For decades, the way mental health services are funded and delivered has been shaped by a familiar model; usually, commissioners design the service and providers deliver it. It’s a transactional relationship with specifications written, contracts signed, and outcomes measured against targets.
However, as mental health needs grow and systems become more complex, this model is starting to creak. Why? Real change in mental health care can’t be achieved through contracts alone. It happens through collaboration, trust, and crucially power-sharing. If we’re serious about transforming mental health services, we need to move beyond commissioning as a transaction and embrace commissioning as co-production.
Why the Traditional Model Falls Short
Commissioning has always been about accountability and ensuring public money delivers public benefit. That’s important. However, when commissioning takes on a rigid, top-down, and short-term target-driven approach, it loses something crucial. It loses the voice of those who use and deliver services.
Providers often feel constrained by specifications that don’t reflect the reality on the ground. People with lived experience, the very people services are designed for, are too often consulted late in the process, if at all. Innovation struggles to breathe in environments where the brief is already written before the conversation begins. The result is services that tick all the right boxes but don’t always meet needs.
Collaboration Changes Everything
At Bridge, we believe the future of mental health care lies in partnership, not procurement. That means commissioners, providers, clinicians, and people with lived experience working as equals to design and deliver services that genuinely work.
So, what does that look like in practice?
Early Engagement: Involve providers and lived experience voices from the outset, not after the spec is signed off.
Shared Goals: Define success together, not just in terms of cost savings, but in terms of recovery, wellbeing, and human dignity.
Flexibility: Build contracts that allow for adaptation as needs change and learning emerges.
Mutual Accountability: Commissioners and providers should both be answerable for outcomes—not just activity.
When those elements are in place, power becomes a shared resource, not a hierarchical structure.
Why Lived Experience Must Be at the Table
We talk about “patient-centred care,” but how often do we truly centre the voices of those who’ve lived it? People with lived experience don’t just bring their stories, they bring their expertise. They know where the gaps are, where services fail, and what real recovery looks like.
Bridge Support has long championed peer support and recovery education because we’ve seen the difference it makes when lived experience shapes delivery. The same principle should shape commissioning. If people who’ve navigated the system aren’t helping design it, then we’re building on assumptions, not insights.
Moving from Risk to Trust
One of the biggest barriers to collaboration is fear. Fear of risk, fear of failure, fear of accountability. Commissioners hold the purse strings, so they often hold the power. But power without trust stifles creativity.
To change this, we need to reframe risk. Innovation carries risk, but so does the status quo. If we keep commissioning in silos, people will continue to fall through the cracks. If we collaborate, we may not get everything right the first time but we will learn, adapt, and improve.
A Call for Courage
True collaboration requires courage—from commissioners, providers, and policymakers. It means letting go of control and embracing co-production as more than a buzzword. It means asking the hard questions:
Are we commissioning for compliance or for change?
Who’s holding the power—and who should be sharing it?
How do we design systems that learn, rather than systems that lock in?
Here’s the truth, mental health is human. It doesn’t fit neatly into contract clauses or quarterly KPIs. It demands partnership, humility, and a willingness to listen. The question isn’t whether we can afford to shift from commissioning to collaboration. It’s whether we can afford not to.
Further Reading
Mental Health Charities & NHS Collaboration
The Economic Benefits of Community Support in Mental Health Care
