Mental health services

Who runs mental health services?

Mental health services are run by NHS organisations, voluntary sector organisations, including charities like Rethink Mental Illness, and private companies. In the language of the NHS, organisations that run services are called ‘providers’.

There are 58 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). This means they can take slightly more independent (of government) decisions about how local services are run and how budgets are spent.

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 it is managed.

NHS organisations work with local authorities to run some mental health services. 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.

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 has 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. Nearly 30 NHS organisations are taking part in the programme. Some 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' (see below).

Some of the changes happening in services run by NHS organisations may also be to do with 'efficiency savings' demanded by the NHS chief executive Sir David Nicholson. The 'Nicholson Challenge' expects NHS organisations to deliver 4 per cent 'efficiency savings' every year until 2014.

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Community-based services and hospitals

Most mental health services are based within the community (rather than in hospitals). On this page, there is information about some of the different types of community-based services and teams, made up of mental health and social care professionals who offer specialist treatment and support to people who experience mental health problems. However, the way community-based services are run varies in different areas.

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).

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 not suitable for people who have been detained under the Mental Health Act.

Specialist mental health outpatient clinics may be based within hospitals. Sometimes these clinics may instead operate from other buildings that are based in the community.

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The role of your GP

Your GP may refer your relative to a specialist mental health service where mental health professionals can make an assessment, give a diagnosis and organise treatment and support. The government says GPs and other health professionals working in primary care services should make sure they know about local mental health services and how to help people access them. This includes services run by voluntary organisations and charities that are not paid for by the NHS.

Your GP should therefore be able to tell you what sort of mental health services are available locally and advise which ones are the most appropriate for your relative.

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Community-based mental health teams

These are teams of mental health professionals who work with people with mental health problems and support them in their homes. The professionals working for these teams include 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. Sometimes they may 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.

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Crisis house

A crisis house offers safe accommodation overnight or for a short period of time to people who are in crisis. They are an alternative to hospital, and often admission can be arranged at any time, day or night. Crisis houses are not available everywhere.

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Crisis resolution teams (also called 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. In the past, people who are in crisis would probably have been admitted to a hospital for treatment. Crisis resolution teams aim to avoid admission to a psychiatric ward by offering people intensive, community-based support at home, or somewhere near their home – at a day hospital, or at a crisis house, for example.

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

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Assertive outreach teams

The mental health professionals who are part of an assertive outreach team aim to stay in touch and 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. 

These sort of teams have been disbanded in some areas.

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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. Research has shown that the earlier people get treatment and support, the better. Some early intervention teams continue to offer specialist support to people for the first few years after they have been given a diagnosis.

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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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 waiting 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. These 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 liaise closely with antenatal services.

There are also mother and baby units staffed by specialist perinatal mental health professionals and staff 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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Psychiatric liaison services

Psychiatric liaison 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 may 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, psychiatric liaison professionals may refer people on to other mental health specialists and services, while in others, they may offer treatment themselves.

Not every NHS hospital has a liaison psychiatry service and there is wide variation in the way these specialist teams work. A report from the Centre for Mental Health published at the end of 2012 called for a development of psychiatric liaison services so they were available in all hospitals, and also potentially in the community.

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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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Recovery houses

Recovery houses are places where people experiencing a mental health crisis can be offered short term support and treatment in a safe environment. They are an alternative to hospital. Recovery houses may be run by voluntary organisations such as Rethink Mental Illness. Recovery houses are not available everywhere.

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IAPT services (Improving Access to Psychological Therapies)

The 'Improving Access to Psychological Therapies' (IAPT) service (supported by government money and run by either NHS or voluntary sector organisations in different areas) was launched with government money to make talking therapies like cognitive behaviour therapy more easily available. So far IAPT services 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; for people who have long-term conditions or medically unexplained symptoms; and for children.

This means CBT for psychosis may become more widely available by 2015 through new IAPT services – the National Institute for Health and Care Excellence (NICE) guideline on schizophrenia says mental health professionals should offer CBT to people to help who are experiencing both positive and negative symptoms of schizophrenia. People who want therapy should be given CBT on an individual basis for at least 16 planned sessions over a period of six months or more. The NICE guideline on bipolar disorder says CBT in addition to medication should be considered as part of a long-term treatment package.

There are currently (at April 2013) six 'pilot' NHS sites where mental health professionals and researchers are developing and working out the best way to run the new evidence-based '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 October 2013) includes working out the most effective way to train therapists. 

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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 child and adolescent mental health services, known as CAMHS.

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.

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

‘Clinical commissioning groups’ are now responsible for planning specialist mental health services (including IAPT services) and ‘commissioning’ them from different organisations that provide services (called 'providers' by the NHS). Those organisations may be NHS 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. Some of the treatments recommended by the National Institute for Health and Care Excellence (NICE) (see What you can expect from the NHS page) may not be available either. However, in August 2012, the Department of Health announced a ‘coming soon’ scheme that will mean in future all NHS organisations must offer drugs or treatment recommended by NICE – or explain to patients why they do not.

Clinical commissioning groups were created by the Health and Social Care Act 2012 and replaced ‘primary care trusts’ or ‘PCTs'.

The clinical commissioning groups are led by local GPs (they also include other health professionals). There has been some concern expressed about how this change will impact on mental health services. In July 2012, for example, members of the All Party Parliamentary Group on Mental Health said they were worried that GPs may not know enough about mental health problems to be able to plan and commission the right sort of services (the concern was expressed in a report Health and social care reform: making it work for mental health).

The Health and Social Care Act is responsible for setting 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. The boards also include representatives of ‘Local Healthwatch’ – a network of new groups set up to represent the views of patients and members of the public. There is a parent 'consumer champion' called Healthwatch England that was launched on 1 October 2012.

NHS England (previously called the NHS Commissioning Board) 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. 

In September 2012, the CQC published the results of a survey of more than 15,000 people who had used specialist mental health services run by 61 mental health trusts in England between July to September 2011. Most people said they had been treated with respect and dignity and had confidence in the health or social care worker they had seen most recently.

However, only 40 per cent of people said they had received a talking therapy in the last 12 months. And almost a quarter – 23 per cent – of those who had been taking prescribed medication for 12 months or longer said that an NHS mental health or social worker had not checked how they were getting on in that time. A large number said they would have liked more support about housing, work, financial advice and benefits.

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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. The Implementation framework also sets out what employers, schools, businesses, local authorities, housing organisations, voluntary groups and care organisations can do to promote good mental health. The Implementation framework is likely to influence the decisions that clinical commissioning groups take about mental health services.

 

 


This page was updated on 23 April 2013
Links on this page last checked: 31 July 2014
Next links check due: December 2014


Other useful websites

GOV.UK: Information and news about the NHS


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


Monitor

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


Other useful websites

National Institute for Health and Care Excellence


Care Quality Commission

The Care Quality Commission’s website includes the results of reviews of different types of NHS and care services, and gives information that can help when making decisions about healthcare.


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


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.