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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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?