Getting pathways and models of care right
Trust leaders can see that, rather than there being issues with the whole system of mental health care, challenges are concentrated within specific parts of the pathway, or within specific patient groups with complex needs. NHS trust leaders and stakeholders have also highlighted their significant concerns regarding the variation in models of care and coverage.
Focus should therefore be directed in the short to medium term at improving, and standardising where necessary, pathways and service models in a number of key areas. This would improve access to the right support in the right setting, and the health and care system’s use of resources more broadly. This would also help to improve understanding of the diverse range of mental health conditions that exist and what evidence-based care and support is available from trust and wider partners that is the most appropriate and effective – or is not and there needs to be further focus on developing – for each condition. This would put mental health in line with our approach to physical health, where we clearly distinguish between and refer to specific physical health conditions and what the most appropriate and effective services and treatments are for each.
Examples provided by trust leaders and stakeholders on where to focus work include:
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Stabilising and improving the mental health urgent and emergency care pathway by, for example, ensuring there is enough capacity in inpatient settings and crisis centres, further supporting the ambulance sector’s role, and using the voluntary sector effectively.
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Developing neurodiversity pathways and right model of care for adults and children, including differentiating between specialist mental health services and behavioural support, and ensuring joined up approaches across health and education.
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Standardising the depression pathway, which could lead to substantial improvements in population outcomes, including related to employment.
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Developing and implementing community-based services for adults with personality disorders so they receive significantly better care and support.
Standardising the availability and consistency of community-based support, which is key to enabling the effective flow of patients through services that are appropriate for their needs, has also been highlighted as critical to focus on more broadly. As has joining up the provision of some services, such as substance misuse services which are currently managed by local authorities in some areas of the country and by the NHS in others, to improve the overall effectiveness of support. The current lack of join up and consistency across the country is impacting the efficiency of service delivery and continuity of care. It has also meant that investment in such key wider services that support mental health service users has decreased as financial pressures on local authorities have risen.
To improve access to the right support in the right setting, and the health and care system’s use of resources more broadly, we need to:
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Design national priorities and policies in a way that recognises the distinctions between different mental health and neurodiverse conditions and the range of services that trusts, and their partners, need to deliver to fully meet individuals’ needs.
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Develop and implement evidence-based standards, models of care and pathways for key areas of mental health and neurodiversity provision to deliver the right care, in the right place at the right time, and improve the health and care system’s use of resources more broadly.
Case study
Yorkshire Ambulance Service NHS Trust responded to 45,000 ambulance calls from individuals with mental health needs in 2023. In 61% of cases responded to by one of the trust's dedicated mental health response vehicles over one year, crews were able to support the patient at home or closer to home with the support of a community partner. The trust has also been working with mental health trusts and the voluntary sector across the region to ensure there are alternative, safe places where patients can access the care they need. The trust has also been working with Bradford's First Response mental health crisis service to create a children and young people’s treatment pathway, which would avoid attendance at an emergency department wherever possible.