Community mental health services play a crucial role in delivering mental health care for adults and older adults with severe mental health needs as close to home as possible.
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.
A new community-based offer will include access to psychological therapies, improved physical health care, employment support, personalised and trauma informed care, medicines management and support for self-harm and coexisting substance use.
By 2023/24, this will enable at least 370,000 adults and older adults per year nationally to have greater choice and control over their care, and to live well in their communities.
This ambition is supported by an additional £1 billion new Long Term Plan funding per year by 2023/24 to ultimately transform the provision of community mental health care for adults and older adults with severe mental illnesses.
Under the Long Term Plan by 2023/24:
- All Sustainability and Transformation Partnerships (STPs)/Integrated Care Systems (ICSs) will have received funding to develop and begin delivering new models of integrated primary and community care for adults and older adults with severe mental illnesses (SMI).
- These new models of care will span both core community provision and dedicated services, where the evidence supports them. The new models will be built around Primary Care Networks.
- A total of 390,000 people with SMI will receive a physical health check.
- A total of 55,000 people a year will have access to Individual Placement and Support (IPS) services.
- New local funding will also be used to maintain and develop new services for people who have specific or additional needs, including Early Intervention in Psychosis (EIP), complex mental health difficulties associated with a diagnosis of ‘personality disorder’, mental health rehabilitation and adult eating disorders.
We have announced a new transformation fund to support this ambition: in 2019/20 and 2020/21, 12 STPs/ICSs are to receive over £70 million of additional funds to test new models of integrated care and four-week waiting times as part of the Clinically-led Review of NHS Access Standards:
- Cambridgeshire and Peterborough STP
- Cheshire and Merseyside STP
- Frimley Health and Care ICS
- Herefordshire and Worcestershire STP
- Hertfordshire and West Essex STP
- Humber, Coast and Vale Health and Care Partnership
- Lincolnshire STP
- North East London STP
- North West London STP
- Somerset STP
- South Yorkshire and Bassetlaw ICS
- Surrey Heartlands Health and Care Partnership
These early implementer sites will test how the barriers between primary and secondary care can be dissolved. They will lead transformation of community mental health services in England in partnership with Primary Care Networks (PCN) and Clinical Commissioning Groups (CCGs), as well as local authorities and the Voluntary, Community and Social Enterprise sector (VCSE), service users, families and carers, and local communities themselves.
We will use their findings to inform the roll out of new models of integrated primary and community care at the national level, and from 2021/22 to 2023/24, all STPs/ICS will receive a fair share of transformation funding to implement these models locally, in addition to year-on-year increases in baseline funding for all CCGs to bolster community mental health provision starting in 2019/20.
NHS England and NHS Improvement have also developed a new Framework to support local systems in implementing the Long Term Plan’s vision for transforming community mental health care.
Further resources are being developed to support improved community services for adults with SMI, including on the implementation of increased access to psychological therapies for people with SMI.
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.
The Framework will be used as the basis for the testing of new integrated primary and community mental health care models across our 12 early implementer sites in 2019/20 and 2020/21.
It is a key resource to inform STPs/ICSs five-year planning process, and to support the effective spend of almost £1 billion new Long Term Plan funding per year by 2023/24.
Adult Eating Disorders Guidance: Community, Inpatient and Intensive Day Patient Care
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.
This guidance will support the development and implementation of commissioner, provider and Sustainability and Transformation Partnership/Integrated Care System plans to deliver effective community adult eating disorder services that are integrated with day and/or inpatient care to reduce admissions, length-of-stay and improve outcomes for users, families and carers. This is in line with NHS Long Term Plan ambitions to establish new and integrated models of primary and community mental health care for adults and older adults, including dedicated provision for groups with specific needs such as adults with eating disorders. This guidance also supports the roll-out of the Provider Collaborative (formerly New Care Models) programme to develop NHS-led Provider Collaboratives for adult eating disorder care.
- Adult Eating Disorders Guidance: Community, Inpatient and Intensive Day Patient Care
- Appendices and Helpful Resources for the Adult Eating Disorders Guidance
See also the Children and Young People’s Eating Disorder Guidance.
Early Intervention in Psychosis (EIP)
From April 2016 the early intervention in psychosis standard was introduced. This requires that more than 50 per cent of people experiencing a first episode of psychosis begin treatment with a NICE-approved care package within two weeks of referral.
People who experience psychosis can, and do, recover. The time from onset of psychosis to the provision of evidence-based treatment has a significant influence on long-term outcomes. The sooner people are able to access evidence-based treatment the better the outcomes they achieve.
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 the standard which is included in the Long Term Plan.
Guidance is available to support ongoing local implementation of the standard by commissioners and mental health providers, working with service users and their families, carers and other partners.
NHS England has worked closely with Health Education England in commissioning training places to support delivery of NICE recommended interventions, with a specific focus on cognitive behavioural therapy for psychosis and family interventions.
NHS England has developed helpful resources for commissioners and EIP services to help them meet the EIP standard. Resources includes technical guidance on reporting for the standard, frequently asked questions and good practice examples.
Demonstrating progress and building sustainability
- The Mental Health Five Year Forward View Dashboard outlines how local areas are performing against key areas including the EIP standard.
- The new Mental Health Services Data Set enables the routine capture and reporting of information regarding referral to response, assessment and treatment times, interventions delivered and outcomes.