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Community mental health framework aims to address inequalities in services

NHS England's framework ties in with ten-year plan to develop greater integration between social care and specialist mental health services 

NHS England's new framework ties in with ten-year plan to develop greater integration between social care and specialist mental health services 

Support by social networks, carers and local community groups is crucial for service users
Support by social networks, carers and local community groups is crucial for service users
Picture: iStock
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NHS England’s new community mental health framework for adults and older adults has been developed with a high level of involvement of people with lived experience of mental illness and service use, as well as carers.

Through the adoption of this framework, people with mental health problems will be able to:

  1. Access mental healthcare where and when they need it, and be able to move through the system easily, so that people who need intensive input receive it in the appropriate place, rather than face being discharged to no support.
  2. Manage their condition or move towards individualised recovery on their own terms, surrounded by their families, carers and social networks, and supported in their local community.
  3. Contribute to and be participants in the communities that sustain them, to whatever extent is comfortable to them.

So why is this happening now?

Early intervention teams

The late 1990s saw a huge investment in community mental health services. New policies and a range of new service models brought improvements in mental healthcare for many. These included the development of early intervention teams for people with first episode psychosis, home treatment and crisis resolution teams as well as assertive outreach services to provide targeted services for those insufficiently supported by longer-standing community mental health teams.

‘We must do much more to improve the physical health of people with mental illness and to address the mental health needs of people with long-term conditions’

Over time though, a combination of austerity-driven funding cuts and a tightening of suitability criteria meant that more people found it difficult to access mental health services. Meanwhile, staff in community mental health teams saw their caseloads rise and faced conflicting messages and demands around a focus on recovery and the need to ‘move people on’.

Battered by withdrawal of supportive services

Many people with mental illness felt battered by the withdrawal of supportive services alongside the decimation of welfare benefits. Rates of suicide in those supported in the community appeared to be increasing in contrast to the reductions reported in inpatient mental health services. Increasing numbers of people were being detained under the Mental Health Act 1983 and an independent review of the act called for ‘a reinvigoration of our community services’.

There is also growing recognition that people obtain most support from family, carers, friends and local communities. Good social networks help prevent loneliness, isolation and ill health, and can aid recovery from mental illness. Health and social care services can only do so much, so need to find ways of working more effectively with local communities, organisations and employers.

We must do much more to improve the physical health of people with mental illness and to address the mental health needs of people with long-term conditions. 

Greater focus on local networks and communities

The framework outlined in this and subsequent documents shows how a greater focus on local networks and communities, boosting primary care and developing greater integration between social care and specialist mental health services can help improve the mental and physical health and well-being of the population.

Commissioned by NHS England in 2017, the framework has been published to tie in with the NHS Long Term Plan. Extra funding has been committed to test, evaluate and refine new models of integrated primary and community care in selected areas and then to support the implementation and expansion across all areas of England by 2024.

‘I witnessed a high level of committed collaborative work across a range of professionals, service users, carers and various organisations’

Integral to this will be developments to increase the capacity of the workforce to support community-based care for adults and older adults with, for example, eating disorders, mental health rehabilitation needs and complex mental health difficulties associated with a diagnosis of a ‘personality disorder’.

I must declare an interest.

National adviser

I was involved in the work to develop this framework as a national adviser, drawing on the research my colleagues and I had published on recovery-focused care planning and coordination, and risk and safety planning. I witnessed a high level of committed collaborative work across a range of professionals, service users, carers and various organisations superbly coordinated by the National Collaborating Centre for Mental Health

But don’t take my word for it. Download the framework and have a read.

Find out more


About the author

Alan Simpson @cityalan is professor of mental health nursing, King’s College London. He works across the Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care and the Health Service and Population Research Department in the Institute of Psychiatry, Psychology and Neuroscience, and with South London and Maudsley NHS Foundation Trust

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