NHS England’s Implementing the Five Year Forward View for Mental Health outlined the key objectives for the development of community-based adult mental health services (CMHS). The CMHS programme will address the following:
- Evidence-based treatment pathways, spanning the journey people make from referral to recovery, will follow those already in place for early intervention in psychosis (EIP), psychological therapies (IAPT) and eating disorders among children and young people. These will include, from 2017/18, pathways for people with severe mental illness (SMI) and those who self-harm. See below for details of the EIP programme.
- NHS England will invest to increase access to integrated evidence-based psychological therapies (IAPT), offering people more convenient and tailored treatment for their physical and mental health needs .There will also be increased access to psychological therapies for people with psychosis, bipolar disorder and personality disorder.
- By 2020/21 NHS England, the Department of Work and Pensions, and the Department of Health’s Joint Unit for Work and Health will ensure that up to 29,000 more people per year living with mental health problems are supported to find or stay in work through increasing access to psychological therapies for common mental health problems (see above) and doubling the reach of Individual Placement and Support (IPS).
- By 2020/21, there should be a national reduction in premature mortality among people with severe mental illness, and NHS England will produce an operational plan to achieve that from 2017/18. NHS England is also leading work to ensure 280,000 more people living with severe mental illness have their physical health needs met by increasing early detection and expanding access to evidence-based physical care assessment and intervention.
Demonstrating progress and building sustainability
- Delivering the proposed improvements to community mental health services will require a consequent expansion in the skills and capacity of the workforce.
- NHS England will work with Health Education England and other partners to undertake an audit of employment services in secondary mental health services.
- The CCG Improvement and Assessment Framework includes indicators for tracking performance in EIP and out of area placements.
- 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.
- The 2016/17 CQUIN on improving physical healthcare to reduce premature mortality in people with severe mental illness is an important lever in addressing the issue of physical health care for this group.
Early Intervention in Psychosis (EIP)
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 new standard introduced in April 2016 requires that:
- More than 50% of people experiencing first episode psychosis begin treatment with a NICE-approved care package within two weeks of referral.
As outlined in Implementing the Five Year Forward View for Mental Health, this figure will rise to more than 60% by 2020/21.
Guidance has been developed which aims 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.
The Royal College of Psychiatrists Centre for Quality Improvement (CCQI) carried out a baseline audit in 2014, ahead of the standard being introduced, to establish the extent to which EIP services across England were delivering NICE- recommended packages of care. The report outlines the significant level of variation in performance of EIP services.
The CCQI is supporting the NICE concordance strand of the standard through a quality improvement network. All EIP services are expected to participate through a self-assessment framework that CCQI will validate and score by the end of 2016/17. Scores will be against a four-point scale to reflect where improvements in EIP services are needed over the next few years, as the EIP workforce develops.
NHS England is working 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.
For more information on early intervention in psychosis services in your area please visit NHS Choices.