Written evidence submitted by Kent and Medway Partnership and Social Care Trust (CMH0093)

What does high-quality care look like for adults with severe mental illness and their families/carers?

To ensure high-quality care for adults with severe mental illness, we recommend a collaborative approach that prioritises the individual's needs and wellbeing. This includes:

• Easy access to services and seamless transitions between care settings.
• Multi-agency collaboration that integrates mental, physical, and social support.
• Strong support for families, carers, and loved ones.
• Utilisation of digital systems to facilitate seamless information sharing and coordination across agencies.
• Cross-fertilisation of roles among providers to minimise unnecessary handoffs and improve care continuity.
• Focus on patient outcomes through relational continuity, joined-up VCSE support, and co-produced services that adhere to national standards and offer stepped, evidence-based care.
• Minimising wait times and ensuring transparency in crisis access, including out-of-hours support.
• Tailoring services to meet the needs of the local population through gap analyses and collaboration with partner organisations.
• Prioritising physical health outcomes with proactive screening and addressing lifestyle factors like smoking and obesity.
• Fostering strong joint working between primary and secondary care with readily available expert advice and guidance.

How could the service user journey be improved both within community mental health services and in accessing support provided by other services/agencies?

To enhance the service user journey, we recommend a multi-faceted approach:

• Strengthening multi-agency collaboration:
• Multi-agency (including VCSE) joined-up care is crucial. This necessitates a shift from fragmented services to an integrated system that addresses mental, physical, and social needs holistically.
• Cross-fertilisation of roles between statutory community providers is key to reducing unnecessary handoffs and improving care coordination.
• Improving care navigation:
• The implementation of care navigators as outlined in the CMH Framework is essential. These professionals can guide individuals through the complex healthcare system, ensuring timely access to appropriate services and reducing confusion and frustration.
• A robust framework for ARRS workers will facilitate improved support and communication between primary, secondary, and other agencies.
• Prioritising person-centred care:
• A focus on family and social networks is crucial for providing holistic and effective support.
• Strengthening system-level collaboration:
• Nationally set expectations on the interface between Mental Health Services (MHS) and other agencies are vital to reinforce and support the development of effective patient interfaces.
• Acute trusts must be included as integral partners in improving the service user journey. The prevailing perception of mental health patients as solely the responsibility of mental health providers must be challenged. A joint approach is necessary to address crises effectively and reduce reliance on emergency departments.
• We must actively develop and promote co-located alternatives to A&E for individuals experiencing mental health crises.
• Empowering service users:
• Increased co-production of services and the development of robust peer support roles/groups will empower service users and ensure their voices are heard in service design and delivery.
• Fostering knowledge sharing:
• Increased access to advice and guidance will enhance the knowledge and skills of professionals across sectors, improving the quality of care and support provided to individuals with mental health conditions.
• Public education campaigns to address expectations around mental health services, and foster a more realistic and informed understanding, as well as encouraging people to seek appropriate support in a timely matter. These campaigns should:
• Promote a greater understanding of the NHS and its resources. Emphasise the valuable role of multi-disciplinary teams, including third sector partners, in providing comprehensive mental health support.
• Highlight the benefits of diverse support options. Clearly communicate that accessing support does not always require seeing a GP or a clinician.
• Educate the public on the range of available services: Inform the public about the different types of mental health support available, including self-help resources, peer support, and community-based interventions.
• Clear and concise information about services and interventions, accessible digitally, through leaflets, and through local community group information sessions, will improve service user expectations and reduce anxiety.

How could this be measured/monitored locally and nationally?

Measuring and monitoring the effectiveness of improved service user journeys requires a multi-faceted approach to provide valuable insights and guide ongoing continuous improvement. Key indicators could include:

• New community metrics within the CMHF: These should capture local priorities and reflect the lived experience of service users.
• Strategic information (SI) monitoring: Utilising existing SI frameworks to track key performance indicators related to access, waiting times, and treatment outcomes.
• Analysis of complaints: Regularly reviewing complaints to identify systemic issues and areas for improvement within the service.
• Patient-Reported Outcome Measures (PROMs): Implementing PROMs like Dialog+ and ReQol-10, owned and held by the patient, with frequent feedback reports to enhance patient engagement and inform care decisions.
• Monitoring adherence to NICE guidelines: Tracking the proportion of service users receiving NICE-recommended treatments, such as Psychological Therapies for Severe Mental Health Problems.
• Prioritising physical health monitoring: Ensuring regular assessments of physical health alongside mental health assessments.
• Centring on patient and carer experience: Regularly collecting and analysing feedback from service users and their carers through surveys, focus groups, and other methods.
• Maintaining and integrating mental health registers: Similar to primary care, establishing joined-up mental health registers across agencies to facilitate data sharing and enable more comprehensive analysis of outcomes.

What is the current state of access for adults with severe mental illness to community mental health services?

There are similar challenges nationally, but in Kent and Medway the challenges include:

• Long waiting lists: Due to high demand and limited resources, many individuals with SMI face significant delays in accessing essential care, such as assessments, medication management, and therapy.
• Geographic disparities: Access to quality mental health care can vary significantly depending on geographic location
• Systemic barriers: Navigating the complex mental health system can be challenging, with fragmented services, poor communication between providers, and difficulties accessing information and support.
• Stigma and discrimination: Despite progress, stigma and discrimination surrounding mental illness can still deter individuals from seeking help and accessing necessary support early on.

What progress has been made in implementing waiting time and access standards for community mental health services?

• Progress in implementing waiting time and access standards for community mental health services has been made, but significant challenges remain.
• Implementation is ongoing: The new standards have been implemented, with ongoing refinement and adaptation taking place to ensure their effectiveness.
• Significant transition period: Moving from an 18-week target to a 4-week target for access represents a substantial shift. Given the "newness of the model" and the complexities of service redesign, it will take time for services to fully comply with these ambitious standards.
• High demand and resource constraints: A significant increase in referrals from primary care has placed considerable pressure on community mental health services. The development of integrated neighbourhood teams, while crucial, is still ongoing, limiting the capacity of the system to meet this increased demand.

How could access be improved across the country?

Improving access to community mental health services requires a multi-faceted approach. Key areas for focus include:

• Investing in targeted therapies: While increased investment in Talking Therapies is crucial, a specific focus is needed for individuals who disengage from traditional services and are severely unwell. This necessitates exploring alternative approaches such as assertive outreach programs.
• Recognising the importance of patient engagement: Success with NICE-recommended treatments hinges on active patient engagement and a willingness to change. Acknowledging this reality requires exploring alternative care pathways, such as those offered by the voluntary, community, and social enterprise (VCSE) sector and social prescribing.
• Defining the scope of complex mental health care: Clearly defining the limits of what complex mental health care can realistically achieve is essential for appropriate resource allocation and avoiding unrealistic expectations.
• Strengthening Primary Care Support: Supporting primary care in developing integrated neighbourhood teams is critical for improving early intervention, prevention, and the management of complex mental health conditions.

By addressing these key areas, we can work towards a more equitable and effective system of community mental health care that meets the diverse needs of all individuals.

 Has the Community Mental Health Framework been an effective tool for driving the delivery of more integrated, person-centred community mental health services? 

The Community Mental Health Framework (CMHF) has the potential to be an effective tool for driving more integrated, person-centred community mental health services. However, several challenges are hindering its full realisation:

• Early progress: While early indicators are promising, it's still early in the implementation process. The framework provides a valuable foundation for moving towards an improved service model, but significant challenges remain.
• Integration with social care: A major obstacle is achieving true integration with social care services. Despite the framework's emphasis on collaboration, significant barriers still exist.
• Demand outstripping capacity: High demand for services, coupled with limited resources and staffing challenges, threatens to overwhelm the system and compromise the quality of care.
• Primary care integration: Addressing the challenges of primary care integration is crucial for the long-term success of the CMHF.

How can community mental health services work with social care, the third sector and local government to better address service users’ health and wider social needs that are wider determinants of mental health outcomes?

Community mental health services can work more effectively with social care, the third sector, and local government to address the wider determinants of mental health outcomes through the following strategies:

• Foster collaborative partnerships:
• Provider Collaboratives and Health and Care Partnerships (HCPs) can play a vital role in facilitating communication, coordination, and shared decision-making between different agencies.
• Develop robust contracting models:
• Long-term contracts with clear performance indicators and shared funding streams can incentivise collaboration and improve service integration.
• Promote skill-sharing and cross-training:
• Embedded cross-pollination of skill sets among professionals from different sectors can enhance understanding, improve communication, and foster a more holistic approach to care.
• Address power imbalances:
• Explicitly addressing power imbalances between clinicians and non-clinicians is crucial for fostering genuine partnership and ensuring the voices of service users and their families are heard.
• Improve data sharing and interoperability:
• Improving the digital interoperability of systems is essential for seamless information sharing, including test requests, results, referrals, and risk information. This will facilitate more informed decision-making and improve the overall quality of care.

How could the funding system be reformed to more effectively drive transformation in the delivery of integrated and person-centred community mental health services?

• Joint commissioning with Health and Social Care:
• Moving towards joint commissioning across health and social care will incentivise collaboration and integrated service delivery. This can involve shared budgets, shared decision-making, and shared accountability for outcomes.
• Targeted and ring-fenced funding:
• Allocating targeted and ring-fenced funding for specific priorities, such as Assertive Outreach and Psychological Therapies, ensures that resources are directed towards critical areas of need. This prevents these vital services from being absorbed into general budgets and becoming underfunded.
• Funding to follow the patient:
• Implementing a system where funding follows the patient across different care settings can incentivise seamless transitions and improve the overall patient experience. This could involve creating pooled budgets that can be accessed by different providers involved in the patient's care.

What blockers or enablers should policy interventions prioritise addressing to improve the integration of person-centred community mental health care? 

Enablers:

• Core standards of community MH care:
• Establishing clear, nationally agreed-upon standards for community mental health care will provide a consistent framework for service delivery and quality improvement.
• Workforce commitments:
• Investing in the mental health workforce through robust training programs, competitive salaries, and improved retention strategies is crucial for ensuring a well-trained and motivated workforce.
• Investment in digital infrastructure:
• Investing in digital infrastructure and data systems will facilitate better information sharing, improve care coordination, and enhance access to services.

Blockers:

• Addressing power imbalances:
• Policies should explicitly address power imbalances within the system, ensuring transparency, accountability, and meaningful involvement of service users and their families in decision-making processes.
• CAMHS waiting lists:
• Addressing long waiting lists for Child and Adolescent Mental Health Services (CAMHS) is critical, as early intervention can prevent mental health problems from escalating in adulthood.

What are the examples of good or innovative practice in community mental health services?

It still feels very early to comment on good or innovative practice. However, development of mental health multidisciplinary teams in the Integrated Neighbourhood Teams focussing on prevention, sustainable interventions for high intensity service users and complex patients is good.

What needs to happen to scale up the adoption of these practices across

Ring fence budgets for community initiatives that focus on prevention and management of complex mental health issues.

February 2025