NHS Long-term Plan
In January 2019 the NHS set out its long-term plan for the future of England’s health services. At the heart of this plan was a commitment to...
Transforming mental health in your community
A local guide to delivering the NHS long-term plan
Who is this guide for?
This guide is for anyone involved in developing local long-term plans or who wants to make sure their local plan is ambitious enough on mental health.
In January 2019 the NHS set out its long-term plan for the future of England’s health services. At the heart of this plan was a commitment to drastically improve the availability and quality of mental health services across the country.
Now the national strategy has been set, every local area in England has been tasked with setting out their plans for delivering this transformation.
Over the summer of 2019 each of England’s 43 Sustainability & Transformation Partnerships (STPs) will be engaging with local communities to establish detailed plans for services over the next five years.
We're Mind, the mental health charity.
Mind’s vision for transforming mental health
Before NHS England’s plan was published, Mind set out its vision for transforming mental health services in England. We identified four areas for action: prevention, access to support, recovery and inequality.
Why we need to focus on prevention
It’s time to build understanding of mental health through targeted public health programmes that prevent mental health problems from developing, or being ignored if they do.
These programmes will be delivered through the NHS and in schools, workplaces and community groups, to help reduce mental health stigma and discrimination.
Why we need to focus on access to support
We need significant investment in mental health so people get timely treatment and support whenever they experience a mental health problem. We need to make sure we’re ambitious about the quality of the services they use.
There also needs to be better community support to prevent mental health crises. When someone is in crisis, high-quality urgent and emergency services must be available 24/7.
Why we need to focus on recovery
It’s time to improve the support people receive as they live with, or recover from, a mental health problem. That means focusing on comprehensive support and care, effectively meeting people’s needs – whatever they are.
It also means getting people the right help to get back into work, education or training.
Why we need to focus on inequality
It’s time to reverse health inequalities, by investing in communities where the prevalence of mental health problems is disproportionately high – and by tackling institutional discrimination.
We need to take a hard look at the causes of persistent inequalities that affect how people engage with services – including racism, poverty, social exclusion, violence and trauma.
How much local NHS partnerships are planning to spend on mental health in 2018-19
Mental health services have been underfunded for decades, resulting in poor quality services and long waiting times for treatments.
The NHS Mental Health Investment Standard requires any increase in overall spending to be matched in mental health. However, Mind's analysis of the latest figures shows significant regional variation, with some areas spending almost half per person on mental health compared to other places.
Mental health and the long-term plan – key commitments
At least £2.3billion a year towards mental health, to help put mental health on an equal footing to physical health.
Increased access to mental health services so that at least two million more people with anxiety, depression and other mental health problems get help.
At least an extra 345,000 children and young people under 25 getting support.
Anyone in mental health crisis able to call NHS 111 and have 24/7 access to the mental health support they need in the community by 2023/24.
By 2023/24, 370,000 adults and older adults with severe mental illnesses getting greater choice and control over their care. They’ll be supported to live well in their communities through new and integrated primary and community care models.
Recruiting more NHS staff to deliver the plan, including new roles such as social prescribing link workers and greater use of peer support.
Cultural change across the NHS to increase staff engagement, attract and retain staff and improve patient outcomes.
Preventing people from developing mental health problems and promoting good mental health
Preventing people from developing mental health problems, and offering early intervention, is better for the people involved and reduces demand on the NHS. Local authorities may be responsible for public mental health. Yet there’s lots the NHS can do to improve and promote prevention.
Key priorities for improving mental health prevention and promotion
Support in school
One in eight young people has a diagnosable mental health problem. However, only one in four of them accessed specialist services last year. This leaves too many young people with no support at all1. Mental Health Support Teams based in schools can help increase access to services. They can also identify young people showing early signs of mental health problems who may not be identified by their GP or mental health services.
1 NHS Digital (2018), ‘Mental Health of Children and Young People in England, 2017’
Support outside of school
It’s vital that services include young people not in school. This includes young people who are home-schooled, have been off-rolled (removing a pupil from the school roll without using a permanent exclusion, when the removal is primarily in the best interests of the school, rather than the best interests of the pupil), or don’t attend school due to special educational needs.
Reaching every young person
NHS services must link up with local authorities to ensure that more vulnerable groups, such as young people in care or those on child protection plans, are supported and safeguarded. Joined up working and a shared understanding of local needs between Clinical Commissioning Groups, local authorities and schools is crucial to ensure young people are supported by the right service at the right time.
Supporting perinatal mental health
Around one in five women will experience a mental health problem during pregnancy or in the year after giving birth. These problems cause distress to the mother and her family. They can also adversely impact the child’s mental health, development and educational outcomes for many years.
The long-term economic and social costs of untreated perinatal mental health problems are £8.1 billion for each one-year cohort of births in the UK2. It’s crucial that both mothers and children get the right support.
Specialist perinatal mental health services have expanded as part of the Five Year Forward View for Mental Health. However, the full range of services are still not available everywhere. Around one in ten new fathers also experience mental health problems, so support must be available for them too.
2 Centre for Mental Health, Costs of perinatal mental health problems, 2015
The majority of suicides are related to mental health. We know that in many cases people have struggled in silence, feeling unable to ask for help. A more coherent and consistent approach to suicide prevention is needed, building on existing local multi-agency suicide plans to significantly reduce suicides among people in contact with mental health services, and those who aren’t.
The NHS has a critical role in shaping local plans and delivering effective interventions, including within primary care, focusing on the most at-risk groups. These include people who self-harm, middle aged men, people in detention, in custody, in contact with the criminal justice system and people who have been bereaved by suicide.
Supporting NHS workers’ wellbeing
Currently more than 300,000 people living with long-term mental health problems lose their jobs each year. The Stevenson/Farmer Thriving at Work review of mental health and employers identified steps the NHS, government and employers need to take to transform the mental health of our nation’s workforce.
There’s currently a high number of vacant posts and high levels of stress among the NHS workforce. Attrition rates are also high. So local NHS plans need to show how they’re going to support the mental health and wellbeing of their own staff to improve recruitment and retention.
Improving public mental health
Local areas must ensure that they partner with local authorities to develop local long-term plans. This is to make sure NHS activity aligns with public mental health and mental health prevention initiatives, building on existing activity around the Prevention Concordat.
Mind wants to see more funding for public health to help stem the flow of people becoming unwell in the first place. Mental health needs to be central to areas as diverse as housing, parks and green spaces, leisure facilities and libraries. The NHS can encourage local government to take action on this. Increased investment in, and access to, public mental health services, parenting programmes, drug and alcohol services, smoking cessation and physical activity programmes is also critical.
What the NHS Long-Term Plan commits to
Putting mental health teams in schools
Mental Health Support Teams will be introduced in schools and colleges in a fifth to a quarter of the country by the end of 2023. NHS England will test approaches to support children and young people outside of education settings. They’ll also provide more upstream preventative support such as information sharing and digital interventions to reduce need for specialist Child and Adolescent Mental Health Services.
Extending perinatal care
Perinatal care will be available from preconception to 24 months after birth, extended from 12 months. Plus, people will get more access to evidence-based psychological therapies in specialist perinatal mental health services, including parent-infant, couple, co-parenting and family interventions.
The NHS will also offer greater access to evidence-based care for women with moderate to severe perinatal mental health problems and a personality disorder diagnosis and increased access to psychological support and therapy, including digital options, in a maternity setting. There will be more support for partners of women accessing specialist perinatal mental health services and maternity outreach clinics.
Extending suicide reduction
NHS England will provide full coverage across the country of the existing suicide reduction programme and design a new Mental Health Safety Improvement Programme for mental health inpatients focused on suicide prevention and reduction.
Offering bereavement support
Suicide bereavement support for families and staff working in mental health crisis services will be made available all over the country. Building on the work of the Global Digital Exemplar (GDE) programme, NHS England will use decision-support tools and machine learning to improve personalised care and predict future behaviour, such as risk of self-harm or suicide.
Improving NHS workers’ wellbeing
The Long-Term Plan (LTP) commits to improving the wellbeing of NHS staff, building on the NHS Health and Wellbeing Framework that includes recommendations from the Stevenson/Farmer review of mental health and employers, and support improved staff health and wellbeing and sickness absence management.
Questions for your local plan
Is your area taking action to support children and young people in schools and outside of schools?
Does the plan set out how it will improve access to specialist perinatal mental health services for women and support for partners?
Does the plan align with the priorities set out in the local multi-agency suicide prevention plan, including targeting at-risk groups? What support will be provided for people bereaved by suicide?
What action will your area take to support the mental health and wellbeing of NHS staff?
Does the plan complement local authority-led public mental health programmes, including those happening under the Prevention Concordat? Is the local authority involved in conversations about mental health prevention and promotion within the plan?
Does the plan include targeted measures to ensure the NHS is helping people with mental health problems to stop smoking, be physically active and manage their weight?
Prevention: good practice examples
Putting children and young people at the heart of services
In 2017, commissioners in Warwickshire re-tendered Child and Adolescent Mental Health Services following a whole system redesign co-produced with young people, parents and professionals.
They created an outcomes framework for Warwickshire focused on a tierless service and early intervention and prevention. Coventry and Warwickshire Partnership Trust successfully submitted a joint bid with Coventry and Warwickshire Mind to deliver the pathway.
Rise is the new name, chosen by children and young people, for the emotional wellbeing and mental health services for children and young people in Warwickshire.
The key aims of Rise are to:
- Support children and young people aged 0 - 25 in a way that matters to them
- Support the whole family – not just the child
- Go the extra mile to reach out to those who need us most
- Provide more focus on prevention and early intervention
- Work in partnership, especially with schools
- Work with families and the child’s network
- Support vulnerable children with complex needs
- Help children and young people bounce back when things get tough
- Make getting help easy – our vision of ‘No door being the wrong door’.
Providing a whole system approach
The Navigation Hub is the single point of entry where staff take calls and referrals. Clinical staff then make an assessment to help staff understand how the young person’s needs can be met by the new model.
Services then work together to provide interventions that meet the young person’s specific needs. Rise works closely with other local providers to ensure young people are referred to the right services – taking a whole system approach to the care and support people receive.
Rise works closely with schools, voluntary community services and Social Care and Primary Care (such as GP practices) to increase access for children and young people who need support.
Creating community hubs
Rise has established five community hubs across Warwickshire, where young people and families can access information, guidance and workshops and speak to a mental health worker. They also have a bus which goes to rural areas of Warwickshire and hard to reach communities to provide information and signposting.
Coventry and Warwickshire Mind employs primary mental health workers for each of the boroughs and districts in Warwickshire within the community hubs. They are also responsible for delivering the Big Umbrella in primary and secondary schools. The Big Umbrella offers a whole school approach providing mental health awareness and resilience interventions through assemblies, one-to-ones and class interventions.
In 2018-19 Rise worked with 20,529 young people through targeted interventions. They reported a 94 per cent improvement to their mental health through the strengths and difficulties questionnaire (SDQ).
Delivering drop-in sessions and free apps
The primary mental health workers work closely with the Primary Mental Health Team in CAMHS to deliver drop-in sessions within the community hubs. The Primary Mental Health Team also deliver the Boomerang programme – a resilience tool focusing on primary schools aimed at training staff in mental health awareness. Coventry and Warwickshire Mind also provide group-based sessions in anger, anxiety and low mood and self-esteem delivered locally.
The partnership is currently developing a detailed communications plan and the website. For example, The Dimensions Tool is a free-to-use app that provides information, support and tools to help meet people’s specific needs. CAMHS developed it with parents and carers, young people and clinicians.
From strength to strength
Coventry and Warwickshire Mind deliver the Looked After Children Service in Warwickshire, working with CAMHS to ensure vulnerable children get the care and support they need. They’re setting up a multi-disciplinary team (MDT) to support this work for children presenting with more complex issues. The MDT will include CAMHS, Children’s Social Care and other key stakeholders.
Rise’s outcomes are monitored every quarter through a range of person-centred measures, such as whether young people feel part of the decision-making process or get a timely response. The partnership works hard to carry this out consistently. For example, it uses one NHS system to input data and recording.
The partnership is going from strength to strength with team building days between Coventry and Warwickshire Partnership Trust and CW Mind and integrated meetings, governance structures and processes for RISE put in place.
Supporting mental health for mothers
Mums Matter is an eight-week intervention designed to support women in the perinatal period experiencing a mental health problem and finding it challenging to manage parenthood.
The project aims to:
- Provide support to improve the wellbeing of mothers so they are better able to look after themselves and their baby
- Improve understanding and awareness of perinatal mental health problems among mothers and their key supporters (like partners, family and friends)
- Tackle common myths and assumptions around motherhood and parenting among women in the perinatal period, which can lead to women feeling bad about themselves.
The service’s interim evaluation shows decreasing levels of anxiety and depression, and increases in social capital, wellbeing and mental health knowledge.
Case study: Stacey’s story
Stacey has lived with depression since she was a teenager, but didn’t recognise what it was. When she had her first child her anxiety rose and she felt overwhelmed.
She had been trying to hold it all together. But when she had her second daughter, she finally opened up to her health visitor who put her in touch with the Mums Matter practitioner. She completed the Mums Matter course and is now a volunteer for the new group.
She now understands and can cope with her depression. She can also cope with the anxiety of being a mum and uses the tools from Mums Matter to help her.
Cambridge Peterborough South Lincolnshire Mind STOP Suicide campaign
STOP Suicide is a CPSL Mind-led campaign that aims to build awareness around how everyone can play their part in preventing suicide in Cambridgeshire and Peterborough – and beyond.
The campaign aims to create a social movement around suicide prevention. It’s a key part of the county-wide Zero Suicide Prevention Strategy, supported by local authorities, NHS teams, voluntary sector organisations, businesses and, vitally, members of the public.
The public are empowered to take the campaign messages into their community as ‘campaign makers’. STOP Suicide’s award-winning approach encourages communities and people to help stop suicide by:
- Being alert to the warning signs
- Asking directly about suicide
- Helping those who are feeling suicidal to stay safe.
The campaign aims to enable direct and open conversations around the difficult subject of suicide. It seeks to break the taboo that prevents those at risk from getting the help they need.
In 2018 the campaign launched bus advertising, radio advertising, community roadshows, and a powerful film to raise awareness. It also harnessed real people’s stories in the press and on social media. It’s one of the most overt public campaigns around suicide prevention in the UK.
Services for people who need support with their mental health
Focusing on prevention (see chapter one) will reduce the number of people developing mental health problems in the future. However, thousands need treatment and support for their mental health now. For too long, those of us with mental health problems have had to put up with second-class services, with two-thirds of people receiving no treatment or support.
This has destroyed people’s wellbeing and cost lives.
Through the Long-Term Plan the NHS has made a national commitment to tackling historic underinvestment in mental health. Nationally, a minimum of £2.3billion per year extra funding will be ring-fenced for mental health services in England.
It has also set out a wide-ranging ambition for how the NHS can build on the existing Five Year Forward View for Mental Health strategy. This will ensure an extra two million people are able to get support for their mental health by 2023/24.
Now we need local planners across the country to turn this commitment into a reality and show how they will improve services in their area.
Key priorities for improving services
More investment in mental health services
We need a significant increase in investment in mental health services across every area. Historic under-investment and the huge unmet need highlight how important extra funding for mental health services is.
Better services for children and young people
We need drastic improvements to services for children and young people from early intervention to crisis support. Only one in four children with a mental health problem reported accessing mental health services last year. Plus, more than 500 young people using Child and Adolescent Mental Health Services (CAMHS) waited more than a year between assessment and beginning treatment. Of those young people accessing services, too many are sent far away from home rather than receiving support in their communities.
Age-appropriate care for young adults
Young adulthood can be a difficult stage of life. Young people experience many changes from leaving school to going to work or university and living alone for the first time.
One in six 17-19 year olds experience mental health problems, rising to one in four 17-19 year old women. Providing age-appropriate mental health support to these young people is crucial. Too often, they fall between the gaps between CAMHS and adult services, meaning either care stops, or a sudden shift to services designed for adults.
Better support for GPs
To support people with their mental health, GPs need support too. They can then make sure people access support earlier before their mental health deteriorates.
Ninety per cent of people receiving treatment and care for their mental health do so solely in primary care settings. But to fulfil this role, primary care needs increased investment and support to help ensure people get high quality, holistic and coordinated care for their mental and physical health.
Re-investing in community mental health support
Years of under-investment in community mental health teams has meant that too often they don’t have the resources to keep people with severe and enduring mental health problems well. As a consequence people face long waits for specialist talking therapies and other treatments. So they’re more likely to end up in crisis or needing more expensive inpatient care.
All-age crisis support in every area
An emergency is an emergency. Yet too many people don’t get adequate support from services when they’re in crisis. Availability of crisis support can be patchy and poor A&E responses to people in crisis are all too common.
Too often the experience for young people in crisis is worse. A&E attendances by young people under 18 tripled between 2010 and 2018. But A&E can be a frightening place for a young person facing a mental health crisis. Local areas must ensure that young people experiencing a crisis can get timely help in the right place, whether at home or in the community, through a single point of access.
These services need to take a holistic view of a young person in crisis, taking into account the role of other difficulties at home, in school, or with parents or friends. Joined up working between agencies is crucial to ensure effective follow-up post-crisis.
Better access to a bed close to home
When people need to be in hospital to keep them safe, they should be able to get a bed close to home. However, inappropriate out of area placements remain high. This means vulnerable people are far from their friends and family when they need them most. As well as increasing their stay in hospital, out of area placements also increase the risk of suicide.
Ending use of force
Far too many people with mental health problems still experience dangerous and humiliating restraint. We need to urgently end the use of force in mental health services. We can achieve this by making sure inpatient care provides a therapeutic environment with a range of treatment and support options enabling people to recover. There should also be a focus on de-escalation to avoid the use of restraint, seclusion and over-medication.
Access to psychological therapies has increased over the last four years.
What the NHS Long-Term Plan (LTP) commits to:
The LTP commits the NHS to increasing the proportion of money it spends on mental health services. This means every local area is expected to meet the Mental Health Investment Standard which tracks the growth of mental health spending.
More of the NHS’s spend on mental health should focus on supporting children and young people. These services must be designed to support all children and young people between 0-25 years old. The NHS must avoid the ‘cliff edge’ of transitions between child and adult services, and effectively link NHS care to other support young people may need.
Twenty-four-seven crisis support should match that available to adults, and within ten years all young people needing support from specialist mental health services should be able to receive it.
The LTP recognises the crucial role GPs and other primary care services play in supporting people with their mental health. It provides significant investment in expanded multidisciplinary teams in primary care. These teams will include mental health workers and new Primary Care Networks are being encouraged to support the expansion of social prescribing and personal health budgets. They can improve support for people with mental health problems.
Building on the Five Year Forward View for Mental Health, the NHS has committed to further increasing the number of people able to receive talking treatments through the Improving Access to Psychological Therapies (IAPT) programme.
The LTP also promises to significantly invest in community mental health teams to provide better support for people with severe and enduring mental health problems, and to reduce the time people spend in hospital.
This will include improving access to specialist psychological therapies and trialing a four-week waiting time for receiving support from a community team. The NHS has recommitted to ending inappropriate out of area placements by 2021.
Support for people at crisis point will also improve with NHS 111 providing a single point of access. Further expansion of mental health support in A&E will see 70 per cent of hospitals have a ‘core 24’ psychiatric liaison team by 2023/4.
Meanwhile, the NHS has recognised the value of providing people with alternatives to A&E when they are in crisis. These services include crisis houses, crisis cafes and sanctuaries. They’re often run by voluntary and community organisations, and can be much more suitable and therapeutic environments for people to get support in a crisis.
Questions for your local plan:
Does your plan meet the Mental Health Investment Standard and increase the proportion of funding going to mental health services year-on-year?
Will your plan increase the proportion of the mental health budget being spent on children and young people’s services?
Are effective plans in place that will ensure all children and young people from 0-25 receive high quality and age-appropriate support for their mental health?
How will plans for the expansion of primary care services improve the support available to people with their mental health? Will mental health workers be fully embedded in local multidisciplinary teams, enabling holistic support for people’s physical and mental health?
Will your plan increase investment in community mental health teams, allowing more people to get timely, high quality support when they need it?
Does your plan commit to providing ‘core 24’ standard psychiatric liaison in all hospitals by 2023/24? Will your local plan include investing in alternatives to A&E where people can seek support in a crisis such as crisis houses or sanctuaries?
Is there a clear plan for eliminating inappropriate out of area placements by 2021?
Mental health services: good practice examples
Active Monitoring: A new mental health service for primary care
Active Monitoring is an early intervention service for primary care, enabling GPs to refer patients to specialist mental health practitioners as soon as they present with symptoms of anxiety, depression, low self-esteem or stress. Rather than deteriorating while they sit on a waiting list for talking therapies, patients get support quickly and learn how to proactively manage their mental health.
GPs refer patients directly to a dedicated local Mind practitioner, who guides them through a self-directed, psychoeducational programme of five face-to-face sessions over eight weeks. Patients develop both a better awareness of their mental health and the tools needed to manage their wellbeing. By offering support at an early stage, Active Monitoring aims to help prevent people’s mental health problems from escalating.
This improves outcomes at the client level and reduces pressure on more intensive and more costly interventions.
Active Monitoring is part of our wider IAPT provision. The tier 1 service supports us to engage with people in community and primary care settings, and the outcomes from the service count toward our prevalence and accessibility targets. Working in partnership with Mind supports us to maintain relationships in the local community and we can also draw upon their experience in mental health service delivery."
Gary Flanagan - Senior Commissioning Business Partner – Mental Health, NHS Oldham CCG
Delivery and Outcomes
Since its initial development in 2014 in conjunction with Tameside, Oldham and Glossop Mind, Active Monitoring has been scaled up to 8 localities across England and Wales. In 2018/19:
- Active Monitoring was delivered in over 80 GP surgeries, with new sites scheduled for Summer 2019
- Over 6000 patients were referred to an Active Monitoring practitioner
An evaluation completed in April 2017 showed that 86% of patients that completed the service improved GAD-7 scores, while 83% improved PHQ-9 scores. Ongoing monitoring shows that these outcomes are replicated in every delivery site, while participants also see a substantial improvement in wellbeing (WEMWBS).
Each Active Monitoring site is funded independently, with the majority coming from local Clinical Commissioning Groups and Health Boards. Active Monitoring services have also attracted funding from Primary Care Networks, NHS Transformation Funds and local trusts and foundations.
"The Active Monitoring service has had a profound effect on the management of our patients with anxiety, panic attacks & mild depressive symptoms who can now be seen, assessed, managed or signposted within the surgery & with no waiting times. I have had excellent feedback from patients who have really benefitted from this service. It is the best in house mental health service we have ever had."
Dr Julia Lloyd, Abbey Medical Practice
"Talking to the practitioner has made me feel so much better. Linda has not only been a valued counsellor, but also a good listener and a person who has given me such good advice. I can now see my way again, and although I know I’ve got some way to go before everything is better, at least I’m on my way. Without this wonderful service, I really don’t think I would be here now."
Northamptonshire Crisis Cafes
Local people using mental health services and carers reported there was little help available, particular out of hours, to help avert a crisis and potential A&E visit or admission.
Since 2017, Northamptonshire Minds in partnership with the local trust Northamptonshire Healthcare Foundation Trust (NHFT) has provided several Crisis Cafés from Monday to Sunday being open between 2pm-10pm. Services are offered to those who are 18 plus and feel they have reached a point of crisis and need further support.
People visiting will be offered support by a peer support worker or a mental health worker (NHFT) who can provide support and guidance on how people can get further help, including accessing other Mind services (advocacy, employment support, women’s only drop in services) or support from their GP or mental health and social services or emergency help. The service reports that most people attending in immediate need for support, find this aspect the most useful.
Value for Money
The total service costs £24,363 per month to operate with a saving of between £7,978 and £22,425 per month. Across the year saving of between £95,746 and £269,105 on A&E tariff, Police, East Midlands Ambulance Service and Urgent Care and Assessment Team only. The wider systems savings (GP time, NHS 111, etc) have not been included in the cost saving analysis
Reach and impact
In the last financial year the Crisis Cafes had 1525 attendances across the 16 weekly sessions. A high number of people attended for ‘immediate needs’ i.e. in crisis and this has had a positive impact on use of A&E and other services, such as the Home Treatment Team and GP.
Peer support workers from the Local Minds are trained and supported by the NHFT. Reported system impact has been stronger links with third sector and access to support outside of the trust. Builds out of hours resilience for those experiencing a crisis and releases pressure on typical crisis response services such as police, A&E out of hours GP.
It was reported that people:
Had increased feelings of being safe and supported
Experienced improved service user experience.
Experienced better access to community services through improved pathways.
Age Better Wellbeing practitioners at Sheffield Mind
Sheffield Mind’s Age Better Wellbeing Practitioner service offers free counselling to people aged 50+ - delivered in people’s homes, community venues or at their office. They support older people to develop social capital, confidence, self-worth, self-help skills and a sense of purpose.
The project is part of a £6m investment programme funded by NHS Sheffield CCG and led by South Yorkshire Housing Association (SYHA) to reduce isolation in people aged 50+. The programme is governed by the ‘Age Better in Sheffield Core Partnership’, which includes older people, representatives from Sheffield City Council, Sheffield 50+, NHS Sheffield CCG, Sheffield Hallam University, the VCF Sector and SYHA.
Sheffield Mind has a strong record in service user involvement. This model of community engagement - offering encouragement, training and support to people, who go on to support other community members to get involved - was a dynamic and positive contributor to the principle of getting services and citizens to work together. Their positive local reputation enabled us to target and recruit volunteers and staff who reflect the communities they serve s; for example 50+ counsellors.
Success was enabled by:
- A great belief in the work we do.
- A dedication to delivering a high quality service meant partners were happy to become a part of the intervention.
- A Wellbeing Centre where people felt welcomed and safe; this ensured their first contact was a positive experience. They could talk to a real person, who allowed them time; they felt listened to and this encouraged them to truly engage with the service.
- Counselling sessions at home which meant they saw a high number of people who otherwise simply wouldn’t have been able to access the service.
- A non-judgemental approach – clients were given a safe space to think and talk about their emotions and their life and through this, enabled them to build resilience.
- The main, and most powerful data shows that people generally really engaged with the five Ways to Wellbeing. Attending therapy reduced how often they saw a GP for their mental health difficulties.
- The main learning from this project is around BAME engagement and that it’s a lengthy process to build trust. Some languages don’t have a word for ‘counselling’. Also, for some cultures it feels more natural to be in group situations.
- The Art Therapy group became very popular, so was expanded to another creative therapy: Movement.
- Some people didn’t feel at ease talking about mental health; therefore the language needed to be adjusted. Wording such as “safe space to talk” or “share your worries time” was used.
- First experiences set the tone.
- Feeling safe and listened to makes it easier for people to engage.
- To be able to professionally manage such a big research project, essential resources (admin support and an effective, easy-to-use database) need to be in place.
What do people say about the service?
As a well-being practitioner on the Age Better project, I have vastly improved my skills as a counsellor by working with an age group which has not traditionally accessed counselling. This group of clients have a vast history which sadly for many has never been heard or appreciated…
The ability to see clients in their home has also meant that many people, who would not traditionally been able to access support have been helped.”
Wellbeing Practitioner, male, over 50
Wholeheartedly recommend this service…I can't tell you what a lifeline it has been - as a carer it is easy to become isolated and the service has re-connected me to the world as well as myself."
Former client, female, age 76
I strongly believe that without this service I wouldn't be where I am now. All I did was cry, felt cut off - but from the time that I took part in the scheme I've learnt so much about depression and how to cope with it. I also already recommended a couple of friends to the service."
Former client, male, age 82."
Many people with mental health problems face other challenges in their lives. These include:
• physical health problems
• unstable or unsafe accommodation
• problems with drugs and alcohol
• contact with the criminal justice system.
Because of these challenges, we need a wide-ranging approach to help them recover. This approach needs to focus on people’s goals and challenges around work, relationships, communities, health, care and more.
Key priorities for promoting recovery
Creating closer links
The NHS can help support people with mental health problems with practical challenges by ensuring services have strong links with agencies and community organisations that can offer advice and support. This can include support with benefits, housing, employment, social care and domestic abuse. To make access easier, these sources of support should be close to primary care and mental health services, co-located where possible.
Better access to social care
Access to social care can be crucial to enable people with mental health problems to live well in the community. It can also prevent them having to go to hospital. Social care is also key to helping people leave hospital safely and continue with their recovery. Mental health social work is vital to the Mental Health Act. The NHS must work closely with social care to integrate support for people with mental health problems.
Support to find work
The Individual Placement and Support (IPS) model effectively supports people with mental health problems to find sustainable work when they’re ready. We know that good work is vital for people’s mental health. Work gives people an income, social contact and greater skills and confidence.
Reducing early deaths
NHS England and Public Health England are leading a programme to reduce premature mortality, as part of the Five Year Forward View for Mental Health. We’re not seeing enough progress here. Too many people with Severe Mental Illness are not getting the physical health checks and follow-up care they need.
What the NHS Long-Term Plan commits to
Better employment support
The NHS will offer increased access to Individual Placement and Support for people with severe mental illnesses to find and retain employment where this is a personal goal. In total, 55,000 people per year will have access by 2023/24.
Supporting homeless people
The NHS will invest up to an extra £30million on meeting the needs of rough sleepers. This will ensure the parts of England most affected by rough sleeping will have better access to specialist homelessness NHS mental health support, integrated with existing outreach services.
More physical health checks
By 2023/24, the NHS will further increase the number of people with severe mental illness receiving physical health checks to an extra 110,000 people per year. This will bring the total to 390,000 health checks delivered each year including the ambition in the FYFVMH.
Questions for your local plan
Have key partners outside of the NHS, such as local authorities and local voluntary and community organisations, been involved in the development of your local plan?
Does the plan have targets to increase access to Individual Placement and Support for people with severe mental illness?
Does the plan address homeless people’s mental health needs?
Does the plan include action to ensure people with severe mental illness get their physical health checks?
Recovery: good practice examples
Boosting recovery through connected support
The Oxfordshire Mental Health Partnership brings together six local mental health organisations to make it easier for people to get the right support when they need it. Oxford Mind’s Benefits for Better Mental Health team are a key part of the partnership.
The Benefits for Better Mental Health team provides advice to people with mental health problems on any area of welfare benefits, whatever their circumstances. Through the partnership, the team has built closer links with social work staff working on mental health wards. It now also provides benefits support to people before they’re discharged.
This joined-up approach can make people’s move to independent living easier. They now leave hospital knowing where to get help.
Support during a tough time
Being admitted to or discharged from hospital can be a confusing and disorientating experience. So the team offers a wide range of support including helping people to understand entitlements, fill in forms and navigate a complex and confusing system.
Most people are unable to work after being discharged. So the focus is often on getting a basic income during recovery through Employment Support Allowance, Housing and Council Tax Benefits and the Personal Independence Payment.
Most people need to engage with the benefits agency to claim benefits. But this canaffect their mental health and stop recovery in its tracks. So the team also helps people to plan ahead and have a coping strategy in case things go wrong.
Get active, feel good - improving wellbeing one step at a time
Mind’s Get Set to Go programme helps people with mental health problems find the physical activity that's right for them. It also supports them to stick at it for long enough to feel the physical, social and mental benefits of being active.
The programme is supported by Sport England and the National Lottery.
The 2017 Get active, feel good campaign promoted the link between getting active and improving mental wellbeing to women from South Asian communities. South Asian women have the lowest participation in weekly sport of any group.
The campaign was developed using a Campaign Sounding Board with representatives from Sporting Equals, Asian Sports Foundation, Black and Minority Ethnic Coaches Association, Sport England, Sheffield University and Rochdale and District Mind.
Mind also worked with over 50 women from South Asian communities at a Diwali event at Stanmore Temple, London, discussing mental wellbeing and physical activity barriers.
The campaign was a mixture of offline, online and media activity, aiming to:
Increase awareness of the importance of physical activity if you have a mental health problem, particularly for South Asian women
promote Mind’s high quality, unbiased information about the benefits of sport and physical activity
promote the Get Set To Go microsite to motivate people who are at the ‘contemplation’ and ‘preparation’ stage of their journey to be more physically active
promote the Elefriends online community as a source of practical peer support for people interested in taking up a sport or physical activity.
Mind worked with PAN, a specialist communications agency, to set up a focus group of 12 women from the target demographic to decide how to best to target this audience and develop key messages. Activities included:
Creating the Mind Wellbeing Award at Sporting Equals’ British Ethnic Diversity in Sports awards as part of a partnership
distributing flyers at Sporting Equals’ sport and physical activity groups, South Asian Women’s groups, the London marathon and 150 Mind shops
developing a new short film featuring a GSTG participant, a new blog from a South Asian woman and new social media content promoting the campaign’s key messages.
The campaign reached an estimated 884,292 people both online and off. It helped Mind engage with new audiences and develop new partnerships.
Birmingham and Solihull Mental Health Foundation Trust (BSMHFT) and Birmingham Mind have been working in partnership to deliver a new recovery service at Rookery Gardens since July 2017.
The service represents a new approach to working with people detained under the Mental Health Act who are moving towards rehabilitation into the community. The development of the service involved the closure of two rehabilitation wards that were no longer fit for purpose.
The range of accommodation at Rookery Gardens includes shared houses, shared flats and self-contained single-person flats. The service is staffed 24 hours a day by an integrated team with psychiatric and nursing staff employed by the Trust and recovery navigators employed by Birmingham Mind.
It was a bumpy road at times with both organisations having to compromise but the service is extremely successful in:
- Supporting people to maintain their relationships in their local communities to enable a smoother and more sustained discharge
- reduce people coming back into the hospital
- Having a strong support plan that is based on the person's whole life and helping them see the interplay of factors that keep them well
- Supporting people to find and secure voluntary work/training and employment whilst still at the service
- Creating conditions for peoples sense of ownership and control over their own lives to be increased.
- Increased patient satisfaction and staff satisfaction
- Less time in hospital
Although only running for 2 years now there have been significant financial savings to BSMHFT as well as the improved outcomes for people using the service as stated above. Evaluation of the service also noted the reduction of incidents of aggression on site put down to:
This was a bold move as there is no other model like this in the country but it clearly has blended the best of the two different cultures and knowledge to improve the outcomes for the people in the service.
Reducing health inequalities for people with mental health problems
All too often, who you are and where you live hugely affects how likely you are to develop a mental health problem.
It also affects your experiences of getting treatment and support. And, shamefully, those of us with severe mental health problems are still likely to die 16-20 years earlier than the general population. This needs to end.
We know that Black or black British people are four times more likely to be detained under the Mental Health Act than white people. Meanwhile, black British people are eight times more likely to be out on a Community Treatment Order (CTO).
Black and minority ethnic (BAME) people also report worse experiences and outcomes from services and are more likely to be restrained. There are many reasons for this including discrimination, deprivation and structural racism, stigma and stereotyping.
People from LGBTQ+ communities also have disproportionately high levels of mental health problems. They are more likely to self-harm and have suicidal thoughts, and often have poor experiences of mainstream services.
Women report poor experiences of a mental health system that doesn’t consider their experiences of violence, abuse and trauma.
People with complex needs (for example people with a mental health problem or a drug or alcohol problem) often experience multiple discrimination and fall into the gaps between services. And people with mental health problems smoke 42 per cent of all cigarettes, with smoking rates much higher than the general population.
Finally, there we know that some diagnoses are more stigmatised than others and we need to do much more to ensure has been a woeful response to supporting the needs of people such as those with with personality disorders, have given their poor much better experiences and outcomes.
People from BAME backgrounds are less likely to recover after using IAPT services than the general population.
Key priorities for reducing health inequalities
The Mental Health Act Review sets out how mental health services can continuously engage with BAME groups through an Organisational Competency Framework (OCF). This ensures services are designed and delivered to reflect the needs and preferences of the local community. It also calls for the introduction of culturally competent advocacy and a more diverse workforce with people from Black African and Caribbean backgrounds represented at all levels of the mental health professions.
Offering different models
The NHS should develop different service models, such as online and face-to-face peer support and mentoring. It should also develop partnerships with voluntary and community sector services that have extensive experience of supporting disadvantaged groups.
The Women’s Mental Health Taskforce has set out what national bodies and service providers can do to take a gender- and trauma-informed approach. This has been picked up in the plans to reshape primary and community mental health services. We’re waiting for the next steps from government on the other recommendations.
Supporting people with complex needs
The NHS and wider services must learn from successful initiatives such as the Making Every Adult Matter (MEAM) approach to coordinating care for people with complex needs.
Helping people stop smoking
We welcome the long-term plan’s commitment to offer smoking cessation to people in contact with specialist mental health services. These services need to be tailored to the needs of people with mental health problems and geared to helping people to develop healthy coping strategies.
Supporting people with personality disorders
People with Personality Disorders need better support. The Consensus Statement on Personality Disorders provides a blueprint on action to ensure people with personality disorder are no longer left behind.
What the NHS Long-Term Plan commits to
Making practical plans
Every system plan must show how local areas will address key health inequalities and how additional funding is targeted to disadvantaged and vulnerable groups. This includes people with disabilities, LGBTQ+ and BAME communities. System plans must take account of the patient and carers race equality framework (PCREF) NHS England is developing.
Support to stop smoking
A new universal smoking cessation offer will also be available as part of specialist mental health services for long-term users and in learning disability services. This will include the option to switch to e-cigarettes while in inpatient services.
Questions for local plans
Is your plan ambitious enough in tackling the health inequalities faced by people with mental health problems?
Is the local system working with the voluntary and community sector to reach groups who experience the worst health inequalities?
Does the plan include ensuring better take up of health checks and follow-up care for people with severe mental illness and tailored smoking cessation for people in contact with specialist mental health services?
Is your plan seeking to address race equality when delivering services and within the workforce?
Tackling inequalities: good practice examples
Engaging with Young African Caribbean men
Mind’s Up My Street programme ran between June 2015 and June 2017 and engaged with 298 African Caribbean boys and young men and 501 community members. Up My Street’s main aim was to develop and pilot approaches that could reduce the number of young African Caribbean men in inpatient mental health services.
We worked with organisations that support young African Caribbean men, to help build people’s resilience and address the factors that could put people at risk of mental health problems. We also built links to enable the wider community to support the mental health needs of young people more effectively.
The programme was evaluated by the Centre for Mental Health and was found to improve participants’ wellbeing.
300 Voices is an engagement model developed by Time to Change. It was designed to improve the poor experiences that young African and Caribbean men have encountered historically, and continue to face, when using mental health services and coming into contact with the police and other front-line service providers.
Whilst supporting attitude and behaviour change among professionals, 300 Voices addressed some of the fear and mistrust that exist between young African and Caribbean men and professionals.
Outcome – Islington Mind
Supporting LGBTQ+ people’s mental health in London
Outcome is a client-led LGBTQ+ service that has been run by a lesbian, gay, bisexual and trans team for 15 years. It’s one of the few LGBTQ+ mental health services in London.
Their main aim is to provide a sanctuary for LGBTQ+ people – somewhere safe where they can be themselves. This includes socialising free from discrimination, receiving therapies to improve their mental health, learning new skills and acquiring knowledge to improve their quality of life.
Their guiding principles are:
To treat each other with respect, fairness and consideration
to be mindful of our individual needs – we are all different but equal
to have a safe environment where we can be ourselves and not be judged.
They currently offer the following specialist services:
Freedom From Fear To Love
A project supported by Mind and Lloyds Bank Foundation, assisting LGBTQ+ asylum seekers and refugees with their transition to a newly “out” LGBTQ+ life. They offer opportunities for LGBTQ+ asylum seekers and refugees to socialise, share experiences and make friends.
People can also take part or facilitate peer-support groups and be active in working together to tackle their specific complex and challenging issues.
As well as group support the project offers a personalised individual programme to ensure LGBTQ+ asylum seekers and refugees have access to information and advice. For example, they can get advice on statutory, voluntary and community services/resources, welfare benefits and suitable housing solutions.
The service also offers a drop-in session providing the opportunity to meet and socialise with others in a safe, therapeutic environment.
United in Strength
A service aimed at supporting lesbian, bisexual and trans women who experience domestic violence.
The service offers sessions including a creative writing group, a singing group, free drop-in art sessions, a cooking group and peer-facilitated yoga. The service also offers a number of peer support groups, including a LBT Women Only Space, a men’s group and Mind Scape –part of the London Paranoia and Beliefs Network. There is also an alternative therapies clinic, offering head and shoulders massages and a psychotherapy service.
The service networks with other LGBTQ+ groups and service providers to raise awareness about the specific needs of LGBTQ+ people who experience mental distress. They invite speakers to help empower clients on issues such as combating homophobia, accessing housing, welfare and training support, safer sex, cooking and nutrition and managing debt.
Working with your communities
Co-production means working with the people you support to design services. It has the potential to transform NHS mental health services by ensuring that they meet the needs of all of the community they serve, including marginalised groups. Working with communities, the local voluntary and community sector, local government and other key agencies will be key to developing local plans.
Key priorities for working with your community
Co-production with communities
By increasing the role of people with mental health problems in shaping services, both nationally and regionally, we can deliver support that’s more empowering and cost-effective.
The National Survivor User Network’s 4PI approach sets the standard for co-production of mental health services.
The NHS People and Communities Board have also produced six principles for co-production. All STPs should be reaching out to their communities to develop their local long-term plan.
Working with children and young people
Local areas should engage meaningfully with young people when designing and delivering programmes which affect them. They should give them opportunities to shape the services they use and direct commissioning decisions.
The NHS Youth Forum is already established as a way to include young people. Plus, the Civil Society Strategy committed to including young people in the spread of Citizen Commissioners (local people supported to make decisions on behalf of their communities). They could have a role in shaping CAMHS.
The local voluntary and community sector
Groups like local Minds have a crucial part to play in the co-design and co-delivery of local services as local experts on mental health. From social workers in local authorities to staff in voluntary organisations, many people already help others to define and reach their goals and meet their day-to-day needs.
They also help people overcome discrimination and exclusion. They deliver innovative, effective and popular services that are often designed in partnership with local service users and can be a key partner in delivering mental health pathways.
They have a strong track record in reaching out to marginalised groups that report poor outcomes from statutory services, such as people from BAME groups. They can provide a voice for people with lived experience of mental health problems, as well as facilitating direct engagement.
We need to make sure NHS England and the government recognise the skills and expertise found on the frontline in their national systems, strategies, funding solutions and priorities.
Local authorities need to be a key partner in developing local plans. That’s because they’re responsible for public health and social care, as well as services that support good mental health, like housing, parks, leisure facilities and the planning system.
This should help facilitate integration between health and social care and will encourage local authorities think about the health and wellbeing of their population in everything they do.
What the NHS Long-Term Plan commits to:
Developing local plans
Local areas will be expected to show how they are developing their plan with local communities, local government, the voluntary sector and other local partners, including representatives of the most marginalised communities.
Questions for your local plan:
- How are local communities, the voluntary and community sector and local authorities engaged in shaping the local system plan?
- How will the voluntary and community sector be involved in delivering the plan?
- What long term commitments does your plan include to embed a culture of co-production throughout services?