Partnership is the oxygen needed to give life to personalisation. Checking the strength and breadth of the partnerships an organisation sustains is a good indicator of how successful they are likely to be in implementing personalisation. There are some excellent examples of joint working between health and social care. Generally speaking, however, history demonstrates continuous and only partially successful government strategies and attempts to improve health and social care partnerships and make them work to achieve better outcomes for people.
(Glendinning, Hudson and Means, 2005). Personalisation challenges health and social care services to more energetically and reliably improve their partnership but also :

• to embrace citizens as equal partners, so that they have more control over decisions in public services, and for their own care and support

and

• to reach beyond health and social care to forge and support strong partnerships with other agencies, communities and local groups

The Health and Social Care Act (uk, 2001) paved the way for the integration of health and social care professionals into integrated mental health teams within one organisation. The aim of this was to streamline processes and to have a more holistic approach to mental health practice. A report drawing on nine research projects carried out between 2003 and 2007 concluded that, in spite of a period of integration, ‘On balance...
at the time of this investigation FACS implementation has revealed and reinforced a growing separation rather than an integration of mental health and social care ideas and practices'. (Newman J, Hughes M ,2007) The report also highlighted differences in culture, priorities and budgetary considerations as ongoing problems. Any real progress towards personalisation requires a concerted effort from both agencies to finally address these challenges. A shift in power and control through the active participation of citizens with mental health needs will be one of the
levers that is needed to break free from these organisational tensions and barriers.
Partnership working is particularly vital for people with complex needs who require a range of services from a range of professionals and agencies. As well as working across and beyond traditional agency and professional boundaries, successful personalisation also requires working across and beyond the traditional single categories that people have been funneled into. This requires ‘sophisticated partnership working to ensure that the experience of people using services is one of coherence and integration' (CSCI, 2009).
I am an equal partner in any health or social care assessment process, and it looks at my whole life, not just at problems and times when I am unwell.
Examples of things that help with this:

• A person-centred and whole life approach, taking into account, for example, people's natural supports and the importance of culture, faith, relationships, family, caring responsibilities, a decent place to live, finance and employment, social and leisure activities (see also Helpful person-centred approaches section)
• A recovery approach that treats people as an equal partner with the hope and expectation of a fulfilled life
• Integrated care pathway approaches
• Investment in support for self-assessment and self-care
• Care co-ordinators who are knowledgeable about the range of opportunities available to people

I have good information and real choices so that I can recover and live life the way I want to.
Examples of things that help with this:

• Promotion of, and support for, personal budgets for health and social care for people with mental health needs
• A focus on wider partnerships and collaborations
• Support for projects that bring together opportunities, activities and information (the Bromley by Bow Centre is an example of this, see Information and References below)
• Commissioning that is led by information from people's real experiences and preferences, and that impacts on the way services are provided (for more info see section on Creative Commissioning)
• Involvement of Experts by Experience as commissioners
• Active input using the skills, expertise and mutual support of citizens (sometimes known as co-production) to build trust, peer support and social activism within communities
• Support for people to become more active citizens and volunteers
• Empowerment of local care managers, clinicians and teams to work more creatively and to innovate
• Senior management support for this approach which gives staff the confidence to do things differently and do different things
• Good, easily accessible, information for staff and people with mental health needs about local life opportunities and options for support (see also Information section)
• Support for people to choose to run their own services and support each other

I can get the support I need to live where and how I want to.
‘Good-quality, affordable, safe housing is essential to our wellbeing. Poor housing or homelessness can contribute to mental ill health or can make an episode of mental distress more difficult to manage. This may also be compounded by the fact that poor housing and homelessness are often linked to other forms of social exclusion, such as poverty. The housing charity Shelter has found links between overcrowded family housing and depression, anxiety, sleep problems and strained relationships' MIND website information on housing and mental health

‘People who are homeless or living in temporary accommodation are more likely to suffer from poor physical, mental and emotional health than the general population, and ill health is often associated with poverty and homelessness... Drug and alcohol misuse and mental health problems are also prevalent amongst the homeless population, and many rough sleepers have multiple needs (e.g. a mental health problem plus one or more other issues, such as alcohol or drug misuse).' (Communities and Local Government, 2005).

The accumulation of rent arrears and lack of communication between housing, care and benefits staff or an unexpected hospital admission can be the cause of housing problems for people with mental health needs.
Ensuring that people's housing needs are taken into account and choices offered that suit where people want to live and the way they want to live their lives, is vital for recovery and staying well
Examples of things that help with this:

• Person-centred CPA and support planning that looks at people's whole lives and support networks
• Mental health housing strategies based on partnership working and informed by good consultation, information from support plans and the views of experts by experience
• Partnership work to implement strategies that lead to the expansion of housing, care and support options
• Partnership and joint systems to ensure that care and support is co-ordinate from admission to hospital onwards
• Accurate mapping of needs and available supplies of housing and support services for
• people with mental health needs carried out in each locality
• Regional or sub-regional support to address shortages in specialist provision
  Shared approaches to assessing needs and collecting and sharing information
  Partnership, co-ordination and joint pathways across health, housing and homelessness services
  Support for innovation
• Guidance to housing authorities on lettings and stability for people with mental health needs
  Advice for social housing services on rent arrears management
  Improved access for all to advice and information about housing and support options
  Training for, health, social care and housing professionals to improve understanding of mental health and housing issues
  Feeling secure that your housing arrangements will not be threatened by any periods of being unwell, or financial difficulty
  Housing that takes account of family life

I have the opportunity and support to develop my interests and learning and participate in cultural, creative, sports, leisure and community activity.
The Report of the Review of Arts and Health Working Group ( DH, 2007) concludes that ‘There is a large amount of evidence and good practice both from the UK and internationally that demonstrates the value of arts and health' and that ‘spending on arts and health is and should be seen as a legitimate, integral part of good health care and good staff management, and entirely appropriate for NHS activity and investment'.
An outcomes study, as part of work on mental health and arts commissioned by the Department for Culture, Media and Sport and the Department of Health (DH, 2007) has demonstrated that for people involved in arts activities:

• There were significant improvements in empowerment, mental health and social inclusion
• There was a significant decrease in the proportion of participants identified as frequent or regular service users
• Arts projects can benefit people with a range of mental health needs, including those with significant mental health difficulties

There is also evidence (Department of Health, 2004) that
‘Physical activity is effective in the treatment of clinical depression and can be as successful as psychotherapy or medication, particularly in the longer term' and ‘ It may also help people with generalized anxiety disorder, phobias, panic attacks and stress disorders and can have a positive effect on psychological well-being in people with schizophrenia'
Examples of things that help with this:

• Support from the Department of Health for arts and health by:

- making clear statements and including arts and health in policies
- creating an environment in which it is considered to be good practice to invest in arts and health
- promoting the substantial evidence base for arts and health
- forming partnerships with other Government Departments and other organisations to expand the contribution of arts and health

• Local authority and PCT support for local arts and health by:

- having a clear arts and health strategy
- commissioning projects and investing in arts and health organisations
- having a dedicated ‘arts co-coordinator' to raise awareness and funding and engage with artists and arts organisations
- providing good information about local arts activities and projects

• Partnerships between Primary Care Trusts, local authorities and sports and leisure organisations and providers to create innovative projects and opportunities for people to improve their health through sport and leisure

• Strategies and action through Local Area Agreements and Local Strategic Partnerships that focus on opportunities for all to improve mental health and stay healthy

I am supported and encouraged to prepare for employment, find work and stay employed.
I can gain the qualifications, skills and training I need to improve my employability and help me progress in my career.
People with mental health needs have one of the lowest employment rates in the uk even though consultations and research repeatedly report that the majority of people with mental health needs want to work (Secker, Grove and Seebohm, 2001). Where people are properly supported into work, and
to continue working, the impact on their recovery can be very significant. Professor Robert Drake, who helped to develop an individual placement and support approach in America, said in speech at the Sainsbury Centre:
‘In following people for 30 years and then following patients who are in dozens and dozens of research studies that are sent around, it's totally clear to me at this point that there's nothing... that we study that helps people to recover in the same way that supported employment does. That doesn't mean that we've had success with everybody... but it does mean that for a significant portion of people we've had tremendous success in the sense of helping them to get out of the mental patient role and recover meaningful lives.'
(Drake, 2008).
One key barrier to employability for people with mental health needs is poor access to further education and training due to stigma and discrimination, low expectations by others about what people can achieve and contribute and lack of support for achievement and success (Social Exclusion unit, 2004).
Examples of things that help with this:

• Individual placement and support schemes that focus on finding paid employment of an individual's choice that matches their skills and interests
• Responding to people who say they want to work and are ready for it, rather than subjecting them to lengthy ‘job readiness' assessment processes or eligibility criteria
• A partnership approach that brings together mental health clinical expertise and vocational and welfare benefits advice to support people to find work and stay employed
• Support that is not time limited and can continue once the person gets a job, and if necessary through their employment careerSupport for individuals to decide for themselves whether to disclose their mental health needs to employers
• Support for employers if this is required and in line with the person's wishes
• Programmes promoting positive attitudes and dispelling myths and misunderstandings among employers and their staff
• Local reviews of the current investment in mental health day services to ensure that there is sufficient investment in vocational services that support people into work and while they are working, social enterprise and services that can provide evidence of success
• Strategies and policies for inclusive learning, including building capacity in the further education system, encouraging and supporting people to access learning opportunities, ensuring equality of provision and raising the achievement levels of learners with mental health difficulties
• Support and resources for teachers and trainers to practice and promote inclusive learning.

I can influence strategic planning of services as part of consultation or as a paid adviser or commissioner (See section on Creative Commissioning).

SIGNPOSTS

arts and health
1.    A prospectus for arts and health, Department of Health with Arts Council England, 2007. This prospectus produced jointly by the Department of Health and Arts Council England celebrates and promotes the benefits of the arts in improving everyone's wellbeing, health and healthcare, and its role in supporting those who work in and with the National Health Service. The prospectus shows that the arts can, and do, make a major contribution to key health and wider community issues. This prospectus stems from the recommendations of the Review of Arts and Health Working Group, commissioned by the Department of Health. (DH, 2007) www.artscouncil.org.uk/publication_archive/a-prospectus-for-arts-and-health/
2.    Norfolk Arts and Health Strategy.www.norfolk.gov.uk/consumption/idcplg?IdcService=SS_GET_PAGE&nodeId=3981
3.    ARC (Arts for Recovery in the Community). An organization working with people who are experiencing emotional or psychological distress to give them opportunities to explore art, find hope of a new beginning and move on with confidence to achieve their life goals. www.artsforrecovery.com
4.    Start. An arts and mental health project in Manchester Mental Health NHS and Social Care Trust for people recovering from a period of serious and long term mental ill health. www.startmc.org.uk/index.php
5.    Mental health, social inclusion and arts: Developing the evidence base The Anglian Ruskin/uCLan Research Team, DH 2007. www.socialinclusion.org.uk/publications/MHSIArts.pdf
employment and adult learning
6.    Meaningful lives: Supporting young people with psychosis in education, training and employment. This statement was launched in London at an event organised by the World Health Organisation and the Department of Health to mark World Mental Health Day 2008. Its promotion aims to increase the focus on the area of functional recovery in early psychosis and bring it to be seen as being equally important as symptomatic recovery in the approach to treating early psychosis.
www.iris-initiative.org.uk/silo/files/meaningful-lives-poster.pdf
7.    Doing what works: Individual placement and support into employment: Briefing 37 Sainsbury Centre for Mental Health (2009). www.scmh.org.uk/pdfs/briefing37_doing_what_works.pdf
8.    Pathways to work provides a single gateway to financial, employment and health support for people claiming incapacity benefits and Employment and Support Allowance. www.dwp.gov.uk/policy/welfare-reform/pathways-to-work/
9.    About time: commissioning to transform day and vocational services Sainsbury Centre for Mental Health, 2008. www.scmh.org.uk
10. Vocational services for people with severe mental health problems: commissioning guidance Department of Health 2006. www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndguidance/dH_4131059
11. Improving services for people with mental health difficulties Learning and Skills Council, August 2006. http://readingroom.lsc.gov.uk/ lsc/2006/learningopportunities/promotion/nat-improvingservicesforpeoplewithmentalhealthdifficulties-ps-aug2006.pdf
12. Strategies for Creating Inclusive Programmes of Study (SCIPS) is a website that provides resources and strategies for teachers and trainers to promote inclusive teaching, learning and assessment. www.scips.worc.ac.uk
13. Lancashire Community Management Programme brings together healthcare professionals and Job Centre Plus. It is a 13 week self-help based project. Individuals work with a case manager to look at barriers to work and plan action to overcome them. www.lancscmp.nhs.uk
14. Employers for Carers is relaunching as a membership forum for employers, offering a range of support from information on good practice to training and consultancy. www.employersforcarers.org/Home
15. Managing mental health and employment: DWP Research Report 537, Annie Irvine SPRu, DWP 2008.
16. Findings of a research project exploring what helps people with mental health needs to manage in work and to retain employment. www.dwp.gov.uk/asd/asd5/rports2007-2008/rrep537.pdf
17. SCIE knowledge Review 21: Supporting People in accessing meaningful work: Recovery approaches in Community Based Adult Health Services, 2008. www.scie.org.uk/publications/knowledgereviews/kr21.asp

18. National Social Inclusion Programme Employment Project for people with mental health needs. www.socialinclusion.org.uk/work_areas/index.php?subid=12

19. PSA Delivery Agreement 16. A Public Service Agreement (PSA) to support adults who are at risk of social exclusion. www.cabinetoffice.gov.uk/media/cabinetoffice/social_exclusion_task_force/assets/chronic_exclusion/psa_da_16.pdf
Co-production and whole life approaches
20. Co-production: an emerging evidence base for adult social care transformation SCIE Research Briefing 31 (2009) SCIE, London. www.scie.org.uk/publications/briefings/briefing31/index.asp
21. Whole Life Workbook: Change the thinking, change the practice, change the system Eastern Development Centre (2009) www.wholelife.org.uk
22. Partners in Policymaking A leadership training course for disabled adults and parents of disabled children. Designed to give participants the knowledge and skills they need to influence decision making and policy making. www.partnersinpolicymaking.co.uk/partners-policy-making.php
23. National Social Inclusion Programe interactive database of bridge building projects to help people with mental health needs actively participate in their communities. Builds on the work done by the National Development Team (now NDTi) for the Making Inclusion Work Project. Includes a section on housing. www.socialinclusion.org.uk/good_practice/?subid=78
Housing and housing support
24. Department of Health website: Housing useful information and links. www.dh.gov.uk/en/Socialcare/deliveringadultsocialcare/Housing/ dH_083237
25. Choice based letting for people with mental health problems NSIP briefing, 2006. www.socialinclusion.org.uk/publications/NSIP_cbL_briefing.pdf
26. Improving the Effectiveness of Rent Arrears Management for People with Mental Health Problem NSIP Briefing 2006. www.socialinclusion.org.uk/publications/Rentarrearsbriefing.pdf
27. Sustainable communities; settled homes; changing lives Communities and Local Government, 2005 Sets out the Government's homelessness strategy. www.communities.gov.uk/publications/housing/sustainablecommunitiessettled2
28. Bringing it all back home: mental health and housing Housing, Care and Support Vol 113/No 2008 pp 30-35. This article calls for better co-operation and co-ordination between mental health and housing support services, and greater recognition of the important role of social housing in community mental health care.
29. Homelessness prevention: A guide to good practice, Communities and Local Government, 2006. www.communities.gov.uk/documents/housing/pdf/150973.pdf
30. Camden Extra Care Housing for people with mental health needs.
www.dhcarenetworks.org.uk/Prevention/MakingItHappen/PracticeExamples/AvoidingInstitutionalism/?parent=3940χ ld=4019
31. Department of Health Care Network. Information on housing and mental health. www.dhcarenetworks.org.uk/IndependentLivingChoices/Housing/
32. Rethink factsheet on housing options for people with mental health needs. www.mentalhealthshop.org/products/rethink_publications/ housing_options_for.html
33. Mental health and the experience of housing problems involving rights Pleasance P, Balmer N, university College London, 2007. http://extra.shu.ac.uk/ppp-online/issue_1_300108/documents/mental_health_ housing_problems_rights.pdf
34. Getting a move on: addressing the housing and support needs of people with mental health needs: Briefing Paper 25 Sainsbury Centre for Mental Health, 2004. www.scmh.org.uk/pdfs/briefing+25.pdf
35. The Department of Health Housing Learning and Improvement Network Promotes new ideas and supports change. www.dhcarenetworks.org.uk/IndependentLivingchoices/Housing
36. The Housing and Support Partnership (H&SP) is a housing and social care consultancy specialising in consultancy, training, development and research in housing where there is a connection with social care and health. www.housingandsupport.co.uk/about.html
37. MIND website page on housing and mental health. www.mind.org.uk/Information/factsheets/crisis+services/Housing+and+mental+health.htm#_ftnref2
38. National Social Inclusion Programme Housing Project for people with mental health needs. www.socialinclusion.org.uk/work_areas/index. php?subid=14. PSA Delivery Agreement 16: Increase the proportion of socially excluded adults in settled accommodation and employment, education or training Cabinet Office 2007. www.cabinetoffice.gov.uk/media/cabinetoffice/social_exclusion_task_force/assets/chronic_ exclusion/psa_da_16.pdf

39. "Care Programme Approach (CPA) care coordinators should have a strong focus on ensuring that employment and housing needs are identified, considered and effectively met as part of individual care plans." PSA Delivery Agreement 16:Increase the proportion of socially excluded adults in settled accommodation and employment, education or training Cabinet Office, 2007. www.cabinetoffice.gov.uk/media/ cabinetoffice/social_exclusion_task_force/asset/chronic_exclusion/ psa_da_16.pdf
Sport , leisure and other universal services
40. Heywood,Middleton and Rochdale PCT have joined forces with Sport England and the Big Lottery Fund to regenerate sports facilities in the community as part of a prevention programme. It has also employed dedicated community workers to develop services the local population want to encourage healthy lifestyles and improve public health. www.hmrpct.nhs.uk
41. At least five a week: evidence on the impact of physical activity and its relationship to health Department of Health. www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndguidance/dH_4080994
42. Open to all: Social inclusion and mental health awareness training for museums and galleries. www.socialinclusion.org.uk/work_areas/index.php?subid=93
Supporting the voluntary and community sector and wider partnerships
43. The Compact is an agreement between Government and the voluntary and community sector in England. It recognises shared values, principles and commitments and sets out guidelines for how both parties should work together. www.thecompact.org.uk. This website explores the compact and the five codes of Practice which underpin it.
44. Volunteering for all, a programme to tackle barriers in volunteering, so that people can have an equal opportunity to take part in voluntary activity. www.cabinetoffice.gov.uk/third_sector/volunteering/volunteering_for_all.aspx
45. Communities in control: Real people, real power Communities and Local Government, 2008. www.communities.gov.uk/publications/communities/communitiesincontrol
46. Bromley by Bow Centre. A partnership between private, public and voluntary sectors with a range of arts, garden and community projects in a well designed building, reflecting the ethnicity of the local community. There is also welfare benefits and employment advice available on the site. www.bbbc.org.uk
47. Creating strong, safe and prosperous communities : Statutory Guidance Communities and Local Government, 2008. www.communities.gov.uk
48. Local Strategic Partnerships are multi-agency partnerships that bring together the public, private, community and voluntary sectors. Local Area Agreements focus on a set of outcomes that are agreed by all as key priorities, such as PSA 16 to improve employment and housing outcomes for people in contact with secondary mental health services. People decide locally how to achieve outcomes by working together. www.neighbourhood.gov.uk/page.asp?id=531
49. NICE public health guidance 9: Community engagement to improve health (NICE, 2008). www.nice.org.uk/nicemedia/pdf/ PH009guidance.pdf
50. Putting Partnerships into Practice Learning from the Southwark experience of the partnership between Making Space and Southwark team for early intervention (STEP). www.mentalhealth.org.uk/our-work/all-adults/putting-partnerships-into-practice/?locale=en
51. National Development Team website on community inclusion. www.ndti.org.uk/what-we-do/work-themes/community-inclusion.aspx
Partnership working (general)
52. Supporting people for better health: A guide to partnership Department for Communities and Local Government , 2006. A guide that draws attention to key issues that need to be considered when setting up services designed to cross organisational boundaries - gives practice examples. www.dhcarenetworks.org.uk/_library/Supporting_ people_for_better_health.pdf
53. Making ends meet: Partnership Audit Commission website giving information, examples and resources about partnership working. www.joint-reviews.gov.uk/money/partnerships/3-22.html#3-221
54. Making partnerships work: Examples of good practice, Department of Health, 2007. www.dh.gov.uk/en/Publicationsandstatistics/ Publications/PublicationsPolicyAndguidance/dH_072998
55. Making partnerships work for patients, carers and service users: A strategic agreement between the Department of Health, the NHS the voluntary and community sector. www.dh.gov.uk/en/Publicationsandstatistics/Publications/ PublicationsPolicyAndguidance/dH_4089515

The National Mental Health Development Unit (NMHDU) is the agency charged with supporting the implementation of mental health policy in England by the Department of Health in collaboration with the NHS, Local Authorities and other major stakeholders.