NHS England’s Implementing the Five Year Forward View for Mental Health outlined key objectives for the development of community-based adult mental health services (CMHS). This 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. From April 2018 all clinical commissioning groups are required to offer IAPT services integrated with physical healthcare pathways. The IAPT Pathway for People with Long-term Physical Health Conditions and Medically Unexplained Symptoms guidance is intended to help with implementation and sets out the ideal pathway for IAPT services.
- NHS England investment to increase access to integrated evidence-based psychological therapies (IAPT), offering people more convenient and tailored treatment for their physical and mental health needs .Also increased access to IAPT 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 increased access to IAPT 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 (SMI). NHS England has published guidance to help ensure at least 280,000 people living with SMI have their physical health needs met by increasing early detection and expanding access to evidence-based physical care assessment and follow-up care. From April 2017, funds entered CCG baselines to deliver physical health checks for people with SMI to enable NICE recommended screening and access to physical care interventions. This funding should ensure that at least 60 per cent of the population on the SMI register receive the required physical health assessment and follow up from 2018/19 onwards, as confirmed in Refreshing NHS Plans for 2018/19.
Adult Eating Disorders Guidance: Community, Inpatient and Intensive Day Patient Care
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
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 national PSMI CQUIN for improving physical healthcare in people with severe mental illness (SMI) is an important lever in addressing the reduction of premature mortality in this group. The CQUIN captures the number of cardio metabolic assessments completed and interventions offered across inpatient settings, early intervention in psychosis services and community mental health teams. The 2017-19 PSMI CQUIN builds upon the progress from previous years, extending its focus to include measuring physical health outcomes among EIP services and improving upon the collaboration with primary care clinicians.
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 is a ‘must do’ within the NHS Operational Planning and Contracting Guidance 2017-2019.
The Mental Health Five Year Forward View Dashboard outlines how local areas are performing against the EIP standard and investment by commissioners into local EIP services.
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.
The Royal College of Psychiatrists’ Centre for Quality Improvement (CCQI)is supporting EIP services to improve the quality of care delivered to patients through a quality improvement network. All EIP services participated in a self-assessment framework in 2016/17. Results will be used by commissioners and EIP teams to recognise areas of good practice and also reflect where improvements in EIP services are needed.
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.
For more information on early intervention in psychosis services in your area please visit the NHS website.