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Adult mental health services – the NHS long term plan

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Mental health services in England are set to be a key beneficiary of increased investment in health over the coming years under the NHS Long Term Plan.

Funding for mental health services is set to grow at a faster rate than the overall NHS budget will for each of the next five years. The NHS in England already spends over 10% of its budget on mental healthcare, meeting the Lancet Commission on Global Mental Health target for high income countries. The Plan includes the biggest ever investment in mental health services, rising to at least a further £2.3bn a year by 2023/24. This could be further increased by local investment decisions.

But what does the NHS Long Term Plan reveal about how adults and older adults with mental illness will benefit from greater investment?

The Plan sets out a work programme for mental health as one the major conditions affecting the population and identifies significant improvements to mental healthcare in the next two years. Recognising that nine out of ten adults with mental health problems are supported in primary care, the Plan proposes continued focus on community mental health services while also making significant investment in crisis care. A review of progress on the Five Year Forward View for Mental Health identified that core community mental health services need to benefit from the kind of focused investment and service standards that has helped specialist services like IAPT to succeed.

A four week waiting time target for adult and older adult community mental health services will be trialled in some areas with a view to rolling out service standards for community mental health treatment across the whole of England in the decade ahead. This follows the introduction of waiting time standards that are now being implemented for IAPT services, early intervention in psychosis, and children and young people’s eating disorders.

The “world-leading” IAPT programme for common mental health disorders such as depression and anxiety will continue to expand, increasing access for those with a long term condition being a particular focus. By 2023/24, an additional 380,000 adults and older adults will be able to access NICE-approved IAPT services. There will continue to be a push to increase access via online therapy treatment options.

In order to tackle inequalities experienced by those with severe mental illness, the Plan highlights the importance of meeting the target to support up to 20,000 people to find and retain employment by 2020/21. An additional 280,000 people with severe mental health issues will have their physical health needs met by 2021 in an effort to address their poorer overall health and lower life expectancy compared to the general population. Mental healthcare available to the homeless population will also be improved.

For those needing inpatient care, acute out of area placements will be brought to an end by 2021. The Plan points out that capital investment will be needed from the forthcoming Spending Review to enable this to happen.

The Plan goes on to list a range of measures to provide better, more appropriate care to those in mental health crisis. Continuing to emphasise the shift to community based care, the Plan proposes that a 24/7 community based crisis response will be established in all areas by 2021, offering intensive home treatment as an alternative to inpatient admission.

NHS 111 will become a single point of access for 24/7 support in a crisis, within the timeframe of the Plan. Alternative responses to crisis will be more widely available, such as safe havens and sanctuaries. Ambulance services will change to reduce conveyance of patients to A&E and mental health nurses will be posted in ambulance control rooms to triage and respond to relevant calls. For those admitted to hospital, mental health liaison services will be routinely available there in all acute hospital A&E departments with 70% meeting the ‘core 24’ service standards by 2024.

The Plan places an increasing focus on population health and proposes that each locality will tackle the determinants of mental ill health, with more accurate assessments of the need for mental health services and the causes of poor mental health to be undertaken in each area.

Coming in for particular mention are the unmet mental health needs of young people. New dedicated services will help them manage the transition from children’s to adult services. Our next post in this series will look in detail at the Long Term Plan for children and young people’s mental health services.

Read the NHS Long Term Plan and join the conversation on Twitter using #NHSLongTermPlan.

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