Mental Health and Multiple Disadvantage: Reflections on the May 2019 Learning Hubs

June 24, 2019

As part of its support offer to MEAM approach and Fulfilling Lives areas, the MEAM Local Networks Team coordinates regional and national opportunities for areas to come together and share learning and good practice.

The most recent series of MEAM learning hubs have just concluded, they were held in May 2019 in Manchester, London and Exeter and focused on multiple disadvantage, mental health and the Mental Capacity Act.

The Learning Hubs: The story so far


In June 2018, MEAM held its first series of learning hubs. The majority of MEAM areas were new to the approach and were in the process of setting up their frontline interventions. In response to this, the hubs focused on ‘What Makes a Good Coordinator?’ The day gave participants space to explore these unique, demanding roles and what it means to bridge the gap between the operational and strategic landscape of multiple disadvantage in local areas.

While most MEAM approach areas were new to coordination, the Fulfilling Lives areas were halfway through an 8-year programme with coordination at its core. Established coordinators were able to reflect on their role, think about how it has changed and ensure their day-to-day practice continues to align with the ethos of the project, as well as giving newer Fulfilling Lives coordinators an opportunity to connect with the rest of the network and recognise their part in the wider programme.


The next set of learning hubs took place in October 2018 and considered coproduction. As part of the MEAM approach, we feel it is essential that MEAM areas think about the meaningful involvement of people with lived experience as early as possible in their journey. As so many of the projects were in the development stage, it was the perfect time to bring people together to share good practice, learn from good practice and spend a day creatively engaging with the concept of coproduction.

Fulfilling Lives areas have been leading the way in coproduction for the last few years and in sharing their learning and expertise with MEAM areas, the day allowed them to reflect on how far they have come and create some space to think about how they would like to see their work progress.

Above all, both sets of learning hubs allowed people to meet, network, share experiences and problem solve. Participants told us that the opportunity to problem solve was an essential part of the day and we were keen to build more opportunities for this into the 2019 programme.

Mental Health and Multiple Disadvantage

By 2019, most areas were delivering interventions and the local coordinators were established in their roles coordinating and challenging their local complex system. Working closely with the coordinators, the MEAM coalition partnerships managers began to identify patterns in the kind of challenges coordinators were facing across the network.

At both an operational and strategic level, access to mental health services for people experiencing multiple disadvantage was a key issue, an area that the Fulfilling Lives areas also identify as challenging. We decided to address the operational need in the first set of learning hubs, and explored what practical tools coordinators need to advocate for their clients and challenge “mental health systems.”

We employed the help of specialist organisation EASL (a mental health team that support agencies working with homeless people) and asked them to design a bespoke half-day session to help the coordinators explore the legislation and legal concepts related to mental capacity and what best interest is in the context of multiple disadvantage. Coordinators spent the morning getting to grips with the legal terminology and exploring how this applies to their day-to-day practice.

Coordinators reflected on the kind of interactions they were having with mental health services, breaking down some of the barriers, agreeing that the goal should always be to open up a conversation, and that giving control back to the client should always be the priority. Finding the space for this kind of conversation is not easy in frontline roles: These often involve crisis intervention and little time for reflection and introspection, and the hubs provide this space. When asked what the most useful part of the day was, delegates fed back:

“Learning more about the legislation and how it can be applied to those MEAM clients we work with. Understanding capacity and its subjectivity”

“Using capacity in conversations with services to have better conversations. Good to also point out that the Mental Capacity Act and the Community Care Act are not everything and can’t always fix everything”

There were also several mental health professionals from local areas at the events who fed back the importance of “hearing third sector perspectives”

After lunch, and a lot of informal networking, delegates took part in a case clinic in small groups. The case clinic is a simple format that structures conversations and facilitates problem solving, ensuring a balanced group dynamic and building in time to pause and reflect.

Each area bought forward current examples that demonstrated their clients experience with mental health services. The scope and variety of the case studies demonstrated just how complex the difficulties are in accessing mental health services for people experiencing multiple disadvantage. Many of the case studies centred on co-occurring substance misuse and mental health issues or dual diagnosis, others looked at clients who had been misdiagnosed or never diagnosed, clients who had additional needs that had not been met, or clients who services had ignored or dismissed once crisis symptoms had subsided. Delegates explained the value of working together to look at existing case work:

“Unpicking together. Learning about services and what works in other boroughs. Hearing other people’s ideas.”

“The Case clinic exercise gave me so much food for thought. A good chance for discussion around skills exchange.”

“After the case clinic I have lots of ideas to progress a case that I have been completely stuck with.”

At the end of the clinic the small groups fed back to the room and were able to get additional feedback from Barney from EASL, as well as the mental health practitioners in the room.

What next?

At the end of the sessions we asked delegates to tell us how MEAM could support conversations around this issue to continue, the feedback requested smaller learning hubs with local partnerships, email updates on good practice and successful challenges of the Mental Capacity Act, as well as facilitation of the case clinic model in local areas. The Local Networks Team already facilitate several regional reflective practice sessions and can support these groups to focus future sessions on mental health and multiple disadvantage, and ensure that the learning hub feedback is taken to MEAM areas leads in their upcoming support action plan meetings.

Finally we asked for feedback on how delegates would take what they had learned at the hub directly into their practice. It was inspiring to see the robust practical ways the coordinators were already planning to apply what they had learned:

“I will feel more confident in dealing with other professionals around mental health and Mental Capacity Act.”

“Contact colleagues in Norfolk around Mental Health work, raise at a senior level the correlation between unmet care and support needs and intentionality.”

“Bring some of service group issues to Westminster MEAM discussion to consider if these are blind spots for us so for example, services for older adults.”