Patient involvement is key to improving mental health care

Case study summary

Against challenges including a large county and a mixed population, the steps2change service in Lincolnshire has developed meaningful opportunities for service users to help improve how talking therapies are delivered. Patient involvement through locally based meetings is central to the values of steps2change and its benefits include an opportunity for mental health service users to suggest ideas for new ways of working, support staff recruitment and raise issues. Talking therapies are psychological treatments for mental and emotional problems like stress, anxiety and depression, and involve working with a trained therapist. It’s important to get feedback from patients to ensure that they are developed and delivered in the most effective way.


I’ve received excellent service twice, and wanted to play a role in helping the Trust to keep improving interaction with patients where and if needed

John, Chair of voice2change, Boston

The challenge

Part of Lincolnshire Partnership NHS Foundation Trust, steps2change is the NHS Improving Access to Psychological Therapies (IAPT) service for a county of 700,000 people. The service operates from nine bases and provides talking therapies for a variety of urban, rural and populations which may vary in size seasonally Gaining service user representation can be challenging: people accessing the service may not want to remain in contact after their treatment has completed. The extensive geographical nature of Lincolnshire, mixed population and limited public transport infrastructure add to the difficulty of engaging with service users over service improvement, provision and development.

How it worked

Steve Skinner, Clinical Lead for IAPT at step2change, said patient involvement is central to the values of the service which champions this by offering real and meaningful opportunities for improving how talking therapies are delivered in Lincolnshire.

“Despite a range of challenges, many current and former patients want to give back and be involved in shaping the future of the service,” he said. “Voice2change is a patient involvement group launched in 2015 by step2change across the county. Although it is not a support or self-help group, those attending find the environment supportive and helpful.”

Voice2change groups have been established in different locations by inviting all patients completing treatment to a local meeting. These take place on a monthly or bi-monthly basis. Voice2change posters in waiting areas and information on the service’s website ensure people with recent experience of the service get encouraged to join the groups.

Groups are initially chaired by a member of staff supported by the Trust’s Head of Public and Patient Engagement. The vision is for all voice2change groups to be chaired by former service users, depending on the confidence level of individuals and maturity of the group membership. Minutes of meetings are shared with the IAPT service leadership which provides a response to all points raised. This two-way communication ensures issues are transparent and acted upon quickly.

Chris Morgan, a Psychological Wellbeing Practitioner and chair of the first voice2change group, said: “The service user’s voice is vital if we aspire to be the best we can possibly be.”

In the last two years voice2change members have made valuable input by

  • suggesting ideas for new ways of working, such as online self-referral, challenging stigma by using well-attended community venues for courses instead of treatment centres, developing a library of online relapse prevention materials,
  • supporting the recruitment of new steps2change staff through shortlisting, setting questions and interviewing as part of a panel,
  • supporting the modernisation of the service, for example through digital therapy,
  • reviewing and critiquing new ideas, including patient access to computerised cognitive behaviour therapy.

Service users are encouraged to follow voice2change on Twitter to get updates and information on common mental health conditions. This has led to a number of new self-referrals and suggestions on how the offer can be improved. This channel also provides an alternative route for feedback.

Impact on service delivery

Steve Skinner adds: “The evolution of voice2change forums has had a positive influence on the development of the service and has been welcomed by all involved. A really good example of how valuable the forums can be is demonstrated by the improvement of the steps2change IAPT website. Voice2change members with web design and marketing experience offered invaluable advice in making the website more user-friendly. This led to the development of a self-referral section and new patient information and service letters.

“Based on the success of engaging with service users in areas of change and service transformation, it is planned to involve voice2change in the development of direct access to some of the digital therapy options. Service users in the voice2change forums have extremely valuable skills and experience which they are willing to share to benefit others who will access support. They are a great asset for our service.”

A former service user and now a voice2change member said:

I feel effective. My confidence has improved. I am a critical friend who can have a say on how to deliver the service and I draw from my own experience of accessing steps2change to make it better for others.