities/countries, as well as within local areas. This has allowed linkages to flourish between service providers/professionals, local governments and the NGO sector, particularly user and relative associations. The processes and methodology of such collaborations are now well understood[1][1].



In mapping the local mental health system, it is important to identify the elements of the intermediate area in each service system. By developing and enhancing the capacity and capabilities within this area it is anticipated that the mental health system as a whole will become more effective and more responsive to the needs of the local service users, their families and the community at large.



Building capacity in this area and enhancing capability are dependent on contributions both from community agencies and from established services (statutory providers). This is usually done through joint training and information sharing, along with detailed service and joint experiences mapping. In each area, this process will bring together key professional groups, managers from within the mental health system and other stakeholders working in the intermediate area, such as NGOs, service user groups and other community agencies.



The current proposal arises from the work already done in Italy and draws on the experience of people involved in the project so far. It sets out how the Joint Experiences model can be used to enhance service capabilities in the intermediate area in four different localities in Italy and Scotland. One aim of the project is to identify the elements of the local system, especially the joint experiences that are located within the intermediate area. Particular attention will be given to studying and monitoring the interactions. If they are well developed the whole local mental health system is likely to improve.



Collaborations or joint projects facilitate the delineation and definition of local innovations and help consolidate good practices through the joint working by different sets of local “actors” or stakeholders such as users, carers, professionals, managers, and policy makers. At a theoretical level the concepts and themes underpinning joint experiences, and actions within intermediate areas as well as in local mental health systems, are further clarified and reformulated. At a practical level new practices will be explored and developed as users, relatives, voluntary agencies, local communities, service providers and others come together to share practice and identify needs within the community.






The current proposal arises from the work already done in Italy and draws on the experience in both countries of:


  • developing and sustaining local mental health systems


  • collaborative working within and between local mental health systems


  • international projects with mixed staff and service user groups



The Joint Experiences approach will be used to enhance service capabilities in the intermediate area. Particular attention is paid to participation of all partners, including service users, in studying the interactions between the intermediaries and the other parts of the system, This will lead to a working model of the interface between service users and carers, the local statutory providers and the many voluntary services in order to establish the best integration of working practices through agreements, protocols etc. It will aid both strategic and operational planning to ensure the best opportunities for service users in their path of recovery.



The West of Scotland (Glasgow and Lanarkshire) has been invited to join Italy in a three-year project, in comparing local experiences. To optimise the learning and development opportunities two sites will be involved in each country: in Tuscany, Florence and Prato and in Scotland, Glasgow and Lanarkshire. In each area a locality (or sector) will be chosen that fits existing service delivery boundaries. The fact that in some places the voluntary sector is not coterminous with these will be one of the challenges.



The main tasks will be:


  • mapping the local mental health systems, in particular activities in the intermediate area


  • introducing a model for facilitating Joint Experiences within each local system


  • identifying “good practice” models


  • exchanging information about innovative practice and learning from each other.



Objectives of the Joint Experiences Project



The following specific objectives are identified. It is expected that as a result of the project there will be a significant increase in the capacity and capability within the intermediate area in the sites chosen for the project.



Learning: Practitioners and managers from different agencies, plus service users and carers will develop skills and knowledge in:


  • team working and partnership


  • self-reflection


  • comparative analysis


  • option appraisal


  • evaluation


  • social inclusion



Service development: The exchange process with its reflective component gives a unique opportunity to:


  • undertake local service mapping


  • clarify roles and responsibilities between agencies


  • share good practice


  • develop local networks, formally and informally


  • consider options for service redesign locally



Outcomes of the Joint Experiences Project



The following outcomes are anticipated in each of the four local areas included within the project


  • increase in the capability and capacity of local mental health systems to implement and sustain joint experiences in the intermediate area


  • increased user participation and self-determination within local mental health systems


  • development of linkages between different Joint Experiences within each local community


  • development of measurable interactions in the intermediate area


  • training of mental health workers in ensuring more holistic local mental health systems






The programme of activities will include:


  • service mapping both within the formal mental health system and in the intermediate areas in the four localities using similar methodology


  • identifying strengths and weaknesses relevant to Joint Experiences in the intermediate areas through sharing of information, joint discussion, exchange visits, symposia and focus groups involving specific client groups/stakeholders


  • joint conferences to monitor the progress of joint experiences and training to ensure joint working in intermediate areas


  • ongoing evaluation with emphasis on measuring service enhancement and user outcomes






Year 1:


International project planning


Local project planning in the four sites. Meetings in Florence, Prato, Lanarkshire, Glasgow


Comparative data collection and elaboration starts in Italy


Joint training with Scottish counterparts to establish the model in Scotland and commence data collection


Exchange visit: Prato Florence Local Mental Health Systems Joint Experiences conference



Year 2:


Implementation of the Joint Experiences model in Lanarkshire and Glasgow


Exchange visit: West of Scotland Local Mental Health Systems Joint Experiences conference



Year 3: Year1 and Year 2 activities continue


Final evaluation


Final Mental Health Systems Conference



Management and Supervision



This will need further clarification between the partners, but it is proposed that the project will be managed through a system of steering groups, co-ordinators and consultants, but with local accountability and line management. An international steering group will be formed with two national steering groups feeding into it. Both countries will have a Co-ordinator responsible for ensuring consistency and progress, plus a Consultant engaged in action research to provide guidance and support. Within each locality a person will be identified as the lead person. Service users will be at the centre of any planning or organisational structures.

[1][1] Agostini, S; Miccinesi, D; Pini, P; Sashidharan, S “Diverse cultural experiences in mental health systems in UK and Italy” MHE&SIND Conference, Aalborg, Denmark, 7-9 August 2008