Sciana Fellow Sarah Holloway reflects on leadership, her experience working within mental health across sectors, and her working group’s focus on prevention and health promotion
Sarah Holloway is the CEO of the Maudsley Charity, a grant-making charity that has a vision of a world in which everyone who experiences mental illness, without exception, gets the support and treatment that they need. Previously, she worked for NHS England as head of mental health for adults and worked across health policy more broadly at the UK government’s Cabinet Office and Department for Health and Social Care.
Sarah also served as a programme director at the King’s Maudsley Partnership, an academic-clinical collaboration focused on transforming mental health services for children and young people. She also has experience within the voluntary and community sector, having led research and evaluation at the mental health charity Mind and now as Chair for South East London Mind. She is a member of Sciana’s sixth cohort.
This interview has been edited for brevity and clarity.
SN: You recently stepped into your new role as chief executive of the Maudsley Charity. How were your first few weeks in the role?
SH: They have been amazing. It’s a real privilege to get to lead an organisation that has the capacity to really support change in mental health care in South London. There’s a lot of new learning for me in the job. There are a lot of areas where I’m doing things for the first time, so that’s been exciting. But the context of South London and the mental health services is quite familiar to me. So, there’s a good balance of stuff that’s new but also stuff that is familiar.
It’s been fantastic getting to know the team at the charity, and I’ve been really impressed by how we conduct our business and, in particular, how we do grant-making and how we involve people with lived experience in the process of making and deciding which organisations we support. Seeing that kind of power-sharing and that co-production in practice has been exciting.
SN: Has this new role changed how you think about leadership?
SH: I think the experience [at] Sciana has really made me focus on how, as a leader, you can build consensus between colleagues and leaders across different organisations. It has made me focus on not just what does my own team and my own organisation need, but [also] what does the wider system need and how can I enable that in how I show up and the leadership behaviours I demonstrate.
I think the other change in this new role has been a bigger focus on listening and asking questions to understand more. I am trying to see the act of asking questions and listening to the answers as a superpower right now.
People, I think, in dialogue and meetings, we all feel a pressure to come to a decision, or a statement or conclusion quite quickly, but I think the experience [at] Sciana and my own leadership journey has made me focus much more on the process of understanding in order to reach consensus and using questions and using dialogue in a much more considered way.
You get to practice some of that at Sciana, which is quite cool. To just practice those approaches in a really safe space.
SN: With your experience working in the mental health system across policy, the NHS, and the charitable sector, how do you define systemic leadership in this area?
SH: I feel really fortunate to have seen the mental health system from lots of different perspectives. I have worked in the voluntary and community sector, I’ve worked in national policy, I’ve worked in a local mental health provider, and in collaboration with academia, and I have some, albeit limited, lived experience.
In all those roles, the challenges [have] been how [to] get people to understand and see the perspectives of the other players in the system. How do you avoid people falling into really easy caricatures and stereotypes about what other partners are like and how they might behave?
Therefore, I think system leadership and mental health means bringing all of those partners together in an authentic way. Helping those partners to build trust, helping those partners to understand the different perspectives at play, and fundamentally having lived experience and the experience of people who use services at the centre of those conversations.
I think so much can get stuck within organisational politics. So, system leadership for mental health requires us to genuinely elevate the voice of people who need and use services and focus on what is shifting the dial in terms of outcomes, as opposed to a more narrow set of organisational goals.
SN: Reflecting on your previous role, what were the key challenges and opportunities in shaping the King’s Maudsley Partnership?
SH: It was such an interesting piece of work, and I’m really optimistic for the future of the King’s Maudsley Partnership. One of the major challenges was trying to identify a set of limited priorities in the context of child mental health, which, as we know, is an area where demand is rising, [the] need is really urgent since over decades we've systematically underinvested in mental health and particularly in children’s mental health. Therefore, there are lots of priorities that a partnership like ours could have focused on, and a real challenge was distilling that into a few tangible top priorities. Another of the challenges [was] finding the space for clinical and academic teams to come together to agree on those priorities.
Clinicians and academics have different sets of priorities that drive what they do day to day. Clinicians are focused on the waiting lists [and] the urgency of their patient caseload[s], [and] the time horizon for academics, seeking funding, delivering research and undertaking dissemination, tend to be more longer term. In short, the incentives and priorities set by their two institutions, the NHS and the university, don’t always align.
So, finding space for those clinical and academic teams to come together to agree [on] the priorities was a challenge and finding space for them to do that alongside patients, carers, [and] families. So, we had to kind of create those new spaces.
I’m really excited about one of the initiatives under the King’s Maudsley Partnership. We’ve created what we call “communities of practice” in certain specific areas of child mental health. We have one, for example, in neurodevelopmental conditions, [and] one in eating disorders. They will be spaces that bring clinicians and academics together, and in time with patients and carers, too, to agree priorities and develop work together.
[There] will be a space for a clinician to say, “The top issue we face in our clinic at the moment is this,” and an academic to think about how they could respond, and [enable] patients and carers to also give their perspective. Without those spaces, there’s a real risk that continually people work in silos.
SN: As part of Cohort 6’s Sciana Challenge, your working group in the Sciana Network is exploring leadership for prevention and health promotion. Can you share more details?
SH: Our group has focused on what the leadership behaviours [are] that you need if you're going to help drive your organisation and the system that you work in to do more in terms of prevention and health promotion. So, how do you, as a leader in an organisation, disrupt the status quo in order to get more focus on earlier, upstream activities?
Lots of people understand the theory of why prevention is important, and there’s a growing acceptance that prevention is important, but what do you need to do day-to-day? What kind of leadership behaviours, competencies, [or] skills would you need if you’re genuinely going to shift the dial on prevention health promotion?
We have been interviewing lots of leaders from different parts of the health system to ask “What’s been your experience of doing this work? What [have] been the opportunities? What have been the challenges? What have been the barriers, [and] what [have] been the enablers?
From that, we’re trying to distil a set of leadership competencies and skills that you will need in order to successfully disrupt and change the focus of your system towards prevention and health promotion. Then, what we’d like to do as a final step is produce something that helps people develop those competencies and skills. We’re trying to think about those competencies and skills as muscles.
We’ve got this analogy of a gym where people might go into a digital platform and say, “Okay, the leadership skill that I really need to drive this change in my system is I need to get better at storytelling.” We will hopefully have some resources and some stuff for people to engage with to get them better at that skill of storytelling.
We want to support people who see themselves as activists and changemakers in the prevention health promotion space, whether that be national people setting policy or whether that be providers of services at a local level who think there’s more that we could be doing upstream.
SN: Cross-sectoral collaboration is essential for children and young people’s mental health. What makes it work?
SH: Trust. I think until partners trust each other, collaboration is really challenging. The work that organisations do—to build relationships with their partners—the importance of that can't be underestimated.
And, again, it goes back to leaders understanding of what their counterparts are facing, so a leader in education understanding what it's like to work in health [or] a leader [in] health understanding what it is to work [in] education—understanding the practical drivers and challenges for their peers and for their partners, and understanding why people act the way they do in a system under pressure, and having some empathy for that.
SN: Working in mental health policy and services can be emotionally intense. How do you protect your own wellbeing?
SH: Firstly, I would say that the work that I've had the privilege of doing, particularly at [the] national level, was demanding, but I don't think it was anywhere near as demanding and emotionally exhausting as the work of frontline clinicians who turn up day in, day out and support people often in real crisis. And the work of people with mental illness who show huge resilience, strength and insight to work through their personal challenges and strive for the lives they want.
Having said that, I did find the period of leading during COVID particularly demanding because there was so much change and a sense that there was so much to do to support mental [health]. During that time, I worked at NHS England in the national mental health team. So, we were trying to develop policies, approaches, tools, [and] resources that could help frontline services and patients and families at a time of significant uncertainty and crisis.
I found [that] during that time, I lost my work-life boundaries. But that experience of losing them has actually taught me how important they are to have, and I have been more intentional about them since.
So, I now am much more focussed on boundaries; times when I’m not close to my email [and] times when I turn things off completely. I also am really intentional about how I fill up my cup. So, how do I charge my batteries when I am feeling despondent or feeling like change is hard? Surrounding myself with people who have delivered change and can inspire you, or going to visit a service that you know is doing brilliant things, or speaking to somebody who’s experienced the service and has got loads out of it.
SN: What are you hoping to take away from this Sciana Network experience?
SH: I want to use this week to reflect on how I act as a leader in my organisation and how I also act as a leader in South London’s mental health system. I want to use this time to reflect on what I need to prioritise, what I need to focus on, [and] what behaviours will be most impactful.
I also want to hear from other Fellows about how their experiences of implementing change and innovation have worked [and] what have been the failures. I want to come away with a clearer, crystallised set of priorities for my leadership at Maudsley Charity.
SN: Is there anything else you’d like to share that you’re involved in that you’d like people to know about?
SH: I would like to emphasise how the scale of the challenge is so significant in mental health because of decades of under-investment and the importance, therefore, of systems moving towards greater parity between physical and mental health.
That is still a big challenge in the system today, ensuring an equal focus on both mental and physical health—mind and body—and not seeing the two as divorced.
I’m really interested in the conversations we’ve been having here with predominantly physical health clinicians and how some of these seemingly small conversations might actually help to shift mindsets and open up more of a focus on underlying mental health drivers of physical health and likewise the physical health needs of people with mental health conditions […]
