‘Systems change’ seems to be growing in popularity, some might even say it’s a new trend. The term may seem nebulous, exciting or utterly overwhelming, depending on who you speak to. But when I first encountered it, it was in many ways unremarkable and straightforward.
Amber lived on the top floor of a tower block, right by the stairwell where people gathered to use drugs; where invariably, she kicked hypodermic needles aside as she walked her daughter to school. This made her feel anxious, and that she was failing as mother. I was speaking to Amber because she had been referred for anxiety management. Maybe it would help her, maybe it wouldn’t. But it almost certainly wasn’t going to put an end to the needles on the floor. She told me that the care taker refused to touch the needles, social services had stopped doing visits to her floor, and that wherever she went to talk about the issue she was directed elsewhere.
But Amber had a good solution. She suggested placing a sharps box at the top of her stairs to catch the needles. She recommended sending drug workers up the stairs to work with the people using, and suggested early evening would be a good time. Said she was willing to be part of a group to make this happen. This was my first contact with systems change. It didn’t feel very shiny, and in many ways in didn’t feel very new. It felt like common sense.
I’m a clinical psychologist, so I’m there to support people’s mental health. But the trouble is that mental health doesn’t exist in a vacuum. And in the case of Amber, we needed to find a better way of working together across services. I have since met hundreds of Ambers, and hundreds more professionals who join me in case meetings to discuss solutions. But often our options are pretty specific and the individuals we’re working with don’t quite fit. So we spend most of our time thinking about how we can make them fit; how we can get people into our services and break down the remaining problems into other people’s services. We’re doing the best we can but there’s something about the system that seems to block us at every turn. It all feels so convoluted and complex. And that’s why we need systems change.
So while the term may sound flashy, it really is just a way of thinking about how we can develop solutions with people and for people. And it isn’t a new concept either—but maybe how we approach it could be done a little differently: by placing service users really and truly at its heart. It’s by doing this that we’ll provide help that works, empowers, and really delivers.