One of the saddest things I’ve seen is patients who have been let down by a lack of service integration, who have had to tell their story multiple times and have fallen through the cracks, not getting the support they needed.
That’s why bolstering and building up our community mental health services across England is one of the most important and significant programmes of investment in mental health in the next few years.
One of the most ambitious areas in the NHS Long Term Plan, the community transformation programme, will finally build up the investment in services and strengthening of links with primary care that those of us on the frontline have been crying out for. Every local area in England is embarking on a new journey to increase provision and support to plug the gaps we’ve been concerned about for years.
We often talk about change in the NHS. There are countless restructures, service reconfigurations, “new ways of working.” Those working in or with mental health services for some time may, understandably, say, “Well, what is really going to change here?”
Significant investment, enabling general practice and mental health to collaborate much more closely, and new specialist help for people with previously underserved mental illnesses and support needs are the main areas of change.
But most of all we might be able to finally find the answers to vital questions around overall improvement of community services.
How can we better provide ongoing support for people with severe mental illness? How can we help those who fall through the gaps between IAPT and secondary care mental health services? How can we better support people with a diagnosis of “personality disorder,” eating disorders, psychosis, or people with mental health rehabilitation needs? How can mental healthcare support physical health?
And, how can we work more closely with our colleagues in general practice and with primary care networks?
To support services in implementing these changes and making the most of the new investment, the National Collaborating Centre for Mental Health published the extended Community Mental Health Framework in February this year. Previously, a short version of this guide had been available, and was being used by the sites who’ve been piloting the new approaches over the last year.
The framework is an essential read for anyone working in community mental health services or primary care mental health, as well as for managers and service planners, and anyone involved in the rollout of the new models.
The investment that comes with all this is incredibly welcome. It doesn’t mean there aren’t challenges though, and there is an elephant in the room.
The diverse range of roles who will be part of delivering this, both from the side of primary care and mental health care, is very exciting. But we still need more psychiatrists across specialties, and the other roles that make up our multi-disciplinary teams are vital too.
Although the Long Term Plan is delivering in getting investment to the front line for these services, there was never an accompanying workforce plan developed, which has been acknowledged to be a huge gap from voices across the healthcare sector. At the Royal College of Psychiatrists, we are calling for a doubling of medical school places, and a multi-year settlement for training and education to grow the workforce needed to help us deliver the Long Term Plan overall.
As services start to embed the changes needed to better support our patients, welcome new colleagues to their teams, and link in with their colleagues in primary care, I hope the Community Mental Health Framework will help guide the setup of new pathways and working relationships. Despite the ongoing need for a bolstered workforce, new roles are being recruited as we speak for community transformation efforts, and my hope is that new teams will come together quickly to move this important work forward.
It is an exciting time to be working in community mental health, and we must seize the opportunity to help our services grow and evolve to make sure we’re offering our best to our patients.
Billy Boland, chair, General Adult Faculty, RCPsych and Medical Director, South West London and St George’s Mental Health Trust
Competing interests: none declared.