Crisis and acute mental health services
NHS England and NHS Improvement is building on the progress made in the Five Year Forward View, which focused on increasing provision of crisis resolution home treatment, and liaison mental health services.
The NHS Long Term Plan sets an ambition for more comprehensive crisis pathways in every area that are able to meet the continuum of needs and preferences for accessing crisis care, whether it be in communities, people’s homes, emergency departments, inpatient services or transport by ambulance.
As well as increasing capacity and improving models of traditional NHS crisis care services, implementation of these ambitions will include a central role for NHS-funded voluntary sector services in providing complementary and alternative models of crisis care. NHS services will also work alongside other system partners including local authorities, police and ambulance services to deliver comprehensive and accessible local crisis care pathways.
The investment will be supported by significant improvements to national data sets to measure activity in crisis services, as well as improved use of outcomes and experience measures to understand the quality of care that is provided.
NHS England and NHS Improvement have recently completed allocation of targeted additional investment of £261 million in community-based crisis teams and ‘crisis alternatives’ from 2019-21. All plans have been nationally assured, and we can confirm that by 2021, every single area in England now has a fully funded plan, covering the following:
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.
- Investment in 24/7 intensive home treatment services in every area by 2021, so people can be cared for at home instead of hospital where appropriate.
- Long standing restrictions on older adult access to crisis services will be removed.
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.
This funding is expected to continue over 5 years, with a total of £179 million being invested in all areas to increase the range of alternative services that can meet the range of different needs and preferences for accessing crisis support.
This investment has largely gone to the voluntary sector providers of these services, which tend to have high levels of patient satisfaction.
They will all be expected to employ peer support workers, providing support from and employment to people with lived experience of using mental health services.
All areas have been asked to use this ringfenced investment to identify local inequalities in access access, experience and outcomes among people who use crisis services, and to seek to implement alternative services that better meet needs of these groups, which will be prioritised based on local demographics.
Simplifying access to urgent mental health support
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.
This will place England as a world leader being one of the first countries to set such ambitious plans for accessing mental health care through a universal 3-digit number.
The nhs.uk page will be enhanced so that by 2021, anyone will be able to find contact details of local mental health crisis services through a postcode search on the nhs.uk website.
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.
The offer will include a comprehensive offer of crisis assessment, brief follow up and intensive home treatment.
The model of care will vary. Depending on local need some areas will provide emergency services by children and young people’s mental health practitioners, but others may provide a blended model which includes support from appropriate trained adult mental health practitioners.
Specialist liaison mental health teams in emergency departments and general hospital wards
While the initiatives above and most of the new investment centres on improving capacity in community-based mental health crisis care, we are also committed to ensuring that when people need to attend A&E, it is equipped to meet their mental as well as physical needs.
There has been significant progress since 2016 in introducing specialist psychiatric liaison teams into emergency departments across the country:
- for the first time, every hospital with a 24-hour consultant led emergency department now has a psychiatric liaison team on site;
- 2/3 of these teams now operate on a 24/7 basis, compared to only 2/5 in 2016;
- 33% are now meeting the ‘core 24’ service standard, compared to only 10% in 2016 (this is on track to meet the ambition of 50% by 2021 and 70% by 2023/24);
- we are investing a further £48 millions from 2019-21 to continue expansion of these services across the country.
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. In particular, the pilots are looking at waiting times and patient experience of:
- Urgent and emergency community mental health crisis response
- Mental health care in emergency departments, including psychiatric liaison
The project is expected to report its findings in Spring 2021, with decisions on roll-out dependent on findings from the evaluation.
The project forms part of the wider national Clinical Review of Standards being led by NHS Medical Director, Professor Steve Powis.
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. This will include:
- £70 million for mental health professionals in ambulance control rooms to improve telephone triage and support, avoiding conveyance to ED where appropriate;
- A national programme to increase mental health training and education of ambulance staff;
- [Subject to the Capital Spending Review] Funding for dedicated mental health response vehicles (and staff) to increase capacity to respond in a more timely manner, in a more suitable vehicle.
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.
To support inpatient mental health services to improve their therapeutic offer, new funding has been secured to increase the level and mix of staff on acute inpatient wards, resulting in more therapeutic interventions and activities for people while they are in hospital. In addition to improving patient outcomes and experience, it is also expected that this will contribute to a reduction in the average time spent in hospital, bringing the typical length of stay in all adult acute inpatient down to 32 days or fewer by 2023/24.
This work builds on the Five Year Forward View for Mental Health commitment to eliminate inappropriate adult Out of Area Placements (OAPs) by 2020/21, supporting a continued focus on and sustainable approach to managing local system capacity.
Reform of the Mental Health Act
The Independent Review of the Mental Health Act (2018) was completed in response to concerns about the use of the Mental Health Act (1983), including rising numbers of detentions and racial disparities in who is detained.
The Government accepted many of the recommendations from the Independent Review in its White Paper, Reforming the Mental Health Act (2021), and set out its proposed changes to legislation in the draft Mental Health Bill (2022). The timings for these changes are still being confirmed – the Bill will need to be approved by Parliament, before coming into force, and would take several years to implement.
The overarching aims of the reforms are to use the Mental Health Act’s powers in the least restrictive way, for people to be viewed and treated as individuals, and to have choice and autonomy about their care, for people to receive care that supports their recovery and delivers therapeutic benefit, and to reduce racial inequalities in experience and outcomes under the Mental Health Act.
In both the Independent Review and White Paper, it was recognised that as well as changing legislation, achieving the overarching aims would require services to make wider changes to the delivery of care.
To support these changes, NHS England has commissioned a two-year quality improvement (QI) programme for inpatient services to co-develop and implement improvements to practice. The programme is being delivered by the PSC and the Virginia Mason Institute and will support 70 inpatient services across England.
To find out more about the programme and how your trust can get involved, please visit the Mental Health Act QI programme website.
Information about NHS England’s wider work to improve the quality of care across mental health, learning disability and autism inpatient settings can be found here: Quality Transformation Programme.
National funding profiles
National funding profiles can be found in the following document: NHS Mental Health Implementation Plan 2019/20 – 2023/24