Adult and older adult mental health

One in four adults experiences at least one diagnosable mental health problem in any given year. People in all walks of life can be affected and at any point in their lives. Mental health problems represent the largest single cause of disability in the UK.

The NHS is placing more national focus than ever before on mental health. NHS England and NHS Improvement aim to deliver a transformation in adult and older adult mental health services by 2023/24, building on the progress made to date towards achieving the recommendations set out in the Five Year Forward View for Mental Health, and aiming to rebalance the provision of care and ensure that people can access the care they need closer to home.

The NHS Mental Health Implementation Plan 2019/20 – 2023/24 sets out the NHS Long Term Plan priorities for improving adult and older adult mental health care over the next five years supported by major new investment. NHS England and NHS Improvement are investing to improve care across a range of services and settings, including mental health crisis care, acute mental health care, and community-based mental health care.

Our key commitments include:

  • Crisis and acute mental health: the Long Term Plan commits to ensuring people can access a  a comprehensive set of  crisis and acute services across the country. Specifically the Long term Plan commits to adult crisis and home treatment teams: Every area in England will have a 24/7 mental health crisis service by 2021. Every service will be ‘open-access’ by 2021, meaning that people and families can self-refer, including those who are not already known to services.
  • Crisis alternatives: Every area has been allocated funding to invest in alternative models of crisis support, such as crisis cafes, safe havens, and crisis houses, providing an alternative to A&E or inpatient psychiatric admission.
  • Simplifying access to urgent mental health support through NHS 111: By 2023/24, anyone seeking urgent mental health support in England will be able to do so via the simple universal 3-digit 111 number.
  • Crisis services for children and young people: By 2023/24 every single area in England will have a 24/7 age-appropriate crisis service for children and young people.
  • Specialist liaison mental health teams in emergency departments and general hospital wards: to ensure that when people with mental health needs attend A&E, it is equipped to meet their mental as well as physical needs.
  • Clinically-led review of standards for urgent and emergency mental health care: 11 pilot mental health trusts are currently testing the feasibility of introducing waiting time and quality standards for urgent mental health services.
  • Response to mental health from the Ambulance service: In recognition of the significant role the ambulance service plays in responding to mental health calls, for the first time there will be a dedicated national investment programme to improve capacity of the ambulance service to meet mental health needs.
  • Therapeutic inpatient mental health care: For people admitted to an acute mental health unit, a therapeutic environment provides the best opportunity for recovery. It is important that care is purposeful, patient-orientated and recovery-focused from the outset, so that people have a good experience of care and do not spend more time in hospital than necessary.

Community mental health

The NHS Long Term Plan and NHS Mental Health Implementation Plan 2019/20 – 2023/24 set out that the NHS will develop new and integrated models of primary and community mental health care. These models will provide more accessible and high-quality care for adults and older adults with a range of severe mental illnesses, including addressing specific needs such as eating disorders, mental health rehabilitation needs and complex mental health difficulties associated with a diagnosis of ‘personality disorder’. Key areas of focus include:

  • The Community Mental Health Framework for Adults and Older Adults: The new Community Mental Health Framework describes how the Long Term Plan’s vision for a place-based community mental health model can be realised, and how community services should modernise to offer whole-person, whole-population health approaches, aligned with the new Primary Care Networks. New models and four-week waiting times are being tested in 12 local areas in 2019/20 and 2020/21 supported by specific new funding, with all parts of England receiving new funding for community mental health over the five-year period, reaching almost £1billion per year extra by 2023/24.
  • Adult Eating Disorders Guidance: As part of work on community based mental health care for adults, alongside work to explore the effectiveness of different approaches to integrated delivery with primary care, NHS England and NHS Improvement are working to improve availability and access to community eating disorder services for adults. Guidance has been published to support commissioners and providers to achieve this.
  • Early Intervention in Psychosis (EIP): The EIP standard remains a priority of the NHS, and the NHS Long Term Plan and NHS Mental Health Implementation Plan 2019/20 – 2023/24 set out continued commitment to building on successful work to date in implementing the national access and waiting time standard.
  • Improving physical health care for people with severe mental illnesses (SMI): NHS England is leading work to reduce the premature mortality among people living with SMI.
  • Individual Placement and Support (IPS): In order to support more people with severe mental illnesses to find and retain employment, NHS England has committed to increase access to IPS services to support 55,000 people a year by 2023/24.
  • Suicide prevention: NHS England and Improvement is building on the progress made in the Five Year Forward View, which had already committed to reducing the suicide rate by 10% by the end of 2020/21. This commitment will be delivered in close partnership with public health and local authorities, Public Health England and Department of Health and Social Care.
  • Suicide Bereavement Support: By 2023/24 we plan that, 100% of STPs will be providing suicide bereavement support services. We are funding local areas to develop their own services for their own population needs. NHS England and Improvement will support local areas with implementation and developing plans for the infrastructure needed to deliver bereavement support.

Older people’s mental health

The NHS Long Term Plan and NHS Mental Health Implementation Plan 2019/20 – 2023/24 commit the NHS to ensuring consistent access to mental health care for older adults with functional mental health needs (i.e. depression, anxiety and severe mental illnesses), and to addressing the mental health needs of older adults wherever they may arise or present, based on need and not age. There will be a particular focus on providing joined-up support to older people across mental and physical health services, and improving the competence, capabilities and skills of the NHS workforce in older people’s mental health.

Key service areas include:

  • Improving access to psychological therapies (IAPT): Local areas will be expected to plan to meet the needs of their local population to address inequalities in IAPT access for older people.
  • Crisis and acute mental health: The needs of older adults are embedded in all adult crisis, acute and liaison mental health Long Term Plan commitments.
  • Community mental health: Older adults will be supported through new and integrated models of primary and community mental health care, which will enable them to have greater choice and control over their care, and to live well in their communities.