NHS Long Term Plan uncovered: mental health parity and rebalancing

Mental health features a great deal in the ten year plan. Chapters two and three, in particular, are worth a read. It commits to seeking to significantly improve mental health services; a number of commitments are made across the spectrum of mental health care from children and young people’s services to adults mental health services. 

Each Integrated Care System will be required to implement integral services that tackle the wider determinants of mental ill health. This is all supported by the creation of a ring-fenced local investment fund worth at least £2.3 billion a year by 2023/24.

What do some of the key commitments and milestones look like?

Perinatal mental health care (paragraphs 3.8 – 3.21)

  • Improve access to high quality care for mothers, their partners and children.

Children and young people’s mental health services (paragraphs 3.22 - 3.30)

  • Funding for this group will grow faster than both overall NHS funding and total mental health spending for adults.
  • Over the next five years, investment will be made into expanding access to community-based mental health services. By 2023/24, an additional 345,000 children and young people aged 0-25 will be able to access support via NHS funded mental health services in schools or college based mental health support teams.
  • An increase in investment in eating disorder services, together with a new waiting time directive by 2020/21.
  • Access to support for those experiencing a mental health crisis. With a single point access  through NHS 111, all children and young people experiencing a crisis will be able to access care 24/7.
  • Mental health support will be embedded in schools and colleges.
  • A new approach to addressing the perennial issue of young adults aged 18-25 transitioning to adulthood mental health services. By 2028, the aim is to move towards service models for young people that offer person centred and age appropriate care for mental and physical health needs, rather than an arbitrary transition to adult services based on age not need. NHS England are noted to be working closely with Universities UK via the Mental Health in Higher Education Programme to build the capability and capacity of universities to improve student welfare services and improve access to mental health services for the student population, including focusing on suicide reduction. 

Learning disability and autism (paragraphs 3.31-3.36)

  • Expansion of Stopping over medication of people with a learning disability autism or both (STOMP) and Supporting Treatment and Appropriate Medication in Paediatrics (STAMP) programmes to stop over medication.
  • By 2023/24 a digital flag in the patient record will ensure staff know a patient has learning disability or autism.
  • National learning disability improvement standards to be implemented over the next five years and will apply to all services funded by the NHS.
  • Accelerate the Learning Disabilities Mortality Review initiative to identify common themes and learning points and provide targeted support to local areas.
  • Do more to ensure all people with learning disability autism or both can live happier, healthier, longer lives.

 Adult mental health services (paragraphs 3.89 – 3.106)

  • New and integrated models of primary and community mental health care will give 370,000 adults and older adults with severe mental illnesses greater choice and control over their care and support them in their communities by 2023/24.
  • By 2023/24 an additional 380,000 people per year will be able to access NICE-approved IAPT services. Four week waiting times are to be tested with selected local areas.
  • By 2023/24, NHS 111 will be the single, universal point of access for people experiencing mental health crisis. There will also increase alternative forms of provision for those in crisis, including non-medical alternatives to A&E and alternatives to inpatient admission in acute mental health pathways. 
  • By 2023/24, the NHS will introduce new mental health transport vehicles, introduce mental health nurses in ambulance control rooms and build mental health competency of ambulance staff to ensure that ambulance staff are trained and equipped to respond effectively to people experiencing a mental health crisis.
  • Post crisis support for families and staff will be available when they are bereaved by suicide and are at a heightened risk of crisis themselves.
  • Mental health liaison services will be available in all acute hospital A&E departments and 70 per cent will be at ‘core 24’ standards in 2023/24, working towards 100 coverage thereafter.
  • Ending acute out of area placements for people by 2021, allowing patients to remain in their local area.
  • As recommended by Professor Sir Simon Wessley’s Mental Health Act Review, capital investment from the forthcoming Spending Review will be needed to update the physical environment for inpatient psychiatric care.
  • Suicide prevention. A new Mental Health Safety Improvement Programme will have a focus on suicide prevention and reduction for mental health inpatients.
  • In light of the fact that 50 per cent of people sleeping rough have mental health needs, £30 million is to be invested on meeting the needs of rough sleepers to ensure the parts of England most affected will have better access to specialist homelessness NHS mental health support.

What next?

The NHS Plan gives a high profile to mental health services for people of all ages and has made a number of significant commitments – from an increase in funding to faster access to high quality care. Faster access to high quality care could help to bring about “parity” for mental health care, a step closer. But challenges still abound not least on workforce

You can read the full NHS Long Term Plan here and mental health services is covered in chapter three.

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