Mental health services

Who runs mental health services?

Mental health services are run by NHS organisations as well as voluntary sector organisations (including charities like Rethink Mental Illness) and private companies that are paid – or 'commissioned' – by the NHS. In the language of the NHS, organisations that run services are called ‘providers’.

There are 51 specialist NHS mental health trusts in England and most of them are already, or soon to be, ‘foundation trusts’ (the government has said all NHS trusts must become foundation trusts as soon as possible). Foundation trusts are independent legal entities that are managed by a board of directors. They are not run for profit and are regulated by an organisation called Monitor, rather than the Department of Health.

People who use services, their family members, staff, nearby residents and representatives of local organisations can all become 'members' of a foundation trust: the idea is that members can have a small say in how the organisation is managed via governors who are elected to represent them and advise the board of directors. If you are a member of a foundation trust, you can vote to elect governors and stand to be one. Governors include patients, staff, local people and representatives of local organisations (the local authority for example).

NHS organisations and local authorities work together to run some services for people who experience mental health problems. In some parts of the country, NHS organisations work with local authorities more formally through 'care trusts' – these sorts of organisations run both mental health services and social care services.

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The role of your GP

The government says GPs and other health professionals working in primary care services should make sure they know about mental health services that are available in their neighbourhood, and how to help people access them.

If your relative is having experiences that may be the symptoms of psychosis for the first time, the GP should refer him or her to an early intervention service (see below) where specialists will carry out an assessment and arrange appropriate treatment and care (as recommended in the 2014 National Institute for Health and Care Excellence (NICE) guideline about psychosis and schizophrenia*). GPs should not prescribe antipsychotics without talking to a consultant psychiatrist.

If your GP thinks your relative has bipolar disorder, they should refer him or her to a specialist bipolar disorder team, or to an early intervention service (as recommended by the 2014 NICE guideline about bipolar disorder).

If your relative has previously been unwell and has been given a diagnosis of a mental illness such as schizophrenia or bipolar disorder, the GP should refer him or her back to specialist mental health services.

If a GP refers your relative to specialist mental health service, he or she could, in theory, be given a choice. The NHS 2014/15 'Choice Framework' (published in April 2014) says people who need to see a mental health specialist as an outpatient can choose where to have their first appointment, and choose which consultant (or other health professional)-led team they see. However, your relative can only choose a team or an organisation that offers the right sort of specialist care and treatment (see 'Services for people who are in a crisis' below). Your relative does not have a right to choose if he or she needs urgent or emergency treatment, or if he or she is detained under the Mental Health Act, or if they are referred to high secure psychiatric services – see 'Forensic mental health services' below.

After experiencing an episode of psychosis, your relative may be discharged from mental health services into to the care of their GP.

The GP practice should have a register of all people who have experienced psychosis to ensure they receive the right care. This will include the names of patients registered with the practice who have been given a diagnosis of schizophrenia, bipolar disorder of schizoaffective disorder (though not everyone who has bipolar disorder experiences psychosis).

*Psychosis and Schizophrenia in adults, NICE Guideline on Treatment and Management, updated edition 2014, does not include recommendations about treatment for people who experience psychosis as a symptom of bipolar disorder, psychotic depression, dementia or Parkinson's disease. These recommendations are contained in other NICE guidance.

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Community-based services

Most mental health services are based within the community (rather than in hospitals), though some specialist outpatient clinics may operate from hospital premises. On this page, there is information about some of the different types of community-based services and teams that are made up of mental health and social care professionals who offer specialist treatment and support to people who experience mental health problems.

Community-based mental health teams comprise psychiatrists, mental health social workers, community psychiatric nurses, psychologists and occupational therapists – all the main professions involved in mental health care. Many teams include a vocational specialist or advisor who can help people prepare or look for work.

Community-based mental health teams operate differently in different parts of the country, depending on the policies of the local NHS mental health trust and local commissioning organisations that spend the NHS budget and plan services in a particular area. Sometimes community-based teams focus on a specific area such as ‘recovery’, or on a specific condition, such as psychosis, or they may be an ‘assessment’ team or a 'treatment' team. Other community mental health teams are ‘generic’, offering support and treatment for a wide range of problems.

Each team will probably have its own base. Team members may see people they support at the base, or they may see people in their own homes, at GP surgeries or at other venues.

The 2014 National Institute for Health and Care Excellence (NICE) guideline about the psychosis and schizophrenia* says all community-based teams should offer people they support all NICE-recommended treatments – including cognitive behaviour therapy for psychosis and family therapy. NICE also recommends that all teams supporting people who have experienced psychosis or who have a diagnosis of schizophrenia or bipolar disorder, should comply with the 2011 quality standard 'Service user experience in adult mental health' (see NICE quality standards page).

*Psychosis and Schizophrenia in adults, NICE Guideline on Treatment and Management, updated edition 2014, does not include recommendations about treatment for people who experience psychosis as a symptom of bipolar disorder, psychotic depression, dementia or Parkinson's disease. These recommendations are contained in other NICE guidance.

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Early intervention in psychosis teams

These specialist teams of mental health professionals work with young people who are experiencing symptoms of psychosis for the first time. The National Institute for Health and Care Excellence recommends people are experiencing symptoms that could be bipolar disorder are assessed and treated by early intervention professionals if a specialist bipolar disorder team is not available.

Early intervention services are run differently in different parts of the country, but all aim to give people and their families appropriate help, treatment and support, including information to help them make sense of what is happening.

Many early intervention teams work closely with other services and agencies to help someone get back to/continue to work or study, sort out benefits and finances and solve any housing problems.

Early intervention teams are usually made up of a range of mental health professionals, including psychiatrists, psychologists, mental health nurses, social workers and support workers. Some teams include vocational advisors or employment support workers (see Early intervention services page). 

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Services for people who are in crisis

Hospital beds are available for people who are very unwell. Sometimes there are specialist wards for people with the same, or a similar, diagnosis that are staffed by doctors who have a particular expertise in this area. Other wards are more general and care for people with all sorts of mental health problems.

Someone with a mental health problem can voluntarily go to hospital if their psychiatrist suggests this would be the best option for them at that time. People can also be compulsorily detained in a hospital under the Mental Health Act if it is in the interests of their health, their safety, or the safety or other people (see Psychiatric wards and Mental Health Act pages).

The National Institute for Health and Care Excellence guidance about psychosis and schizophrenia* recommends people who are very unwell should be treated at home if at all possible (see 'Crisis resolution and home treatment teams' below). If someone does need care in hospital, NICE says the ward where they are admitted should be suitable for them.

A 2014 media investigation highlighted that in the last two years, mental health trusts have cut the number of hospital beds: as a result, people who are unwell have sometimes had to travel miles for treatment and/or have been admitted to wards that are not suitable for their age or symptoms.

*Psychosis and Schizophrenia in adults, NICE Guideline on Treatment and Management, updated edition 2014, does not include recommendations about treatment for people who experience psychosis as a symptom of bipolar disorder, psychotic depression, dementia or Parkinson's disease. These recommendations are contained in other NICE guidance.

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Crisis resolution and home treatment teams

These are teams of mental health professionals who treat people with serious mental illness when they are very unwell – when they are experiencing an episode of psychosis, or have tried to take their own life, for example.

Crisis resolution teams aim to avoid admission to a psychiatric ward by offering people intensive, community-based support at home. They should offer a 24-hour, 7-day-a-week service. The teams consist of nurses, psychiatrists and support workers who can prescribe and monitor medicine, help resolve practical difficulties, offer talking therapies and support family members.

Crisis resolution teams 'gate keep' – they assess people who are in crisis and decide whether they can offer appropriate support or whether that individual needs to be admitted to hospital.

After the crisis has passed, crisis resolution team members are also responsible for planning what happens next in terms of the ongoing care and support offered to an individual.

If someone is admitted to a psychiatric ward, the crisis resolution team may offer support when the individual is first discharged from hospital.

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Day hospitals and crisis houses

In some parts of the country, people who are very unwell may be offered support at acute psychiatric day hospitals instead of being admitted to a traditional psychiatric ward. Day hospitals are an alternative to home treatment for people who have support at home in the evening and at night, but not during the day. They are not suitable for people who have been detained under the Mental Health Act.

In a small number of places, there are residential crisis houses that offer safe accommodation for a short period of time to people who are very unwell. They are an alternative to hospital for people who do not want to be admitted but cannot be treated at home by the crisis resolution team. This may be, for example, because someone has no support at home. Crisis houses are staffed around the clock by trained mental health staff or trained support workers. The local crisis resolution and home treatment team will work very closely with a crisis house.

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Assertive outreach teams

The mental health professionals who are part of an assertive outreach team aim to help people who have a history of serious mental health problems but who find it difficult to keep in contact with mental health services, even though they may still need treatment. Assertive outreach teams (or AOTs) will visit people at home, at flexible times, or at a location of an individual's choice, and encourage them to accept support and treatment from mental health services again. In some areas, these kinds of teams have been disbanded.

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Forensic mental health services

Forensic mental health services are for people with mental health problems who have been arrested, who are on remand or who have been to court and found guilty of a crime.

Forensic mental health units are an alternative to prison for people who have mental health problems and offer specialist treatment and care. They are ‘secure’ units, which means that people who are referred there are not free to come and go. Most people are detained in secure forensic services under mental health legislation.

People with mental health problems can be transferred to forensic mental health units at the time of arrest, during court proceedings, or when they are in prison. They may be referred while they are on remand and awaiting trial. A referral is usually made following an assessment of an individual’s needs, or a psychiatric report.

Some areas also offer community-based forensic services. There are specialist teams of mental health and social care professionals who may, for example, offer support to people discharged from a forensic unit (see Forensic mental health services page).

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Perinatal psychiatric services

Perinatal psychiatric services support women who experience mental health problems around the time of pregnancy and birth – women who experience puerperal psychosis, for example (see New mothers page). Perinatal specialists – including psychiatrists and mental health nurses – may be based within ‘liaison perinatal psychiatric services’ in general hospitals where they work closely with antenatal services.

There are also mother and baby units staffed by specialist perinatal mental health professionals and other team members who can help care for new born babies. In some parts of England, there are perinatal psychiatric community teams offering support to pregnant women and/or new mothers in their own home.

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Liaison psychiatry services

Liaison psychiatry services are made up of specialist teams based in general hospitals, working on accident and emergency departments and inpatient wards.

Members of the team can assess and treat patients who may be experiencing mental health problems while they are in hospital for a physical health problem. They work with older people who are experiencing dementia or delirium, for example, or with people who have come to casualty because they have self-harmed or are in crisis. 

In some hospitals, liaison psychiatrists will refer people on to other mental health services, while in others, they offer treatment themselves.

Not every NHS hospital has a liaison psychiatry service and there is wide variation in the way these specialist teams work. Many organisations, including the Centre for Mental Health and the Royal College of Psychiatrists, have called for the development of psychiatric liaison services so they are available in all hospitals, and also potentially in the community.

In October 2014, the government pledged to invest money in 2015/16 on providing a liaison psychiatry service in more hospitals ('Achieving better access to mental health services by 2020', published by the Department of Health/NHS England).

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Recovery

Many NHS organisations are currently re-organising and re-structuring their services to make them more supportive of people’s personal recovery rather than just focusing on medication and other treatments (see Recovery page).

For example, the Department of Health commissioned the NHS Confederation’s Mental Health Network and the Centre for Mental Health to run the ‘Implementing Recovery through Organisational Change’ (ImROC) programme. The programme, which started in April 2011, ultimately aims to change how NHS mental health services operate and has included training for front-line staff to make sure their way of working supports recovery. Some NHS organisations have hired paid peer support workers – people with personal experience of mental health problems – to work alongside mental health professionals. Others are developing 'Recovery Colleges'.

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Recovery Colleges

A Recovery College is a new type of service that gives people with mental health problems the opportunity to access education and training programmes designed to help them on their road to recovery.

The courses are devised and delivered by people with personal experience of mental illness working together with mental health professionals.

The idea is that Recovery Colleges help people become experts in self-care and give them the skills and confidence they need for work and get on with their lives. You can find out more at the Centre for Mental Health website where you can download a briefing paper about Recovery Colleges that have been set up as part of the 'Implementing Recovery through Organisational Change' (ImROC) programme.

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IAPT services (Improving Access to Psychological Therapies)

The 'Improving Access to Psychological Therapies' (IAPT) service was launched by the government to make talking therapies like cognitive behaviour therapy more easily available. Either NHS or voluntary sector organisations run IAPT services. So far, they have concentrated on offering support to people who have depression or anxiety. Now IAPT services are being developed for people who have a serious mental illness such as schizophrenia. This means CBT for psychosis may become more widely available in future.

There are six 'pilot' NHS sites where mental health professionals and researchers are developing and working out the best way to run a new talking therapy service for people who have experienced the symptoms of psychosis; for people who have been given a diagnosis of bipolar disorder; and for people who have been given a diagnosis of a personality disorder.

The pilot work (that started in November 2012 and is due to end in 2015) includes working out the most effective way to train therapists. To find out more, visit the IAPT website.

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Children and young people

Mental health services for children and young people aged up to 18 in England are provided by specialist child and adolescent mental health teams, known as CAMHS (Child and Adolescent Mental Health Services).

All professionals working in CAMHS specialise in working with children and young people, and include psychiatrists, psychologists, social workers, psychiatric nurses, psychotherapists, occupational therapists and family therapists.

GPs can make a referral to CAMHS. Sometimes teachers, health visitors, school nurses and social workers can also make referrals.

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Who decides what mental health services are available in your area?

‘Clinical commissioning groups’ are responsible for planning specialist mental health services and ‘commissioning’ them from different organisations that provide services (called 'providers' by the NHS). Those organisations may be NHS trusts or foundation trusts, voluntary sector organisations, including charities, or private companies.

The sort of mental health services available in each area is determined by the way clinical commissioning groups decide to spend their budget. This means some of the types of services described on this page may not be available where you live.

Clinical commissioning groups were created by the Health and Social Care Act 2012 and are led by local GPs.

The Health and Social Care Act also set up various other new organisations and structures. These include ‘health and wellbeing boards’, made up of representatives from the clinical commissioning groups, local authorities and public health experts. The role of health and wellbeing boards is to help plan local health and social care services.

NHS England oversees the clinical commissioning groups and allocates their budgets. NHS England is also responsible for commissioning some specialist mental health services. The Department of Health is no longer the headquarters of the NHS, and no longer directly manages any NHS organisation. Its role is now to 'shape and lead' the new health and care system – setting national policies, for example.

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Care Quality Commission

The Care Quality Commission inspects and checks the quality of all health services and adult social care services that are provided by the NHS, local authorities, private companies and voluntary organisations in England. The Care Quality Commission also protects the interests of peoples whose rights are restricted under the Mental Health Act. 

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Government policy

The government published a new mental health strategy in February 2011. 'No health without mental health: a cross-government mental health outcomes strategy for people of all ages' stresses that mental health is as important as physical health. It aims to improve people’s mental health and wellbeing through 'high quality services' and focuses on early intervention and prevention, recovery and challenging stigma and discrimination.

In July 2012, the government published plans for making the recommendations of 'No health without mental health' happen. This document is called the 'Implementation framework' and was co-produced with five mental health organisations – Rethink Mental Illness, the NHS Confederation Mental Health Network, the Centre for Mental Health, Turning Point and Mind.

'Closing the gap: priorities for essential change in mental health' was published in January 2014. This paper listed 25 'priorities for action' to improve mental health care over the next two to three years. The priorities included introducing target waiting times for mental health services (for the first time ever) and making sure commissioning organisations get information about what mental health services are most effective to inform their decisions

In October 2014, the government published 'Mental health services: achieving better access by 2020'. This document pledges to set waiting times for mental health services (as there are for physical health services) and promises to allocate more money to provide inpatient beds for children, and expand IAPT services, liaison psychiatry and early intervention services in 2014/15 and 2015/16. 

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Friends and family test

NHS England has introduced the friends and family test to enable people to provide feedback on the services they have received. The theory is that the test – that asks patients and service users how likely they are to recommend the service to your friends and family –can help to identify poor quality services. It was first introduced in accident and emergency departments and on wards in April 2013. Now NHS England plans to introduce it into GP practices from December 2014 and in mental health services from January 2015.

 

 


This page was updated on 24 November 2014
Links on this page last checked: 24 November 2014
Next links check due: April 2015


Other useful websites

NHS Choices: A-Z of mental health trusts in England


GOV.UK: Information and news about the NHS


The health and care system explained, published by the Department of Health, 26 March 2013


Resources

No health without mental health: a cross-government mental health outcomes strategy for people of all ages

published by HM Government, 2 February 2011


No health without mental health: implementation framework

published by Department of Health et al, July 2012


Closing the gap: priorities for essential change in mental health

published by Department of Health, January 2014


Mental health services: achieving better access by 2020

published by Department of Health/NHS England, October 2014


Other useful websites

Care Quality Commission


Monitor

Monitor is the independent regulator of NHS foundation trusts. You can find out more about how foundation trusts operate by visiting this website.


Resources

Guides to help develop better mental health services

The Centre for Mental Health and other mental health charities have created the 'Mental Health Strategic Partnership'. The Partnership has produced a series of 'No health without mental health' briefings to help clinical commissioning groups, local Healthwatch, health and wellbeing boards and other policy makers make sure there are good quality mental health services in their area. The briefings were commissioned by the Department of Health and published in October 2012.

You can download them all at the Centre for Mental Health website.