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.
Care Programme Approach: position statement
The Community mental health framework replaced the Care Programme Approach (CPA) for community mental health services. It enables services to shift away from an inequitable, rigid and arbitrary CPA classification and bring up the standard of care towards a minimum universal standard of high-quality care for everyone in need of community mental healthcare.
This position statement has been developed in response to queries regarding the national policy position and direction of travel away from the CPA.
Since April 2021, all integrated care systems (ICSs) have received transformation funding to deliver new and integrated models of primary and community mental health care. The position statement will support ICSs to transform, expand and improve community mental health services in line with the framework.
Individual Placement and Support (IPS)
People with severe mental illness (SMI) have low rates of employment (8% vs 75% in the general population). Individual Placement and Support (IPS) is an employment support intervention involving intensive, individual support, a rapid job search followed by placement in paid employment, and in-work support for both the employee and their new employer. It is the best evidence-based approach to help people in this group get and keep a paid job.
As a key commitment in the Five Year Forward View for Mental Health (FYFVMH), NHS England has committed to doubling access to IPS services nationally by 2020/21, enabling more people who experience SMI to find and retain employment, equating to 20,000 people.
The recently published Long Term Plan (LTP) committed the NHS to supporting an additional 35,000 people with severe mental illnesses where this is a personal goal to find and retain employment by 2023/24, a total of 55,000 people per year. This investment will support people to get back into or gain access to employment. It will improve outcomes and recovery for people, meaning they spend less time in hospital and live healthier, happier lives.
To aid the expansion of IPS provision in England, NHS England and NHS Improvement are working with partners Social Finance to deliver IPS Grow, an infrastructure support initiative, which consists of: hands-on implementation support from a network of IPS experts; a workforce development programme; and tools for effective reporting, monitoring and evaluation of services.
A range of IPS Grow resources and guidance has been developed and is available for:
For more information on IPS, visit:
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.
NHS England publishes regular statistics on performance against the waiting time element of the standard.
Improving physical health care for people with severe mental illness (SMI)
NHS England is committed to leading work to reduce the premature mortality among people living with severe mental illness (SMI).
People with severe mental illnesses are at higher risk of poor physical health. Compared with the general patient population, patients with severe mental illnesses are at substantially higher risk of obesity, asthma, diabetes, chronic obstructive pulmonary disease (COPD) and cardiovascular disease. People with a long-standing mental health problem are twice as likely to smoke, with the highest rates among people with psychosis or bipolar disorder.
By 2020/21, the NHS will ensure that at least 280,000 people living with severe mental health problems have their physical health needs met. As set out in the NHS Long Term Plan, by 2023/24, the NHS will further increase the number of people receiving physical health checks to an additional 110,000 people per year, bringing the total to 390,000 checks delivered each year.
Improving Physical Healthcare for People with SMI Guidance for CCGs details the action and collaboration required by commissioners and providers in primary and secondary care to improve access to and the quality of physical health checks and ensure appropriate follow-up care is given. Positive practice examples and tools can be found in the supporting annexes. Public Health England’s report provides more information on physical health inequalities for people with SMI.
NHS England publishes quarterly statistics on the number of people with SMI receiving a full physical health check.
A practical toolkit for mental health trusts and commissioners is also available to help providers and commissioners improve the physical health of patients with serious mental illness in secondary care. The toolkit looks at different approaches to implementing the Lester screening tool.
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.
Suicide prevention is a complex system-wide challenge which requires close working between the NHS, public health and partner organisations, tailoring evidence of what works to local need and determinants.
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.
By 2023/24, we plan that 100% of Sustainability and Transformation Partnerships STPs will have received investment for a localised suicide reduction programme. This will support locally-led initiatives and there will be significant local autonomy on how it is implemented, as long as it is in line with published guidance.
To support this commitment, NHS England and Improvement has commissioned a national Quality Improvement (QI) offer jointly delivered by The National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH) and The National Collaborating Centre for Mental Health (NCCMH).
Suicide Bereavement Support
For each person who dies, as many as 135 people can be impacted; and in many cases this may be an underestimate. We also know that people who are bereaved by suicide are at risk themselves, which makes it ever so important to support family and friends in the days, weeks, and months, after a bereavement.
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.
To enable delivery, we are working with partners Support After Suicide Partnership to deliver postvention bereavement implementation support in addition to a central hub of resources.
National funding profiles
National funding profiles can be found in the following document: NHS Mental Health Implementation Plan 2019/20 – 2023/24