Beyond the headlines: how mental health services are driving transformation under pressure

Introduction

Across the country, mental health trusts have been driving large‑scale transformation for years, well ahead of the 10-year health plan and its three shifts. Yet the picture presented by high-profile inquiries, investigations and headlines is often incomplete. It risks telling a story of a sector defined solely by failure, rather than one making inroads for patients while grappling with unprecedented demand, constrained resources and a rapidly evolving operating environment. Public discussion often misses the innovation and the sheer scale of transformation that has already taken place - and continues to take place - across mental health services every day. The sector has been a real trailblazer in improvement, demonstrating what modern mental health care can look like when innovation is supported.

In recent years, mental health services and the trusts that provide them have been thrust into the national spotlight, often in the most challenging of circumstances. The families and loved ones of all those whose care and treatment fell short deserve answers and lessons must be learned. Trust leaders are committed to making improvements and to ‘letting the light in’ where needed, and understand that listening to patients, communities, service users and their families is a key ingredient to making improvements. 

As government and the NHS prepare to set out a new approach for mental health in 2026, with Nick Broughton recently appointed as the new National Priority Programme Director for Mental Health, Learning Disability and Neurodevelopmental Conditions at NHS England, there is a critical opportunity to reset the narrative. A more balanced public discussion around mental health care is needed to ensure evidence-based improvement efforts are supported. Focusing only on failings risks obscuring what is working and demoralising staff, both of which can stall hard-won progress already underway.  If momentum is to be sustained, national policy approaches must reflect the reality: acknowledging success while clearing the obstacles that prevent trusts from realising their full potential.

This piece highlights the transformation in NHS trusts which is already shaping the future of mental health services: moving care closer to home, embracing digital tools, and strengthening prevention. The below examples demonstrate how, with the right national support and sustainable investment, the sector can continue to deliver safer, more effective and more compassionate care - despite the immense pressures it faces. 

Striking the balance

Over the last 50 years, mental health services have undergone one of the most radical transformations in healthcare, shifting towards community-based care delivered by multidisciplinary teams, alongside the development of new treatments. Since the Five Year Forward View, trusts have made significant progress on ambitions to increase access and transform models of care. 

The prioritisation of innovation and improvement by mental health trust leaders persists, with new examples found across all of NHS Providers’ visits to mental health trusts across England. These examples align with the 10-year health plan’s three shifts, which can be supported and built upon, with the right enablers. 

Yet these efforts have been hampered by recent falls in the share of NHS spend invested in mental health services and the Mental Health Investment Standard (MHIS) having been watered down in the medium-term, and speculation over its future in the long-term. This challenge is reflected in the State of the Provider Sector survey, which showed only 9% of trust leaders surveyed agree that investment in mental health is proportionate to the demand for services, while three quarters (76%) disagree. Despite ongoing innovation across the sector, quality of care and patient safety are at increasing risk due to the mismatch between demand for services and the overall funding, capital and workforce available. 

How national priorities are being embedded on the ground

Hospital to community

For many years, providers of mental health, learning disability and autism services have been trailblazers in working together with wider partners, both formally and informally, to shift care into the community. This was part of “community transformation”, a process which began in 2019, and is now championed by broader government ambitions in the 10-year health plan.

East London Foundation Trust (ELFT) has been leading the way and are one of the six pilot sites across the country delivering new Neighbourhood Mental Health Centres, which provide 24/7 community mental health support to their local community. The pilots build on well-established community transformation programmes across the country, with examples in Somerset, Hartlepool and North East Lincolnshire. ELFT’s service in Tower Hamlets has been co-produced with local service users, Look Ahead, a charity providing care support and housing, and the Tower Hamlets Mental Health Alliance. It aims to provide timely, culturally appropriate person-centred interventions, including short-stay ‘hospitality’ beds, helping to prevent crisis, reduce A&E attendances, and avoid unnecessary hospital admissions.

ELFT’s work expands beyond adult services; they have also been embedding its child and adolescent mental health services (CAMHS) in community services to improve access, and the community mental health team have successfully piloted an acute hospital in reach pathway. The latter has reduced the number of medically fit for discharge days by 50% for those waiting for intermediate care community beds by integrating more closely with the local acute hospital in Bedfordshire.  

Across the sector, this type of partnership working is becoming the norm, not the exception. NHS Providers’ State of the Provider Sector Survey showed 58% of mental health providers are already collaborating with neighbouring trusts, while a further 31% say this is under consideration. These models show how, even under sustained pressure, providers continue to lead the shift towards community-based, integrated mental health care, delivering the transformation that national policy now seeks to scale.

Analogue to digital

Fully harnessing digital technology, in particular electronic patient record systems that are fit for purpose in mental health services alongside shared care records, will create significant opportunities for enabling data-driven decision making. This will support better and safer mental health care, improve patient and staff experiences, and ultimately enable more personalised care. 

NHS Providers’ State of the Provider Sector Survey showed mental health trusts are strong adopters of digital investment, with the majority (55%) of mental health trusts reporting investment in areas such as improved IT systems and electronic patient records. It is important to get the basics right and make sufficient investment in digital fundamentals, and NHS mental health trusts are showing how effectively they can innovate once this is secured.  

Greater Manchester Mental Health NHS Foundation Trust has developed an award-winning dementia suite, which includes a simulation suite where patients can take a bus to places that they remember – like the beach. When the patient arrives to the beach they are then fully immersed in the sights, sounds and smells of the seaside. This kind of innovation demonstrates the sector’s commitment to delivering personalised care, and when given the opportunity to invest in it, better care can be delivered for patients.  

Treatment to prevention

Mental health trust leaders have stressed the importance of the sector being supported to develop and focus on implementing preventative solutions to reduce the demand for mental health urgent and emergency care services over the longer term.  NHS figures show there continues to be high numbers of people reaching crisis. NHS data shows this pressure clearly: in December 2025, there were 6,697 very urgent referrals to crisis care teams, 4,144 new detentions under the Mental Health Act, and by the end of the month 23,600 people were subject to the Act, including 16,552 detained in hospital. 

We must do more to prevent people reaching crisis point in the first place by addressing the wider determinants of mental ill health, prioritising early intervention, and enabling the delivery of the right care in the right place at the right time.  When providers have been given the space and flexibility to do this, they have demonstrated they can deliver meaningful change. 

At Sussex Partnership NHS Foundation Trust, the Discharge Outreach Recovery Service offers a strong example of treatment shifting towards prevention in practice. Jointly funded by the trust, the local council and the voluntary sector, the service provides up to six weeks of support in people’s own homes, helping to prevent unnecessary admissions and enable earlier discharge from hospital. It supports the timely discharge of people from psychiatric acute and rehabilitation wards, who are medically fit to leave but require short‑term community support related to their mental health or social circumstances. At a cost of around £80 per patient per day, the service has already demonstrated significant impact and value for money, saving millions by reducing demand for inpatient care. 

This preventative approach is further strengthened by the trust’s work to address local housing issues. Recognising the strong link between homelessness, poor housing and deteriorating mental health, Sussex Partnership has invested in a dedicated team of 12 housing specialists who work closely with the multiple councils across the trust’s footprint to provide rapid intervention and secure suitable accommodation. By tackling a key social determinant of mental health, the trust is supporting people to live well in the community, as well as relieve pressure on inpatient services and the wider system.

Sustaining the momentum

Despite the clear progress and innovation taking place across mental health services, financial pressure is already forcing difficult trade‑offs. NHS Providers' State of the Provider Sector Survey showed 19% of mental health providers have de‑prioritised spending on transformation initiatives, and a further 32% are considering doing so, meaning over half of the sector risks scaling back improvement work at precisely the moment it is most needed. The Mental Health Investment Standard has effectively become a ceiling rather than a floor and action is needed to address the long‑standing imbalance between mental and physical health funding, if transformation is to be sustained and local need properly met. Although funding increases are planned, these will only cover inflationary pressures, and even this is at risk due to mounting pressures on wider system budgets. National bodies should build on the sector’s proven experience of improving services through devolved management of budgets and resources, including by empowering mental health collaboratives. 

To secure this progress, national bodies must provide stronger support for innovation and improvement, ensuring that good practice is systematically identified and spread across mental health and the wider NHS. This must include reforms to regulatory approaches, such as the CQC’s assessment frameworks, used to recognise excellence and actively support improvement. Alongside this, there needs to be increased trust autonomy to manage their finances more flexibly and reduce the inappropriate bureaucracy linked to the piloting of new ideas. 

The examples highlighted throughout this piece show that when trusts are supported to innovate, they pursue bold and creative approaches to improving care and productivity. This demonstrated that transformation is a pathway to securing the sustainability of the sector. Without the right enablers, progress will stall, with direct immediate and long-term consequences for patients. Taken together, these changes are essential to sustaining progress and delivering the high-quality mental health care that people deserve.  

Conclusion

As government and the NHS shape the next phase of mental health policy beyond 2026, there is a vital opportunity to reset the conversation, moving beyond a focus on failure towards a balanced, evidence‑based approach that recognises progress, learns from failures while expanding what works, and addresses the structural barriers holding the sector back.  

With the right support, mental health services can continue to lead the way in delivering safer, more effective and more compassionate care, turning today’s improvements and innovation into tomorrow’s standard practice.