It is important to recognise the progress that has been made by the sector to grow the mental health workforce, expand services and provide the best possible care as close to home as possible with the staff and resources available.
We outline below some examples of the innovation and improvement that has taken place within mental health services in recent years, across the key common themes that have emerged from our conversations with trust leaders about their view of the features of high-quality care.
Many examples highlight how the mental health sector is already delivering the three shifts (across treatment to prevention, hospital to community, and analogue to digital) that the government wants to make in health and care. They also highlight the opportunity that exists to expand the sector's role.
Person-centred, family and carer-friendly, and trauma-informed
Mental health care should be person-centred, family and carer-friendly, and trauma-informed. Seeing the issues that service users are experiencing in the context of past events helps them feel safe and build on their strengths and the support around them. Care must also be holistic, taking into account meeting a person's general physical health needs as well as their wider personal, social and employment needs.
Case study: working with and in the community to provide holistic care
Mersey Care NHS Foundation Trust's Life Rooms service is an innovative model incorporating a strong social and community focus to support people's mental and physical wellbeing. The model has now been replicated in a handful of sites across Merseyside. The service opened in 2018 and is housed in an old library. The team links with over 300 voluntary organisations, Citizens Advice and cultural organisations like the Royal Liverpool Philharmonic, providing support with issues from housing and employment to lifestyle and exercise. Co-production with local people, including with ethnic minority communities, has been fundamental to its success, as well as a willingness of the trust board to take a risk and try a new approach.
Case study: listening and acting with the local community to improve reach and impact
South London and Maudsley NHS Foundation Trust has been focused on its engagement with the ethnic minority communities it serves, with a particular focus on rebuilding trust with these communities through innovative outreach work such as the ground-breaking South London Listens programme. Through the programme the trust has helped create over 50 Be Well Hubs and provided training to pastors in local Pentecostal churches to identify and address poor mental health in their congregations. Over 7,500 families also now have access to a new virtual waiting room co-developed from the trust's work listening to communities.
Staff with the right skills, values and behaviours
Services should be delivered by a skilled multidisciplinary team of staff with the right values and behaviours who can assess holistically and provide high quality interventions and therapy on a consistent basis. Staff having respect, compassion, courage, understanding, and good communication skills is particularly important. Staff should also be an advocate for the people in their care and trained in positive behaviour support. Trust leaders have also suggested that every community team should contain an addiction therapist doing intensive work with service users and their carers. Addiction is a significant cause of mental illness and barrier to recovery, yet very few settings have access to expertise in the management of addictions.
Case study: using values-based recruitment and involving experts by experience
Tees, Esk and Wear Valleys NHS Foundation Trust has an established set of values and a behaviour framework which inform the questions used by recruitment managers when recruiting new staff. The trust involves experts by experience from its service user reference group, supported by independent advocates, in the recruitment process of new staff.
Case study: raising awareness and upskilling staff to improve support
Kent and Medway NHS and Social Care Partnership Trust has embedded staff awareness raising and training initiatives across its organisation, and has a learning disability multidisciplinary team that works to support staff in general mental health services to plan care and provide the right support to people with a learning disability or autistic people so their individual needs can be met within mainstream services when this is the most appropriate setting.
Specialist, time-limited inpatient care focused on recovery
When inpatient mental health care is required, it should be specialist, time-limited and focused on people's return to recovery. There should be clear plans for discharge, supported by high-quality, robust and regular care and treatment reviews. All relevant services, such as housing and community mental health teams, should be involved at the point of an individual’s admission. To help facilitate discharge, secure and high-quality housing provision should be available in places where people want to live, alongside specialist community services with the capacity and resources to support people to remain in their own homes.
Trust leaders have also highlighted the importance of:
- inpatient care being delivered in a therapeutic physical environment that aids recovery;
- seeing people who are referred to mental health services far more quickly; and
- increasing the availability of alternative services to hospital.
Case study: providers and partners collaborating to transform inpatient services
Providers of mental health, learning disability and autism services have been trailblazers in working together, both formally and informally with local partners, to improve the delivery of specialised services at scale through NHS-led mental health, learning disability and autism provider collaboratives. The benefits of this approach are evidenced in reduced inappropriate out-of-area placements, increased investment in community-based services and support, and enhanced patient experience and outcomes.
Case study: delivering improvements to patients' lives while making cost savings
Tees, Esk and Wear Valley NHS Trust has been working with Home Group, a hospital discharge service, to introduce a dedicated service to help reduce patients' length of stay on wards and to support an effective route to discharge people into the community, while keeping patients' needs front and centre. A study of Home Group's two active north east-based hospital discharge services showed there was a reduction in the average length of stay of 71 days per person. Alongside helping patients to be back in their community sooner, this equated to a saving per person of over £27,000, or a total of £1.5m across the 56 service users involved in the study.
Collaboration with service users and people with lived experience
Trusts are developing ways of working in collaboration with service users and people with lived experience to plan and, in some cases, help deliver services. Trust leaders have also emphasised the importance of trusts taking a collaborative approach within their organisation (such as physical health and mental health teams working well together) as well as with local system partners such as commissioners and social care and housing providers.
Case study: drawing on lived experience to design and deliver services
Over 250 people with lived experience of Essex Partnership University NHS Foundation Trust services now regularly work with the trust, actively participating in project and programme working groups, providing peer support to current patients and service users and supporting recruitment processes where appropriate.
Case Study: using information on patient experience to improve services
Berkshire Healthcare NHS Foundation Trust collaborated with an independent healthcare review organisation, iWantGreatCare, to work towards their vision to be recognised as the leading community and mental health service provider by their patients, staff and partners. The trust developed a standardised patient experience measurement framework in collaboration with patients and staff to be used across all of their 160 services in children's, community and inpatient mental health. iWantGreatCare helped the trust develop a set of seven questions that helped gather consistent, reliable and comparable information about patient experience to inform service improvements.
Case study: co-designing the redevelopment of services within the community
South West London and St George's Mental Health NHS Trust worked with patients and services to integrate their services with the surrounding community through their Springfield Village redevelopment project, which is part of a £150m investment co-designed with patients and service users. It provides a new mixed-use community, combining healthcare facilities and residential neighbourhoods in a parkland setting. Springfield Village will include the creation of more than 800 new homes, a new public square, shops and a 32-acre public park.
Enabling earlier access to effective care and reducing care backlogs
Facing a severe demand-capacity mismatch, trusts have been working with local partners to meet the needs of as many individuals in their local areas in the best way possible. We have heard of trusts, for example:
- setting up day services to provide an alternative to admission to hospital;
- using digital solutions to expand access to care where appropriate; and
- working with schools, GPs and their partners in local authorities and the voluntary sector.
Case study: using digital tools to deliver more effective services for patients and staff
Oxleas NHS Foundation Trust has rolled out a series of digital tools designed to allow staff to work in the most effective way possible: spending more time on delivering care rather than on administrative processes. The tools also give patients more control and choice over their care. Before the pandemic, the trust conducted about 1,000 video consultations per year. Now, the trust averages around 2,800 video consultations per month. Virtual appointments are a good option for many patients where this is clinically appropriate, giving them greater choice over how their care is delivered. It also offers greater scope for staff to work flexibly, while continuing to see a higher volume of patients per day.
Case study: collaborating with partners to deliver earlier, more holistic support
Bradford District Care NHS Foundation Trust has worked with Mind in Bradford and other local voluntary and community organisations to provide more intensive holistic support earlier to individuals and better meet growing demand. People are receiving person-centred support earlier, which is having a positive impact on their mental wellbeing. It has also created more capacity for community mental health teams to help address mental health care backlogs.
Case study: using a single point of access
Referrals have increased by over 21% since Lancashire and South Cumbria NHS Foundation Trust introduced a single point of access via their initial response service in 2022, demonstrating significant improvement in access to mental health services. The number of accepted cases by the trust's community mental health teams are around three times more than the NHS benchmark average, and there has been an increase in individuals accepted into services in year by 37%.