More resilient communities

A recurring punctuation of my time working in the New Zealand mental health sector for over 30 years was the publication of national plans and strategies. The first of these was “Looking Forward” in 1994.

On reflection, "Looking Forward" was the start of a long journey in New Zealand mental health, evolving from basic strategy to a comprehensive, principles-driven, rights-based approach, focused on whole-of-system transformation, equity, and wellbeing. “Looking Forward” was followed by:

Moving Forward: The National Mental Health Plan for More and Better Services (1997)

Blueprint for Mental Health Services in New Zealand: How things need to be (1998)

Te Tāhuhu – Improving Mental Health 2005–2015: The Second New Zealand Mental Health and Addiction Plan (2005)

Blueprint II: How things need to be (2012)

Rising to the Challenge: The Mental Health and Addiction Service Development Plan 2012–2017 (2012)

Kia Manawanui Aotearoa: Long-term pathway to mental wellbeing (2021)

Pae Ora (Healthy Futures): is the foundation for the transformation of New Zealand’s health system. It aims to make quality health care accessible for everyone, no matter who or where they are. (2022)

 Kia Manawanui – long term pathway to mental wellbeing (published in 2021) takes this core to another level, with the aim to ensure people and whānau have their basic needs met, know how to strengthen their own mental wellbeing, and live in communities with diverse, well-integrated avenues for support when and where it is needed.

“Communities will be empowered to support mental wellbeing and lead community-based solutions and will be able to plan and deliver services and supports more effectively[1].”

Pae Ora (Healthy Futures)[2] further endorses this direction, stating at the head of its six strategies: 

 Since the start of this millenium, encouragement of greater cross-sector collaboration, engagement and partnerships in how we (as whole communities) respond to poor mental health and wellbeing have evolved into guidance. This guidance now needs to articulate and support expectation. The ability to effectively engage, partner and collaborate across sectors is now a critical skill-set – and frankly one we (as a sector) we have struggled to master.

He Ara Oranga (2018) could not have stated it more clearly: “New Zealand’s mental health and addiction problems cannot be fixed by government alone, nor by the health system.”

The Ministry of Health recently announced that they will begin public consultation around the development of a new Mental Health and Wellbeing Stratagy early in 2026. 

While we might feel some frustration at the pace of change and ambivalent delivery against some quite exceptional plans and strategies, the reality is that the differences between working in the mental health sector in 1993 and the sector in 2026 are like comparing chalk and cheese. In 2026 we have both a platform and opportunity to further realise, implement and embed what have been consistent themes and principles – and for some decades.

In fact I think we may potentially be at the nexus of what I believe to be a once in a generation opportunity. My fix of optimism comes from developments in the UK.

 In 2019, NHS England published the Community Mental Health Framework which described place-based, whole-population health approaches which had six core aims:

• Promote mental and physical health and prevent ill health.
• Deliver effective, evidence-based treatment through collaborative, person-centred care.
• Improve quality of life, enabling people to participate fully in their communities.
• Ensure continuity of care, avoiding “cliff edges” caused by referrals, thresholds, or unsupported discharge.
• Tackle health inequalities through joined-up working across statutory and non-statutory services.

Inclusive services for people with complex, co-existing needs and those facing marginalisation.

 To apply these principles of the Community Mental Health Framework in practice, the NHS are now piloting (until mid 2026) six Neighbourhood Mental Health Centres in:

1. Whitehaven (Cumbria) – Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust
2. Acomb (York) – York Mental Health Partnership[3]
3. Heeley (Sheffield) – Sheffield Health and Social Care NHS Foundation Trust
4. East of Birmingham – Birmingham and Solihull Mental Health NHS Foundation Trust
5. Tower Hamlets (London) – East London NHS Foundation Trust
6. Lewisham (London) – South London and Maudsley NHS Foundation Trust

Directly inspired by the pioneering 24/7 community-based system developed in Trieste, Italy, this initiative aims to move away from traditional, institutionalized care toward holistic, person-centred, and accessible support in the community.

 For so many years the successful approach developed in Trieste tended to be either dismissed, or was subjected to attempts to package it conveniently as a model; something to be transplanted, bought and sold. Instead, the approach is better understood as being built on principles of minimal coercion, and co-production, with services designed around individual life plans rather than clinical pathways, where services are designed around the needs of the whole community rather than segmented by specialism.

As Dr. Roberto Mezzina explains: “[It] means going beyond the medical approach…”  working alongside “the person, their stories, their lives, their networks” to develop “their life plans.”

The six NHS pilots “opened for business” in 2025. Each centre is led by a partnership between NHS providers, people with lived experience and not-for-profit / charities, and social enterprise organisations. The centres are typical owned / managed by a community organisation. Through this structure the Centres are also accountable to the communities they serve.

Key features of the six centres include:

• Open 24/7: Walk-in access at any time, no referral needed.
• One-stop shop: Mental health, housing, employment, and social support, income support, money management and other “clinics” offered by partnership with key community agencies… under one roof.
• Guest beds: 6 residential rooms serving a [primary care registered] population of approximately 50,000–60,000. Room occupancy is based on individual need rather than throughput. (Initial feedback indicates that all beds have very rarely been full at the same time).
• Person-centred: Designed to reduce fragmentation and improve continuity of care-based:
• Located in neighbourhoods to reduce stigma and improve access.
• Integrated Practice Teams: Including clinical, peer support workers and community-based support and social workers, employment / housing support specialists… 

 Professional roles are flexible, with less emphasis upon strict demarcations and more emphasis on therapeutic relationships; “doing what needs to be done”, rather than strict adherence to job titles. A corollary of this is that the service does not operate with different teams (eg. a crisis team, a home/community-based team...) “transactional processing” is kept to an absolute minimum:

An inquiry commissioned by the UK House of Commons to examine what care is available through Community Mental Health Services for “people living with severe and enduring mental illness” included a site visit to the 24/7 Neighbourhood Mental Health Centre run by the East London Foundation Trust (Barnsley Street).  

They conclude:[5]

• Delivering real change and achieving parity of esteem in mental health care requires dismantling the current fragmented system and reimagining service design and delivery.
• The 24/7 Neighbourhood Mental Health Centre pilots seem to be genuinely transformative. The experience from Trieste, and early evidence from Barnsley Street, show that radically different, individualised, community-based care gets results.
• We also heard that the model shows possible cost savings for the wider system. Realising large-scale reform will depend on sustained and ringfenced investment to enable stretched Integrated Care Boards to take the action needed.
• This must be matched by a profound cultural shift across the system from clinicians to commissioners to government.
• We believe there should be a 24/7 Neighbourhood Mental Health Centre in every community.

“Looking Forward" (1994) began our journey in Aotearoa New Zealand on a pathway to a more rights-based approach in responding to poor community mental health - focused on whole-of-system transformation, equity, and wellbeing.

In the last few years we have been tentatively exploring this kind of development now being introduced in the UK. We already have a sophisticated and increasingly networked and connected community-based NGO sector – we have been gingerly “dipping our toes in the water” with examples of similar service designs (eg. community-led acute alternatives).

In fact we have the building blocks already…. What is needed now is the courage, commitment and the will.

Notes and references

[1] https://www.health.govt.nz/publications/kia-manawanui-aotearoa-long-term-pathway-to-mental-wellbeing

[2] https://www.health.govt.nz/strategies-initiatives/health-strategies/pae-ora-strategies

[3] https://yorkcvs.org.uk/wp-content/uploads/2025/05/Presentation-4.pdf

[4] https://www.moneyandmentalhealth.org/field-trip-how-neighbourhood-mental-health-centres-can-help-break-the-link-between-financial-difficulty-and-mental-health-problems/

[5] https://publications.parliament.uk/pa/cm5901/cmselect/cmhealth/566/report.html