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Further investment and support for mental health services

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The new long-term plan for the NHS in England has vowed to continue further investment and support in mental health services.

NHS England have announced strategies including a 24/7 community-based mental health crisis response, mental health transport services and liaison support in A&E departments to show its commitment to the service.

“We will continue to expand access to IAPT services for adults and older adults”

NHS Long Term Plan

In its NHS Long Term Plan, published yesterday, NHS England outlined ways in which it aims to further support mental health services under its third chapter – titled Further progress on care quality and outcomes.

The health service has announced a “renewed commitment to grow investment in mental health services faster than the NHS budget overall for each of the next five years” as part of its 10-year plan.

NHS England said this pledge means mental health will receive a growing share of the NHS- which will see at least a further £2.3bn a year by 2023-24.

Among the key milestones for mental health services outlined in the plan, are new and integrated models of primary and community mental health care which will give 370,000 adults and older adults with severe mental illnesses greater choice and control over their care and will support them to live well in their communities, by 2023-24.

“The long-term plan represents vital progress towards parity of esteem for mental health services”

Sean Duggan

The plan added that the new community-based offer will include access to psychological therapies, improved physical health care, employment support, personalised and trauma-informed care, medicines management and support for self-harm and coexisting substance use.

It said the move includes “maintaining and developing new services for people who have the most complex needs and proactive work to address racial disparities”.

In addition, the health service has vowed to ensure a 24/7 community-based mental health crisis response for adults and older adults in England by 2020-21. This comes as part of their promise to “expand” services for those who are experiencing a mental health crisis.

According to the long-term plan, in a survey from three years, ago only 14% of adult respondents felt that they were provided with the “right response” in a crisis.

As part of the plan, NHS England said services will be “resourced to offer intensive home treatment instead as an alternative to an acute inpatient admission”.

As previously reported by Nursing Times, NHS England is set to ensure that anyone experiencing a mental health crisis can call NHS 111 and have 24/7 access to support they need in the community.

By 2023-24, NHS 111 will be the single, universal point of access for people experiencing mental health crisis, the plan stated. In this, it was also highlighted that NHS England will increase “alternative forms of provision for those in crisis”.

The plan noted that this includes non-medical alternatives to A&E alternatives to inpatient admission in acute mental health pathways.

Also under the new long-term plan, ambulance staff will be trained and equipped to respond effectively to people in a crisis and new mental health transport vehicles will be introduced, it noted.

It added that mental health nurses will also be introduced into ambulance control rooms to “improve triage and response to mental health calls”.

According to the chapter, “a six-month pilot in the Yorkshire Ambulance Service NHS Trust showed that 48% of mental health calls were usually conveyed to A&E, but only 18% when triaged by a mental health nurse”.

Although the long-term plan does not reference it, Nursing Times previously reported on a different pioneer scheme which aimed to send a specialist nurse and a paramedic in a car on blue lights for people experiencing a mental health crisis.

The London ambulance mental health nurse and paramedic pioneer scheme is expected to reduce mental health hospital admissions by 48% from 58,000 to 30,000 per year by giving people the help they need in the community.

Though no specific mention in the plan, it does state that it will introduce some form of mental health transport vehicle to reduce inappropriate ambulance conveyance or by police to A&E – but does not provide any further details or suggest that it will be rolled out nationwide.

It did claim however, that it will build mental health competency of ambulance staff to ensure that they are trained and equipped to respond effectively to people experiencing a mental health crisis.

Another key strategy for mental health services outlined in this chapter includes the availability of mental health liaison services.

“The mental health sector has been stung particularly hard by the workforce shortages”

Sean Duggan

According to the NHS leaders, in 2016, only 12% of hospital A&E departments had an all-age mental health liaison service meeting the “core 24” service standard, stated the NHS leaders in their plan.

As a result, NHS England have stated in their plan that such services will be in all acute hospital A&E departments and 70% will be at ”core 24” standards in 2023-24, expanding to 100% thereafter.

On another note, the plan also referred to the accessibility of NICE-approved Improving Access to Psychological Therapies (IAPT) services, claiming that by 2023-24 an additional 380,000 people per year will be able to access the service.

“The Five Year Forward View for Mental Health set out plans for expanding IAPT services so at least 1.5 million people can access care each year by 2020-21,” said the new document, referring to the existing five-year plan for transforming mental health services published in 2016.

“We will continue to expand access to IAPT services for adults and older adults with common mental health problems, with a focus on those with long-term conditions,” it explained.

Sean Duggan, chief executive of the Mental Health Network, which is part of the NHS Confederation, said: “The long-term plan represents vital progress towards parity of esteem for mental health services and has come through genuine and meaningful engagement with the sector.

Sean Duggan

Sean Duggan

Sean Duggan

“The £2.3bn ringfenced local investment fund for mental health will help alleviate the severe pressures on the system as well as improve and increase access to mental health services,” he said.

He added: “We welcome the commitment to focus on increased spending for children and adolescent services which will help treat 345,000 more children and young people by 2023-24 (see box, below).

“Implementing clear access standards for community and emergency mental health care is a step towards putting mental and physical health on an equal footing. Meeting these standards will improve the care people receive while at their most vulnerable,” said Mr Duggan.

“But there are challenges to achieving this bright vision,” he said. “The mental health sector has been stung particularly hard by the workforce shortages, with 20,000 vacancies.

“It is vital we have the right staff in the right places to provide care, and they need the right facilities to do so. We look forward to the publication of the NHS workforce implementation plan and the capital settlement as part of the comprehensive spending review,” he said.

Key plans for children and young people’s mental health services under the new long-term plan:

  • NHS England will continue to invest in expanding access to community-based mental health services to meet the needs of more children and young people and by 2023-24, at least an additional 345,000 children and young people aged 0-25 will be able to access support via NHS funded mental health services and school or college-based Mental Health Support Teams.
  • Over the coming decade NHS England’s goal is to ensure that 100% of children and young people who need specialist care can access it
  • Over the next five years, NHS England will also boost investment in children and young people’s eating disorder services- the NHS said it is on track to deliver the new waiting time standards for eating disorder services by 2020-21.
  • Children and young people experiencing a mental health crisis will be able to access the support they need- expanding timely, age-appropriate crisis services to improve the experience of children and young people and reduce pressures on accident and emergency (A&E) departments, paediatric wards and ambulance services.
  • With a single point of access through NHS 111, all children and young people experiencing crisis will be able to access crisis care 24 hours a day, seven days a week.
  • Mental health support for children and young people will be embedded in schools and colleges.
  • A new approach to young adult mental health services for people aged 18-25 will support the transition to adulthood.
  • The NHS said it is making a new commitment that funding for children and young people’s mental health services will grow faster than both overall NHS funding and total mental health spending- meaning for the first time children and young people’s mental health services will grow as a proportion of all mental health services
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