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How do we shape integration in mental health services?

How do we shape integration in mental health services?

Improvements to support for patients with mental health conditions in London have been a positive change, says Florence Cantle

A lot of time and hard work has gone in to try to fix the service gaps between secondary care and primary care mental health services.

The community mental health framework has set out to improve the patient journey between different levels of service delivery in between primary and secondary care mental health services.

However, challenges in recruitment, retention and skills gaps within the mental health workforce have led to increasing service pressure, resulting in more staff leaving the profession and moving on to different career paths. When mental health patients are not clinically fit to be at home and have to stay in hospital for intensive treatment, it is devastating to see them go without regular contact with families and friends due to their condition.

Cross sectoral working between agencies – including key stakeholders such as Integrated Care Systems (ICSs), primary care networks (PCNs), mental health service providers and the voluntary sector – enhances the relationship and the communication between different disciplines striving to work for patients with severely mental illness (SMI) who are well enough to be living in their local communities.

Having introduced the Additional Roles Reimbursement Scheme (ARRS) in 2019, the NHS helps primary care providers to redefine their scope of practice in primary care. There are many ARRS roles on offer to support patients with mental health conditions – for example, mental health practitioners, health and wellbeing coaches and social prescribing link workers.

There are certainly some barriers and challenges for primary care networks in recruiting the right people due to various reasons – for example a lack of understanding of the roles and the responsibilities of the ARRS roles or a lack of a joined-up approach in terms of supervision, training and development.

Although the current arrangements between primary and secondary care providers is of course focused on supporting the workforce for the interests of patients with mental health conditions, there must be a way to improve working conditions within various mental health roles in primary care and in secondary care while, at the same time, improving patient pathways between the primary care and secondary care mental health settings.

Addressing this challenge, Transformation Partners in Health and Care (part of Royal Free London NHS Trust) has worked in partnership with NHS England and NHS providers in London with a primary focus on strengthening the integration between Improving Access to Psychological Therapies (IAPT) services (now NHS Talking Therapies), primary care networks and secondary mental health services to improve patient experience and outcomes.

By gathering and sharing resources concerning different workforce models and an integrated care pathway model between IAPT and core teams/community mental health teams with guided principles, a practical guide tool was co-created and co-produced by two task groups on workforce and pathways respectively. The guided principles have been co-established in a model of good integration which originated from some good case studies in the UK. This will provide clarity around creating an easy and clear pathway of care between NHS Talking Therapies and core teams/community mental health teams.

This tool will be published and be shared among different primary care and mental health professionals and groups at place/neighbourhood and regional levels in London.

As long as we have strong commitment for something we believe in, no matter how hard and how challenging the current NHS climate is, together we will get there and succeed in making things happen through small changes to the quality of life for patients with mental health conditions in London.

Florence Cantle is a programme manager for primary care at NHS England, London region