Mental health services

• Who runs mental health services?
• Foundation Trusts
• Community mental health teams
• Crisis resolution teams (also called home treatment teams)
• Assertive outreach teams
• Early intervention in psychosis teams
• Outpatient clinics
• Psychiatric hospitals
• Acute day hospitals
• Forensic mental health services
• Care Programme Approach
• Children and young people
• Government policy
• National organisations involved in mental health care

Who runs mental health services?

The NHS has primary and secondary services. Primary care services are your first point of contact with the NHS: your GP, your dentist, your optician, for example. NHS walk-in centres, and the NHS Direct phone service are also primary care services.

These services are managed by organisations called NHS Primary Care Trusts – you may see them described as PCTs, though ‘PCT’ is no longer in their title. They are now just called ‘NHS’ followed by the name of the area they cover – NHS Southwark, for example. 

These trusts spend about 80 per cent of the total NHS budget: they each cover a specific area and decide what health services the people living within their boundaries need. PCTs are responsible for providing health services directly, or for paying other organisations to provide them. This is called commissioning. PCTs work together with local authorities as joint commissioners to plan and provide some services, particularly community mental health services.

Secondary services are specialist services, often provided by other sorts of NHS Trusts. These include specialist mental health services, provided at hospitals, outpatient clinics, or by community-based teams of health professionals. Joint commissioners make decisions about the type of specialist services they buy – or commission – from other Trusts to meet the needs of the populations they serve. Most mental health services are run by NHS Mental Health Trusts but they are usually integrated services. This means they include social workers employed by the local authority.

The sort of mental health services available varies according to the way local NHS organisations decide to spend their money. The types of services and community-based teams listed on this page may be called different names in different areas, or may not be available in your neighbourhood.

GPs refer people to the specialist services they need and will know what mental health services are available locally.

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Foundation Trusts

Many NHS Trusts are Foundation Trusts. This is a status conferred by the Department of Health that gives the NHS organisation a little more power over how it runs its services and how it spends its budget. Local people and local organisations can become members of Foundation Trusts to have a say in how they are managed.

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Community mental health teams

These are teams of mental health professionals who work with people with mental health problems. You may see community mental health teams referred to as CMHTs. The professions 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. Some include vocational advisors who can help people prepare or look for work. Each team member often has their own individual case load. Community mental health teams have been around for a long time and have become the mainstay of community-based (as oppose to hospital-based) mental health care.

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Crisis resolution teams (also called home treatment teams)

These are teams of different types 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 usually have been admitted to a hospital for treatment. Crisis resolution teams (or CRTs) aim to avoid admission to a psychiatric ward by offering people intensive, 24-hour community-based support, either at home or somewhere nearby – a day centre or crisis hostel, for example.

After the crisis has passed, crisis resolution team members are responsible for planning what happens next in terms of the ongoing care and support offered to an individual. This often involves referral to the community mental health team.  

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Assertive outreach teams

Nurses, social workers and other mental health professionals make up these teams, which aim to contact and help people who have a history of serious mental health problems but who find it difficult to keep in contact with community mental health teams, 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 the person’s choice rather than expect them to keep appointments. Members of an assertive outreach team share responsibility for the people they work with rather than having individual caseloads.

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Early intervention in psychosis teams

These specialist teams of mental health professionals work with people aged between 18 to 35 who have experienced their first episode of psychosis, or who are having experiences that may herald a first episode, or who have been unwell for less than three years. Early intervention teams offer a wide variety of support packages to people who are referred to them (see Early intervention services page).

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Outpatient clinics

People with mental health problems may be treated at specialist outpatient clinics run by NHS Mental Health Trusts. Outpatient clinics are often based in community mental health centres or local hospitals.

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Psychiatric hospitals

Someone with a mental health problem can voluntarily admit himself/herself to hospital if their psychiatrist agrees 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 of other people (see Psychiatric wards and Mental Health Act pages).

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Acute day hospitals

Acute psychiatric day hospitals offer diagnosis and treatment to people who are very unwell who would otherwise by admitted to a traditional psychiatric hospital ward. They are not suitable for people who are detained under the Mental Health Act.

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Forensic mental health services

Forensic mental health services are for people who have mental health problems who have committed a serious criminal offence, or who are thought to be at high risk of committing a serious crime.

Forensic mental health services are usually based in ‘secure’ units and hospitals when people who are being treated are thought to be a risk to themselves or to other people. There are different levels of secure units: low, medium and high. Some areas also offer community-based forensic services for people who do not require hospital but who have previously committed offences, or at risk of committing offences if they are not treated.

There are three high security hospitals in England and Wales that are used to treat people being held under the Mental Health Act and who are thought to pose a significant danger to the public. They are Ashworth, Rampton and Broadmoor. A small number of people are held indefinitely in high security hospitals because they are thought to pose a serious threat to the public because of a previous history of physical and/or sexual violence.

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Care Programme Approach

People with a high level of needs, or who receive care from more than one professional may be offered a package of mental health services under the Care Programme Approach (CPA). This means the health and social needs of an individual are assessed and then a written ‘care plan’ is produced, detailing all the services that individual is to be offered. Each person receiving care under the CPA should have a care co-ordinator, an individual mental health professional responsible for making sure he or she has access to all the services in the care plan. Each care plan should be regularly reviewed to make sure the services it includes are still appropriate. Family members can only see the care plan with the permission of the individual they support. People with less complex needs or who are seeing just one mental health professional may not be treated under the CPA. They should still be given clear information about the care they are offered, including advice on how to seek care in a crisis, or if their needs change.

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Children and young people

Mental health services for children and young people aged up to 18 are provided by Child and Adolescent Mental Health Services, known as CAMHS.

Professionals working in CAMHS are employed by a range of organisations, including different types of NHS Trusts and local authorities social services or education departments.

There are four ‘Tiers’ of services offered by CAMHS, although the way services are organised varies across the country.

Tier 1 services are provided by professionals who are not mental health specialists: GPs, for example, health visitors, school nurses, teachers, social workers, youth justice workers and voluntary agencies. They can refer children and young to more specialist services.

Tier 2 services are provided by children and adolescent mental health specialists working in community-based venues like GP practices, paediatric clinics or schools. These specialists could include psychologists and counsellors, for example.

Tier 3 services are specialist services for children and young people with more severe and complex problems. They are usually provided by specialists working in a community mental health clinic or child psychiatry outpatients clinics. The professionals offering these services are likely to include child and adolescent psychiatrists, social workers, clinical psychologists, community psychiatric nurses, child psychotherapists and occupational therapists.

Tier 4 services are for children and young people with the most serious mental health problems. They may be provided in day units, highly specialised outpatient clinics or in-patient units.

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Government policy

New Horizons: a shared vision for mental health is a document from the Department of Health published in 2009, outlining how mental health services should be developed in England and Wales over the next 10 years.

The development of NHS mental health services in England and Wales over the past decade was governed by the previous policy document called the Mental Health National Service Framework (NSF), published in 1999. This report included plans for early intervention services and increased access to talking therapies, both of which have been implemented.

The plans outlined in New Horizons include:
• Providing services and treatments in a way that people with mental health problems want them provided;
• Giving people more of a say in the treatment they receive;
• Helping people to understand mental health problems and stopping unfair treatment of people with mental health problems;
• Help and support for young people when they transfer from child and adolescent mental health services to adult mental health services when they are 18.

The National Service Framework for Children, Young People and Maternity Services (the Children’s NSF) is the government’s 10 year programme governing policies on children’s health, including mental health. It was launched in September 2004.

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National organisations involved in mental health care

National Institute for Health and Clinical Excellence
The National Institute for Health and Clinical Excellence (NICE) is responsible for producing ‘clinical guidelines’ for health professionals, which state how people with specific illnesses and conditions should be cared for in England and Wales. NICE also produces ‘technology appraisal’ guidance, which advises on when and how drugs and other treatments and procedures should be used in the NHS (see What you can expect from the NHS page).

Department of Health
The Department of Health is the government department responsible for strategies, policy and guidance about health care (including the NHS), social care, health protection, health improvement and health inequalities issues.

Care Quality Commission
The Care Quality Commission is the independent regulator of health and social care in England. The organisation inspects and checks the quality of health and adult social care services that are provided by the NHS, local authorities, private companies and voluntary organisations. It is also charged with protecting the interests of peoples whose rights are restricted under the Mental Health Act. The Care Quality Commission replaced the former Healthcare Commission, Commison for Social Care Inspection and the Mental Health Act Commission in April 2009.

National Mental Health Development Unit
This Unit was launched in April 2009 and runs programmes funded by both the Department of Health and the NHS. It also advises on the best way to improve mental health and mental health services. The Unit takes over some of the work previously carried out by the National Institute for Mental Health in England.