Case study summary
Understanding how integrated care systems are supporting people’s mental health.
Mental health problems represent the largest single cause of disability in the UK. One in four adults experiences at least one diagnosable mental health problem in any given year, and the life expectancy of people with severe mental illnesses can be up to 20 years less than the general population.
The Five Year Forward View for Mental Health set out plans for expanding mental health services so at least 1.5 million people can access Improving Access to Psychological Therapies (IAPT) services each year. The Long Term Plan made a renewed commitment to expand access to IAPT services for adults with common mental health problems, with a focus on those with long term conditions.
New and integrated models of primary and community mental health care are also being developed to support adults with severe mental illness. For many people experiencing mental health crisis, sanctuaries, safe havens and crisis cafes provide a more suitable alternative to A&E. These services exist in a number of areas and are being provided at relatively low costs with high satisfaction.
Supporting new and expectant mothers’ mental health
New and expectant mums who are struggling with their mental health in Hertfordshire are getting access to specialist perinatal mental health support through a new community service.
The multidisciplinary Community Perinatal Team (CPT) offers a range of interventions including psychological therapies, support from nursery nurses and occupational therapy, as well as practical advice and help for mums about caring for themselves, their babies and families. It also provides specialist training for multi-agency professionals, including health visitors, GPs and midwives, to help ensure women at risk of or who are experiencing perinatal mental health problems can be identified earlier, and receive faster access to treatment and support.
Over its first year, the service saw more than 700 women from more than 1,600 referrals. Approximately two-thirds referred were experiencing perinatal mental health problems for the first time, but around 74% had a history of other mental health problems.
While some women were signposted to other services, 72% of those identified as needing support from the CPT had a face-to-face assessment within six weeks, the average time being 32 days. Urgent and emergency referrals are usually managed on the same day they are received, organised by either the CPT or the mental health crisis team.
Supporting people in mental health crisis
Greater integration of services across the NHS, voluntary sector and local authority has enabled Cambridgeshire and Peterborough to provide more effective support to people experiencing a mental health crisis.
By establishing a community-based mental health crisis First Response Service (FRS), the county has been able to provide responsive support for anyone experiencing mental health crisis.
Before the service was launched, there was no capacity to see people in need of mental health care out of hours, except via A&E. And there was no self-referral route, meaning many sought help direct from A&E.
Open 24/7, the FRS provides support for people of all ages across Cambridgeshire and Peterborough. It welcomes self-referrals as well as urgent referrals from carers, GPs, ambulance crews, police and the emergency department. The result has been a 20% reduction in the use of the emergency department for mental healthcare and a 26% decrease in the number of people with mental health needs being admitted to acute hospitals from the emergency department.
It has also resulted in fewer ambulance call-outs, assessments and conveyances to the emergency department and reduced the need for out-ofhours GPs to see people in mental health crisis.
Teaming up mental health nurses and paramedics
A new scheme launched in 2018 has senior mental health nurses and experienced paramedics working together to support those experiencing a mental health crisis in London.
The London Ambulance Service scheme aims to treat patients at home, which is often a better environment for those experiencing mental health problems. When an emergency mental health call comes in, the 999 call handlers work alongside a mental health nurse in the control room to decide whether to dispatch the mental health car.
At the scene, both clinicians will assess the patient, with the nurse able to assess mental health and provide brief psychological interventions and the paramedic able to assess their physical needs.
Of all the calls London Ambulance Service receives every day, nearly 10% are from people experiencing mental health problems. As well as reducing unnecessary and stressful hospital trips, the new mental health response team should free up ambulance crews who might otherwise spend a long time on scene dealing with a complex mental health case. By responding together, the specialist ambulance crew is expected to reduce mental health hospital admissions from 58,000 to 30,000 per year once it is fully rolled out across the capital.
Providing a safe haven
To give people in mental health crisis, or at risk of developing a crisis, a better option than presenting at A&E, Frimley Health and Care launched the Aldershot Safe Haven Café. Open every day and evening throughout the year, the cafe aims to help people avoid the need for emergency NHS care.
Adopting a safe haven approach, the cafe encourages self-management and independence by preventing crisis escalation, improving access to other services, accelerating treatment provision, and providing effective care planning.
Staffed by psychiatric nurses and other mental health professionals from across the NHS and voluntary sector, the cafe not only helps people at the point of crisis, but reduces social isolation for vulnerable people, helping them to maintain their mental health.
Analysis of service user emergency department usage shows an overall downward trend following attendance at the Safe Haven service. Psychiatric admissions have reduced for the Safe Haven service catchment area, as have mental health-related police deployments across the area.