Guidance published on patients’ choice in mental health care

NHS England has today published guidance for commissioners, GPs and providers to help them support patients to choose their mental health care.

From 1 April 2014 patients with mental health conditions have had the same rights as physical health patients to choose where they have their first outpatient appointment.

They are able to choose any clinically appropriate provider in England as long as a clinical commissioning group (CCG) or NHS England has a contract with them.

Work is already underway to improve information on mental health conditions and treatments for both patients and referrers; improve information to help patients choose a provider; and make sure money follows the patients to incentivise providers.

Commissioners, GPs and providers are encouraged to adopt the interim guidance while NHS England consults further with them on areas that need to be improved, as well as the work to embed this choice in the coming years. NHS England will also hold engagement events with patients.

Dr Martin McShane, NHS England’s Director for Long Term Conditions, said: “Patients’ right to choose who provides their mental health care and treatment is a major step towards establishing ‘parity of esteem’, or equal status, between mental and physical health services in the NHS.

“Helping patients make choices about their care is at the heart of NHS policy. Choice will drive improved services and patient outcomes. We will be working closely with health professionals and patients to ensure they have the support they need for choice to work well, in the interest of patients.”

Minister for Care and Support, Norman Lamb MP said: “I am absolutely committed to achieving equality between mental and physical health care. That’s why, for the first time, anyone referred for mental health treatment now has the right to choose who provides their care, as is the case with physical health.

“Through the mandate, we have asked NHS England to make sure that choice will be fully embedded by 2015. This guidance is an important step in helping health and care providers ensure that anyone referred for mental health treatment is supported to make informed decisions about their care.”

The guidance covers issues such as how to support patients in the choices they are able to make; how to respond to any significant changes in where patients are referred to when patients make their choices;  and clarity on pricing and paying for mental health services.

As with physical health conditions, with the help of their GP patients can now choose who provides their care. Patients can choose to be referred outside of their local area to a provider anywhere in the country.

There are exemptions to the new right to choice, such as patients who need high secure psychiatric services or who are detained under the Mental Health Act. These are set out in the guidance.

Interim guidance for commissioners, providers and GPs


  1. NHS England says:

    Thank you for your comments and queries on the new legal right to choice of mental health provider.

    We have been consulting on the interim guidance for referrers, commissions and providers and aim to publish an updated version next month. We will publicise this as widely as possible to all relevant audiences.

    We are currently developing a programme of work to help embed this legal right to choice which will include assessing what information and support patients need to help them access their legal rights to choice.

    Kind Regards
    NHS England

  2. Sam Allen says:


    In the interim guidance you refer to worked up scenarios and flow diagrams that will be available towards the end of the consultation period. Can you please advise if these are available yet?

    Kind regards


    • NHS England says:

      Hi Sam,

      Thank you for your query about case scenarios and other tools for referrers, providers and commissioners. We have used the consultation period to strengthen these and are now aiming to publish both alongside the next iteration of the guidance.

      Kind Regards
      NHS England

  3. Pearl Baker says:

    This sounds good in principle but who will infirm these patients of this right?

    Having just received DOH Monitor Framework Agreement, how can the Monitor carry out his responsibilities.’Process for setting objectives’ ‘The DOH is RESPONSIBLE for overseeing the health and social care system’.

    Setting objectives for the system and ensuring an integrated system;

    Overseeing national respecting their operational independence; and

    accounting for the performance of the system.

    This is totally impossible. The MONITOR is not connected to the patient or the public. They do not inform the Public of their existence.

    The MONITOR is clearly unable to perform this essential part of their agreement, however it would seem acceptable on this basis that should they be failing in this part of their agreement the DOH could be challenged as the responsible organisation.’Integration’ the new ‘buzz’ word, but you must first find out your partners in ‘integration’.

    My meeting with a Consultant recently stated they had never heard of the MONITOR! but they were completely overwelmed with patients being doubled booked for consultations.

  4. Lynne Kenny says:

    This information needs to be made more available to both professionals and patients . My recent experience with Birmingham and Soluhul Mental Health Trust has been far from open and transparent.

  5. Pearl Baker says:

    I am delighted that more attention is being given to Mental Health, however there are a number of ‘hurdles’ to jump before we commence this process.

    I have challenged Ian Duncan Smith MP DWP Minister ‘fit for work ‘ scheme on a number of issues. Schizophrenics and Bipolar disorders are recognised as ‘severe and enduring mental illnesses’ yet they are being sent ‘fit for work’ questionnaires despite already being in a programme of support from Health and Social Care. This questionnaire is being sent to every individual, without first checking the patients medical records.

    The Ministerial reply has now confirmed that any individual suffering from a severe disability will not be expected to engage into a work placed programme.

    This was a VICTORY for common sense, and not only covers Schizophrenics and Bipolar attempts but other severely disabled groups.

    A Bulletin in NHS England should highlight the above. I am engaged with MIND and Rethink following this success.

    The next problem we have is that of the Care Manager Co-Ordinator. They require more training regarding their responsibilities to their client, including up-to date NHS England Bulletins informing them of what their client should expect from them, regarding their rights under the Law and Policies, including the Care Act.

    The Monitor should play a more active role, in determining whether his ‘licensed’ provider has a monitoring system in place to ensure they are not failing their patients.

    The LA are also failing their COP Property and Finance clients by not providing them with Independent Mental Health Advocates. This is a conflict of interest.

    The client will never know what they are entitled to if the Care Manager Co-Ordinator is not required to keep up with information such as this latest Bulletin.

    The Care Manager is not aware of my success with the DWP Minister.

    Those placed into the COP by the LA are most at ‘risk’ of financial abuse by those supposedly their to provide a life that they choose, as often spoken about by NHS England.

    I acknowledge Norman Lambs MP Minister for Care and Support ambition to make life worth living for the mentally ill, but my reference to three organisations involved in this process show I have enormous experience and expertise that cannot be replaced, my challenge to Iain Duncan Smith DWP Minister was a great success.

    I am happy to provide my knowledge and expertise with NHS England and the DOH for free, in the long run it would save me time in challenging a system that is not able to implement an Integrated care and support due to the complexity of agencies not even considered as part of the system, but are.

    • Helen Waine says:

      How can members of the public support the work you are undertaking? Mind and Rethink have very good on-line resources, but not everyone caring full-time for severely mentally ill family members; or ill people themselves, have the time or concentration skills to find the information they need and then act upon it – especially since the resources and organisations that should be able to help are either disappearing through cuts or being so oversubscribed it is difficult to get help when it is most needed. Altogether Now is a brilliant newspaper for physically disabled, and gives latest information on disability issues in an easily understood form, and lots of information on organisations that will help. I know the paper wanted to do a similar thing with mental health issues, proposing a MentalZone feature, but did not get the grant it needed. Could something similar be taken up and distributed to mental health and carer’s forums? In short, how do we get the public to notice your work, support it and help service users and carers to understand their rights and insist upon them?