Please note:

• Spend on MHIS categories should not include services funded by service development funding (transformation funding) or spending review allocations. These are to be considered separately. 
• Spend on MHIS categories must not cover COVID-19 costs such as personal protective equipment. 
• Investment to tailor services to young adults should be included in the relevant children and young persons or adult categories of spend, depending on local funding arrangements.
• Investment to tailor services to older adults should be included in the relevant adult categories of spend.
• Spend on people with a learning disability or autistic people should only be included in the relevant children and young people or adult MHIS categories of spend where there is a co-occurring mental health need, and where services are being accessed for that mental health need. Learning disability and autism are otherwise excluded from the MHIS and should be captured in categories 18a, 18b or 18c.
• Spend on attention deficit hyperactivity disorder (ADHD) should not be included in any of the MHIS or learning disability or autism categories detailed below. For reporting purposes, please report ADHD spend against the ADHD category in the ledger.
• Low volume activity (LVA) amounts to NHS mental health providers should be included in MHIS and recommended to be included in category 20 mental health placements in hospitals.

The categories of spend below are grouped together for relevance, and so are not necessarily presented in order.

For example, categories 1, 2 and 21 relate to children, young people and schools, and so are presented together.

Category 1: Children’s and young people’s mental health

Not including children and young people with learning disabilities.

In scope for this category:

Includes expenditure on services for children’s and young people’s (CYP) mental health across the whole care pathway, from early years settings through to crisis care and intensive support:

• Services in primary and community settings, including acute hospitals.
• NHS services, including CYP mental health services commissioned or co-commissioned from or delivered in local authorities, schools, further education colleges and the voluntary sector.
• Any spend that is additional to that allocated in SDF funding to deliver mental health support teams in schools and colleges or as a 4-week waiting time pilot.

Spend for young adults’ (18–25s) mental health can be included in full or in part in this category, or in the community mental health for adult categories, depending on local funding streams.

Out of scope for this category (non-exhaustive; includes direction for common queries)

Does not include expenditure on:

• Learning disability, autism and ADHD support; or services in cases where there is no co-occurring mental health need.

Category 2: Children’s and young people’s eating disorders

In scope for this category

Includes expenditure on:

• Eating disorders for CYP (up to 19th birthday) and their families or carers for delivery of dedicated community eating disorder services in line with the evidence-based treatment pathway for eating disorders (2015).

Out of scope for this category:

n/a

Category 21: Mental health support teams in schools (MHSTs)

In scope for this category

Includes all MHSTs established in previous financial years from 2018/19 and planned integrated care board investment to establish new teams in 2025/26.

Out of scope for this category (non-exhaustive; includes direction for common queries)

n/a

Category 3: Perinatal mental health (community)

Including maternal mental health services [MMHS] (formerly maternity outreach clinics).

In scope for this category

Includes expenditure on the following:

• Specialist perinatal mental health community services that provide multidisciplinary assessment, treatment and care in a community setting, which includes:
  • evidence-based psychological interventions
  • treatment for women who are experiencing, have a history of, or are at high risk of serious mental ill health during pregnancy or the 1st year after birth, extending to the 2nd postnatal year by 2023/24

• Services to include advice, training and assistance to primary care, maternity, acute and other mental health services on the treatment and management of serious perinatal mental illness, as well as expenditure on supervision/oversight for staff in maternal mental health services (MMHS, formerly maternity outreach clinics) (see below).

• Specialist perinatal mental health community services that work with women and families for an extended period; expected to be from conception to 24 months after the birth of the child by 2023/24, up from current timeframe of conception until 12 months after birth of the child.

• Multidisciplinary specialised perinatal community mental health teams including:
  • medical
  • psychological
  • nursing
  • occupational therapy
  • social care
  • pharmacy
  • peer support

• All types of MMHS contracts (it is envisaged that some MMHS may be commissioned from mental health providers, some from maternity providers and some from a combination of these; all should be included in this category).
  • These provide targeted assessment, treatment and care in a community setting for cohorts of women who experience mental health difficulties arising directly from, or related to, the maternity experience; likely to include a range of midwifery, psychological reproductive health inputs to work with women with mental health difficulties arising from birth trauma, severe fear of childbirth (tokophobia) and loss.

Out of scope for this category (non-exhaustive, includes direction for common queries)

Does not include expenditure on:

• activity potentially badged as ‘perinatal’ but taking place in generic community mental health services, or crisis or liaison services – this should be included in the category for the relevant service
• maternity-led bereavement services – this should be reported as maternity spend and should not count toward the MHIS
• specialist midwives, health visitors – this should be reported as maternity spend and should not count toward the MHIS
• talking therapies workers – this should be included in Category 4: Talking therapies

Category 4: NHS talking therapies for anxiety and depression

For people with common mental health problems (adult and older adult).

In scope for this category

Includes expenditure on:

• talking therapies, for anxiety and depression (only, including services embedded in general healthcare pathways for people with long-term conditions)
• any relevant spend for the 18–25 cohort as part of delivering a comprehensive service for 0–25s as set out in the NHS Long Term Plan

Out of scope for this category (non-exhaustive, includes direction for common queries)

Does not include expenditure on:

• psychological therapies for serious mental illness (SMI) – this should go into category 9a: Community mental health
• CYP services for under-18s

Category 5: A&E and ward liaison mental health services

Adult and older adult.

In scope for this category

Includes expenditure on:

• mental health liaison (‘liaison psychiatry’) services based in general acute hospitals

These are distinct specialist mental health teams based in general hospitals that provide mental health assessment, treatment and care planning in general hospital emergency departments and inpatient wards for adults of all ages

Out of scope for this category (non-exhaustive, includes direction for common queries)

Does not include expenditure on:

• community-based crisis resolution home treatment teams that provide in-reach mental health crisis care to general hospitals – this should go into Category 7: Adult community crisis)

Category 6: Early Intervention in Psychosis team (EIP)

Ages 14-65.

In scope for this category

Includes expenditure on:

• specialist EIP teams that have been commissioned to provide the full range of psychological, psychosocial, pharmacological, and other interventions shown to be effective in NICE guidelines and quality standards, including support for families and carers
  • EIP services also triage, assess, and treat people with an ‘at-risk mental state’ (people at high risk of developing psychosis), as well as help those not triaged to access appropriate treatment and support

• spend on service users aged 14+ receiving help from EIP services should be included in this category, as part of delivering a comprehensive service for 0–25 as set out in the NHS Long Term Plan

Out of scope for this category (non-exhaustive, includes direction for common queries)

Does not include expenditure on:

• ‘EIP activity’ in generic community mental health services – this should be included in Category 9a: Community mental health

Category 7: Adult community-based mental health crisis care

Adult and older adult.

In scope for this category

Includes expenditure on all ICB commissioned services that provide urgent, emergency, and acute mental healthcare outside A&E or inpatient settings, including:

• crisis home resolution treatment teams (CRHTs) that exist in all areas to provide initial urgent and emergency mental health response (immediate assessment and treatment) in communities, usually people’s homes – as well as intensive home treatment for a time-limited period as an alternative to inpatient mental health admission

• in most cases, one single team provides both community crisis response and ongoing home treatment, but in some areas separate teams provide the urgent and emergency mental health response and the ongoing home treatment; in these instances, the expenditure on the teams should be combined

• crisis houses (usually used as an alternative to admission, often run by the voluntary sector)

• crisis cafes, sanctuaries, havens, etc (often used as an alternative for people experiencing crisis or pre-crisis)

• Police liaison, street triage (ICB expenditure on services jointly commissioned with police services, for example mental health nurses in control rooms, police cars)

• single points of access, crisis telephone helplines

• any relevant spend for the 18–25 cohort as part of the contribution to delivering a comprehensive service for 0–25s, as set out in the NHS Long Term Plan

• psychiatric decision units (short-term assessment and observation units intended to continue assessment, consider alternatives to admission)

• acute day care services (usually act as a step-up or step-down service from inpatient care as part of the acute mental health pathway; they usually offer assessment, treatment, activities, and care planning for a time-limited period)

• step-down beds (to support effective discharge from inpatient services into community settings)

• Section 136 suites (for assessment of people detained under section 136 of the Mental Health Act 1983)

• any other ‘crisis alternative’ services

Out of scope for this category (non-exhaustive, includes direction for common queries)

Does not include expenditure on:

• mental health provision from ambulance services – this should be in Category 8: Ambulance response services
  • however, it is understood that in a very small minority of local service models, ambulance mental health response is commissioned and highly integrated with the local mental health crisis care pathway; and as such, it may not be possible to distinguish spend
  • in these cases, mental health response from ambulance services should be categorised in adult community crisis care

Category 8: Ambulance response services

In scope for this category

Includes expenditure on:

• mental health specific initiatives from ambulance services, designed to improve the ambulance response, such as:
  • dedicated ambulance joint response vehicles and the required staffing (including both physical and mental health professionals)
  • mental health professionals supporting triage in ambulance service emergency operations centres
  • mental health training and education of the ambulance workforce

Out of scope for this category (non-exhaustive, includes direction for common queries)

Does not include expenditure on:

• usual ambulance response to mental health calls (this would not be included in mental health spend)
• mental health initiatives that do not involve the ambulance service
• street triage models funded by the police

Category 9a: Community A – community services that are not bed-based or not placements

Community mental health (adult and older adult), including new integrated models for serious mental illness and pathways for eating disorders (excluding supported housing and placements in the community).

In scope for this category

Please note: community mental health services comprise multidisciplinary teams offering specialist assessment, treatment and care to adults and older adults (aged 18 to end of life) with mental health problems, in their own homes and in the community.

Includes all commissioned spend to expand and transform community mental health pathways for people with serious mental illness, such as:

• workforce across community mental health services, including assessment and brief intervention teams, recovery teams, assertive outreach teams, generic community mental health teams for adults and older adults

• primary care specialist provision for people with moderate to severe mental health problems (excluding talking therapies) – this can include the mental health provider share of costs for ARRS mental health practitioner roles that are jointly funded by primary care networks

• any spend additional to that allocated in SDF funding to deliver continued expansion of new integrated models of community mental healthcare for adults and older adults (including expenditure on all services that provide support to adults and older adults with functional mental health needs, but not including expenditure on services that provide dementia support only); this includes:
  • dedicated community-based services to support people who may have a diagnosis of ‘personality disorder’ or complex emotional needs
  • dedicated community eating disorder services (for adults aged 19 and over)
  • dedicated community-based services to support people with community mental health rehabilitation needs
  • psychological therapies for people with severe mental health problems in line with implementation guidance
  • community mental healthcare commissioned from the voluntary, independent or third sectors for people with serious mental illness, where in line with the categories listed here and does not cover any of the out-of-scope exclusions
  • individual placement and support (IPS) services to provide employment support to people with serious mental illness
  • infrastructure and programme management costs (for example, to support recording and flow of data to mental health services data set, implementation of outcome recording, and other non-pay costs)
  • any relevant spend for the 18–25 cohort as part of delivering a comprehensive service for 0–25s, as set out in the NHS Long Term Plan

Out of scope for this category (non-exhaustive, includes direction for common queries)

Does not include expenditure on:

• hospital services for people with mental health needs, learning disabilities, or problems with substance misuse
• any inpatient care, placements, rehabilitation with overnight or accommodation function, supported housing or any other type of accommodation setting
• care home services with nursing
• care home services without nursing
• domiciliary care services including those for children
• shared lives (formerly known as adult placement)
• supported living services
• dementia

Category 9b: Community B – supported housing services that fit in the community model and are not delivered in hospitals

Community mental health (adult and older adult), supported housing and other accommodation-based support.

In scope for this category

Supported living and other accommodation-based care, support, and rehabilitation in line with the Community Mental Health Framework, which details a core community mental health service that brings together what primary care currently provides for people with less complex as well as complex needs and what secondary care community mental health teams and residential settings (including supported housing and care homes) currently provide.

This is likely to include integrated models of care which bring together clinical support, social care support and peer support around accommodation-based support.

Includes:

• care home services with nursing
• care home services without nursing
• domiciliary care services
• shared lives (formerly known as adult placement)
• supported living services

Out of scope for this category (non-exhaustive, includes direction for common queries)

Does not include expenditure on:

• community-based services for people with mental health needs – Category 9a: Community mental health excluding housing and placements
• community mental health rehabilitation teams that do not have overnight or accommodation responsibilities
• any services registered as hospitals for people with mental health needs, learning disabilities, or problems with substance misuse
• continuing healthcare – any expenditure coded to continuing healthcare cost centres that relates to mental health conditions should be captured under Category 17: Mental health in continuing healthcare

Category 20: Mental health placements in hospitals

In scope for this category

Includes all individually-commissioned placements in services registered as hospital services for people with mental health needs.

These placements are likely to be commissioned per individual and partly or fully funded through section 117 responsibilities.

Likely to include:

• ‘locked rehabilitation’ placements or wards
• non-local NHS rehabilitation wards classed as community, complex, high dependency, long stay, complex care
• high-cost specialist placements
• high dependency wards
• personality disorder units (non-specialised commissioning)

This does include out-of-area placements for more specialist services not provided in the locality, and these services will often be commissioned from non-NHS services.

Includes low volume activity amounts to NHS mental health providers.

Out of scope for this category (non-exhaustive, includes direction for common queries)

Does not include expenditure on:

• adult mental health acute wards, adult mental health paediatric intensive care unit wards, and older people’s mental health wards registered as hospital services for people with mental health needs
• dementia care and treatment
• care home services with nursing
• care home services without nursing
• domiciliary care services including those for children
• shared lives (formerly known as adult placement)
• supported living services
• low volume activity amounts to NHS acute or community providers

Category 10: Mental Health Act 1983

In scope for this category

Includes ICB-commissioned expenditure on:

• long-term care for people following detention under sections 3 and 117 of the Mental Health Act 1983
• Section 12 of the Mental Health Act 1983 – this relates to ICB remuneration of section 12 – approved doctors for the assessments and interviews they undertake and medical recommendations they make under the Act
  • previously likely to have been included within the ‘other adult and older adult – non-inpatient, excluding dementia’ category

Out of scope for this category (non-exhaustive, includes direction for common queries)

Does not include expenditure on:

• Category 20: Mental health placements in hospitals
• spend on long-term care for people following detention under the Mental Health Act where the primary diagnosis was dementia, learning disabilities, autism (which should be included in learning disabilities and autism below), or acquired brain injury (which is not within scope of the MHIS)

Category 11: Serious mental illness physical health checks

In scope for this category

The majority of physical health checks for people with serious mental illness and follow-up actions should take place within primary care.

Specialist mental health care can support people to engage with primary care and, in certain situations, it will be appropriate for secondary care or voluntary, community and social enterprise services to deliver these checks.

Examples include if someone is an inpatient or if someone is being supported by a community mental health team and struggling to engage with primary care.

Checks delivered by secondary care should be funded through ICB baseline funding.

Annual physical health checks for people with serious mental illness to be completed in primary care are now funded via the GP Contract and Quality Outcomes Framework (QOF) incentive scheme for primary care.

Any MHIS spend noted here should be on top of national level investment into QOF to support physical health serious mental illness checks.

Includes expenditure on:

• physical health assessment for people with serious mental illness not eligible to receive a check in primary care
• follow-up intervention (as required) for people with serious mental illness in secondary care settings

This spend will be one element of the overall investment in community models for serious mental illness.

Out of scope for this category (non-exhaustive, includes direction for common queries)

Does not include expenditure on:

• physical health checks delivered in primary care
• any other assessment, intervention or care in community mental health or new integrated models, including NHS-commissioned voluntary sector services – this would be included in Category 9a: Community A mental health
• use of additional SDF funds on outreach support to increase uptake of physical health checks

Category 12: Suicide prevention

In scope for this category

Includes expenditure on:

• specific NHS-based suicide prevention initiatives relating to mental health patient safety in primary care, inpatient or community settings
• any expenditure contributed by ICBs to wider local suicide prevention work led by public health teams in local authorities

Out of scope for this category (non-exhaustive, includes direction for common queries)

n/a

Category 13: Local NHS commissioned acute mental health and rehabilitation inpatient services

Adult and older adult.

In scope for this category

Includes expenditure on services that are part of the locally commissioned inpatient pathway:

• Acute mental health inpatient services, defined as acute beds for male and female adults to provide care with intensive medical and nursing support for patients in periods of acute psychiatric illness.
• Money spent as part of the NHS Long Term Plan ambition to improve the therapeutic offer in adult acute inpatient settings (this could include staffing or other resources required to deliver this care).
• Psychiatric intensive care units – psychiatric intensive care for patients who are in an acutely disturbed phase of a serious mental disorder.
• Older adult inpatient services – for the psychiatric care of older patients on older adult mental health wards who are living with frailty alongside a functional mental illness (for example, psychosis, affective and behavioural disorders), including complex co-morbidities.
• Rehabilitation inpatient services – local inpatient services that provide support to people with complex needs and co-occurring conditions.

Out of scope for this category (non-exhaustive, includes direction for common queries)

Does not include expenditure on:

• dementia care and treatment – this would be included in dementia spend
• longer-term, individually-commissioned mental health hospital placements, including non-local or ’locked’ rehabilitation placements – this should be in Category 20: Mental health placements in hospitals
• any ICB-commissioned independent sector provision for adult mental health services, including expenditure on out-of-area placements – this should be in Category 14: Adult and older adult acute mental health out-of-area placements
• admissions to general and acute settings (non-mental health NHS providers)

Category 14: Adult and older adult acute mental health out-of-area placements

In scope for this category

Includes expenditure on any ICB-commissioned independent sector provision for adult acute out-of-area placements resulting from local bed capacity pressures.

This includes out-of-area placements for the following bed types:

• Acute mental health inpatient services, defined as acute beds for male and female adults to provide care with intensive medical and nursing support for patients in periods of acute psychiatric illness.
• Psychiatric intensive care units – psychiatric intensive care for patients who are in an acutely disturbed phase of a serious mental disorder.
• Older adult inpatient services – for the psychiatric care of older patients on older adult mental health wards who are living with frailty alongside a functional mental illness (for example, psychosis, affective and behavioural disorders), including complex co-morbidities.

Out of scope for this category (non-exhaustive, includes direction for common queries)

Does not include expenditure on:

• locally-commissioned and provided acute mental health inpatient services – these services should be included in Category 13: Acute inpatient services (adult and older adult)
• dementia care and treatment – this should be included in dementia spend

Longer-term individually commissioned mental health hospital placements, including non-local/’locked’ rehabilitation placements (this should be in category 20. Mental health placements in hospitals).

Category 16: Mental health prescribing

Non-core MHIS.

In scope for this category

Expenditure on prescribing mental health drugs should be in line with NICE guidance, or (where available and appropriate) in line with recommendations from regional medicines optimisation committees.

We ask ICBs to specify whether expenditure is NHSBA ePACT system actual costs or net ingredient costs.

Where drugs can be used for multiple conditions, only the expenditure on such drugs used to treat a mental health condition should be included; ICBs may need local clinical input to enable appropriate apportionments.

This category includes expenditure on:

• hypnotics and anxiolytics (BNF legacy 4.1 or equivalent therapeutic class defined by the BNF, excluding pregabalin)
  • include an estimate of expenditure for pregabalin when used as an anxiolytic only

• drugs used in psychosis and related disorder:
  • oral antipsychotic drugs (BNF legacy 4.2.1 or equivalent therapeutic class defined by the BNF, excluding prochlorperazine)
  • depot/long-acting antipsychotic drugs (BNF legacy 4.2.2 or equivalent therapeutic class defined by the BNF)
  • drugs used for mania and hypomania (BNF legacy 4.2.3 or equivalent therapeutic class defined by the BNF) [excluding carbamazepine and sodium valproate]
  • include an estimate for carbamazepine and sodium valproate when used for mania/hypomania (excludes use in other conditions)
  • antidepressant drugs (BNF legacy 4.3 or equivalent therapeutic class defined by the BNF), excluding amitriptyline and nortriptyline
  • include an estimate of expenditure for amitriptyline/nortriptyline when used as an antidepressant
  • central nervous system stimulants and drugs used for mental health disorders

Out of scope for this category (non-exhaustive, includes direction for common queries)

Does not include expenditure on:

• drugs prescribed for dementia – to be included in the dementia spend, not in prescribing
• expenditure on the same drugs that are being used to treat non-mental health conditions – this would not be included in the mental health categories
• central nervous system stimulants and drugs used exclusively for the management of ADHD
  • use of these stimulants and drugs for other mental health services should be included where separately identifiable
  • however, if not separately identifiable, then they should be excluded, given use is expected to be low

Category 17: Mental health in continuing healthcare

Non-core MHIS.

In scope for this category

Includes any expenditure coded to continuing healthcare cost centres that relate to mental health conditions and should be included as non-core mental health expenditure.

This may include:

• care home services with nursing
• domiciliary care services

Out of scope for this category (non-exhaustive, includes direction for common queries)

Does not include expenditure on:

• any dementia costs in continuing healthcare – to be included in the dementia category line
• The continuing healthcare for non-mental health conditions – this would not be included in the mental health categories
• categories 9b: Community B mental health supported housing; 14: Out-of-area placements; and 20: Mental health placements in hospitals

Category 18a: Learning disability

Not included in MHIS.

In scope for this category

Includes:

• community learning disability teams
• learning disability dietetic services
• learning disability mental health inpatient services
• acute liaison nurses/liaison nursing teams

Out of scope for this category (non-exhaustive, includes direction for common queries)

n/a

Category 18b: Autism

Not included in MHIS.

In scope for this category

Includes:

• autism diagnostic services (all ages)
• autism diagnostic services (paediatric neurodiverse)
• autism specialist inpatient services
• pre-diagnostic support services
• post-diagnostic support services
• specialist autism community services

Out of scope for this category (non-exhaustive, includes direction for common queries)

n/a

Category 18c: Learning disability and autism (where not separately identifiable)

Not included in MHIS.

In scope for this category

Baseline expenditure for services for children (0–18) and adults with a learning disability, autism or both including:

• intensive support teams
• crisis teams
• learning disability and autism forensic teams
• learning disability and autism mental health inpatient services
• keyworkers for children and young people
• health funded crisis respites for children and young people with a learning disability, autism, or both
• health funded community support for people in their own homes
• continuing care for children and continuing healthcare for adults with a learning disability and autistic people
• personal health budgets for people with a learning disability and autistic people
• LeDeR review teams
• positive behaviour support services

Out of scope for this category (non-exhaustive, includes direction for common queries)

Does not include expenditure on:

• people with a learning disability and autistic people accessing mental health services with reasonable adjustments in place as required
• services for people with ADHD without a learning disability or autism

Category 19: Dementia

Not included in MHIS.

In scope for this category

All services intended to assess, diagnose, treat, and provide support for dementia pre and post diagnosis.

Out of scope for this category (non-exhaustive, includes direction for common queries)

Mental health services with adaptations for patients with dementia.

Category not applicable

In scope for this category

CQUIN contract values where applicable.

Out of scope for this category (non-exhaustive, includes direction for common queries)

Where CQUIN applies to a provider contract, it should be added to the value of service lines attributable to any of the above categories on a pro-rata basis.

The pro-rata CQUIN value for service lines outside the mental health reporting categories should be excluded.

Examples of exclusions are any non-clinical services such as car parking charges or any community nursing services for joint mental health and community providers.

Publication reference: PR1297
Classification: Official