Shaping neighbourhood health: reflections and insights from mental health providers

This briefing summarises reflections about the development of neighbourhood health from the perspective of mental health trust leaders. It outlines their priorities, concerns and expectations, highlighting the challenges, risks and opportunities for mental health trusts as policy and implementation progress. 

The insights draw on conversations and engagement with mental health leaders since the publication of the 10-year health plan (10YHP) for England, exploring how the government’s ambition for a neighbourhood health service is being interpreted locally, what it means for mental health services and where trusts see opportunities and ongoing challenges. 

In this briefing, we use the term ‘neighbourhood health’ to refer to the government’s ambition for a more integrated, community-based health service that brings professionals together in patient-centred teams, strengthens primary and community care, and reduces avoidable hospital admissions. 

The 10YHP places neighbourhood health at the centre of the ambition to shift care from hospitals into the community. While general practice is expected to play a major role, the plan emphasises that NHS trusts, including mental health, community and acute providers, are all essential to delivering neighbourhood services and ensuring coordination between services. 

The recently published Neighbourhood Framework reinforces this direction, setting out five national minimum goals with associated objectives and metrics across three reform priorities for integrated care boards (ICBs): improving services for people requiring routine healthcare, strengthening proactive care, and providing better alternatives to hospital-based care. Although often viewed through a physical health lens, these priorities have implications for mental health services. 

The 10YHP includes specific commitments to integrate mental health into neighbourhoods, including 24/7 neighbourhood mental health care models and a new Modern Service Framework for severe and enduring mental illness. Neighbourhood mental health centres are intended to bring together a range of community mental health services, including crisis care, short‑stay beds, psychological therapies and multidisciplinary teams to reduce fragmentation, improve patient experience and provide more proactive, place‑based support. 

The plan also commits to expanding urgent mental health provision through dedicated mental health emergency departments (MHEDs) offering rapid assessment and short‑stay care as an alternative to A&E, with early sites informing future national standards. Despite these commitments, mental health trusts have felt less prominent in neighbourhood policy discussions.  

New population‑based delivery models, such as single or multi‑neighbourhood provider contracts (SNPs and MNPs) and integrated health organisation contracts (IHOs), are intended to support neighbourhood services and encourage a shift from hospital-based to community care. Mental health providers already have extensive experience delivering community‑based alternatives to hospital care, and their expertise is directly relevant to neighbourhood ambitions. Mental health, learning disability and autism (MHLDA) provider collaboratives offer practical examples of shared planning, budget management and pathway transformation, demonstrating how joint accountability can improve outcomes, reduce inequalities and reinvest savings into community services. As the shift to community‑based provision accelerates, these lessons will be increasingly relevant.  

This section examines the key factors that enable or hinder mental health trusts’ involvement in developing neighbourhood health services. It explores how neighbourhood models could support more integrated, person‑centred care and tackle long‑standing inequalities, while also highlighting the structural, cultural and operational challenges that may constrain progress.  

Drawing on trust leaders’ insights, it outlines what mental health services need to play a full role in neighbourhood working and what national and local leaders should consider to ensure these models deliver meaningful and sustainable change. 

Achieving parity of esteem 

Mental health must be treated as central to neighbourhood working, not an optional add‑on. Trust leaders emphasise that national policy, when taken in the round, still falls short in setting clear expectations that mental health support should be embedded in every neighbourhood model. This is particularly important for people with severe and enduring mental health conditions, who face some of the greatest inequalities and whose needs should shape local neighbourhood design. Addressing mental health inequalities linked to poverty and ensuring support for people living with long‑term physical health conditions as well, further reinforces the case for achieving true parity of esteem. 

Achieving this parity requires more than ambition. With no new funding attached to neighbourhood health, early progress has relied heavily on staff going above and beyond rather than structural investment, something leaders are clear is not sustainable. The National Neighbourhood Health Implementation Programme has supported 43 areas to accelerate existing good practice in neighbourhood health, but the project is coming to an end, and there was no additional revenue funding attached. There were also concerns from some about the lack of visibility of mental health within the programme. Without dedicated resource and given other government priorities, neighbourhood working in relation to mental health, risks depending on goodwill rather than being embedded as a core way of delivering care. 

However, trust leaders emphasised that shifting a greater proportion of care out of hospitals and into mental health community services will only be possible if the long-standing issue of underfunding across the system is addressed. They noted that the Mental Health Investment Standard (MHIS) remains an important mechanism for safeguarding growth in mental health budgets. However, leaders said that while government has expressed an ambition to shift more care out of hospital, it has not yet set out what this means for mental health specifically – nor how mental health services should feature within wider cross‑government work on rebalancing resources between acute and community provision.  

Leaders want to see a targeted and strategic approach to allocating funding across the system, including the Voluntary, community and social enterprise (VCSE sector), to ensure budgets genuinely support the left shift.  

Clarifying the purpose of neighbourhood working 

Trusts report significant variation in how neighbourhood working is interpreted. While the recent Framework provides a clearer articulation of the aims and priorities, it is important that neighbourhoods are supported to tailor services to local needs, reduce inequalities and improve the wider determinants of health. It's essential that neighbourhood models recognise that different population groups will require different levels and forms of integration. It was also clear from trust leaders that children and young people (CYP) must not be an afterthought for neighbourhood working. They cautioned that if neighbourhoods focused too heavily on adults with complex, long‑term conditions this could unintentionally push CYP services to the margins. 

The Community Mental Health Framework, a place-based community mental health model, offers a strong starting point, but trust leaders are still looking for clarity on how it fits with and is built upon by wider emerging neighbourhood models. Trusts also highlight the importance of aligning neighbourhood ambitions with other national programmes, such as the mental health 24/7 pilots. 

A further challenge is the lack of systematic evaluation, which trust leaders highlighted in relation to community mental health transformation: a significant body of learning and practice already exists, which should be built upon. Evaluation of what has worked well, what has not, and why, should become standard practice. 

Mental health trusts see themselves as far more than service providers. They view themselves as anchor institutions; organisations with the reach, relationships and legitimacy to drive system‑wide change. If neighbourhood models are to fulfil their potential, they need to reflect the broader contribution of mental health providers. That means designing neighbourhoods that don’t just add-on mental health to existing structures but genuinely draw on the full spectrum of mental health, physical health and community‑based support. 

Establishing robust governance 

Governance remains one of the most challenging aspects of neighbourhood development. For mental health trusts - often operating across one or more systems and multiple primary care networks - the picture is complicated. Neighbourhood health exists at the geographical footprint closest to populations, so the right structures need to be in place to bring all partners together to make decisions, design care models and collaborate to deliver services.  

In some examples, trusts describe overlapping structures and unclear accountability. ICBs and system partners need to establish clear, streamlined yet robust governance, as well as clarity on provider roles and expectations to enable meaningful collaboration. There are, however, some foundations to build on. For example, the Community Mental Health Framework, has in some places facilitated the creation of partnership arrangements, including expansion of mental health practitioners within primary care. 

Alongside governance challenges sits a regulatory gap that trust leaders are becoming increasingly concerned about. Regulation has not kept pace with integrated models of care, and while CQC frameworks rightly need to assess individual organisational performance, trusts argue that greater recognition is needed for services that are being designed across organisational boundaries. 

Strengthening integration with partners 

Integrating care around the needs of people with severe mental illness, rather than organisational boundaries, offers a transformative opportunity to address their mortality gap by tackling stigma, exclusion and poor access to services. 

Building the right conditions for collaboration 

Where neighbourhood integration works well, mental health is embedded from the start. Integration relies as much on culture and relationships as on structures, with leaders emphasising the value of early involvement in shaping priorities and designing multidisciplinary teams. When mental health is treated as a strategic partner rather than an add‑on, services feel more coherent, credible and able to deliver meaningful change. 

A shared cross‑system vision is essential, yet representation in decision-making forums, due to incentives and targets, often leans towards acute services, with limited input from mental health, community and primary care. Places progressing well often have acute leaders with experience across these sectors, helping create a more balanced and collaborative environment. 

Effective integration also requires confronting local history. Long‑standing tensions between primary and secondary care can quickly resurface without deliberate efforts to rebuild trust (more insight on this can be found in this NHS Confederation report). Leaders describe the need for humility, consistency and a willingness to compromise.  

Partnership with VCSE organisations is another critical ingredient. These organisations play a central role in addressing the social determinants of health - such as housing, debt, and loneliness - that shape mental health outcomes and provide early intervention and preventative support. Effective neighbourhood teams must be able to work across NHS and voluntary sector boundaries, creating regular spaces for honest dialogue and shared problem‑solving. To meet the needs of their populations, new models must be designed, developed and evaluated by local communities and people with lived and living experience, especially those who are particularly underserved by current structures. 

Learning from pilots and strengthening pathways 

Mental health neighbourhood 24/7 pilots are giving systems a valuable opportunity to build on existing strengths, tackle fragmentation and test new approaches. Trust leaders see the pilots as spaces to experiment, learn and refine before scaling. 

Developing neighbourhood-based mental health teams, including the 24/7 pilot models, offer opportunities for more integrated, place-based care, but also introduce risks that providers are actively working to manage. As some trusts restructure their community mental health teams (CMHTs) to align more closely with neighbourhood footprints, there is a need to avoid patients receiving inconsistent levels of support depending on which team an individual is allocated to, and preventing any inadvertent siloing of people who continue to access CMHTs. There is also a concern that people with more complex needs could be diverted into neighbourhood teams that are not designed or resourced to provide specialist secondary care. These changes must be managed carefully to avoid gaps in provision. 

Leaders emphasise the need for both primary and secondary care expertise to shape the stepped‑care model (a patient-centred framework that offers the least intrusive, lowest-intensity treatment first). Clear distinctions are needed between conditions that can be supported in primary care, such as depression, anxiety, OCD and body dysmorphia, and those, including schizophrenia and psychosis, that require specialist input. 

Finally, trust leaders caution against neighbourhood models that separate mental and physical health needs. People with severe mental illness die 15–20 years earlier than average, often from preventable conditions such as cardiovascular disease and diabetes. When these needs go unrecognised, whole‑system costs rise: between 12-18% of all NHS expenditure on long-term conditions is linked to poor mental health and wellbeing – between £8bn and £13bn in England each year. Neighbourhood teams must therefore ensure physical health services are equipped to support mental health needs and have clear routes to specialist support. The neighbourhood model should act as a bridge to integrated care, not a barrier. 

Supporting the workforce 

Neighbourhood teams can resolve long‑standing fragmentation by bringing together the right mix of skills around the person rather than around organisational boundaries, ensuring those with severe mental illness receive more coherent, joined‑up care. 

The scale of cultural change needed cannot be underestimated. Neighbourhood working requires significant behaviour shifts, new ways of working across professional boundaries, and the realignment of organisational identity. 

Trust leaders emphasise the need to equip psychiatrists and wider specialised mental health staff to work confidently in integrated, community‑focused settings, and to ensure mental health and learning disability expertise is fully embedded within neighbourhood teams rather than treated as specialist add‑ons. Given the breadth of mental health specialisms, neighbourhood models must be carefully designed to avoid repeating the same pitfalls seen in physical health, where people can fall between services. Done well, neighbourhood care can reverse this fragmentation by organising expertise around individuals’ needs rather than professional silos. 

Above all, leaders stress that neighbourhood working will only succeed if the principle that mental health is everyone’s business becomes a shared expectation across the entire workforce. Without this shift, new neighbourhood structures risk simply recreating old boundaries. 

Improving digital and data foundations 

Digital and data infrastructure remain major obstacles to neighbourhood integration. Trusts report difficulty linking data across inconsistent platforms, alongside complex information‑ and risk‑sharing arrangements. These issues slow collaboration, limit insight and make it harder for neighbourhood teams to operate as a single, coherent system. Leaders are clear that a more consistent national approach is needed. 

Shared national digital solutions, such as standardised information‑sharing agreements, memorandum of understandings and data‑sharing templates, would allow local systems to adapt, rather than rebuild, core processes. Trusts argue that the NHS should use its national scale to reduce duplication and support interoperable digital practices, freeing local teams to focus on improving care rather than navigating bureaucracy. 

Some trusts are developing internal informatics systems that generate richer patient‑level insight, for example, analysing Talking Therapies completion rates by demographic group to identify where care could safely shift to primary or neighbourhood settings. However, without stronger data linkages across organisational boundaries, these tools cannot reach their full potential. 

Leaders also warn that the 10YHP’s push for more data-driven service planning risks excluding people with minimal data footprints - often those facing the greatest inequalities. Without deliberate safeguards, neighbourhood approaches could inadvertently reinforce, rather than reduce, existing disparities. 

Managing rising demand and improving outcomes 

Mental health services are facing sustained and growing demand, often exceeding capacity across both adult and children’s services. Leaders describe a system under pressure, with around 60% more people in 2024/25 than in 2017/18 being supported by mental health providers. While mental health service users are often separated into distinct pathways, and broader integrated neighbourhood models should avoid repeating this, a broader, integrated approach needs to be ready to respond to rising everyday mental health issues without overwhelming the system, backed by sustainable investment and clear boundaries.  

These pressures may be exacerbated by wider system reforms. For example, Community Diagnostic Centres may reveal unmet physical health need, but also risk funnelling more demand into already stretched system. Trusts stress that neighbourhood working must be aligned with broader system reforms to avoid unintended consequences. 

On productivity, leaders understand the need to better understand how funding can be used more effectively, but they urge realism. Innovations such as ambient voice technology may eventually support community teams, and the biggest opportunity to release resources lies in reducing avoidable hospital admissions - an outcome that takes time. Experience from long‑term condition management shows that meaningful reductions in hospital activity can take a decade or more. Early community mental health transformation data similarly shows no immediate drop in admissions, and leaders caution against expecting quick wins. 

Many therefore argue that reducing hospital admissions is not the right primary measure of success. A narrow focus on reducing beds can distort priorities and overlook what matters to people. Trusts instead want outcome measures that reflect recovery, community priorities, health inequalities, and what makes the most difference to patients. And it is these measures that should be embedded across all requirements from the centre. 

Mental health trusts have a pivotal role in shaping neighbourhood health services. Their clinical expertise, links to local communities through a history of co-production and long‑standing relationships with VCSE partners make them an essential part of designing models that integrate physical, mental and social care. Where mental health has been embedded from the outset, neighbourhood pilots are already showing benefits: stronger multidisciplinary teams, more coherent pathways for people with complex needs and early signs of a shift towards shared purpose and collaborative problem‑solving. Trusts bring not only specialist knowledge but also deep understanding of population needs and inequalities, insight that is critical to the success of neighbourhood models. 

These opportunities come with significant challenges. Trusts must navigate unclear national expectations, constrained funding and the task of integrating specialist expertise into generalist neighbourhood teams without compromising quality. For policymakers, the message is clear: neighbourhood health will only deliver its potential if mental health is treated as integral, not optional. For providers, the challenge is to continue building trust, strengthen partnerships and shape neighbourhood models around local population needs, existing provision and the lived experience of the people they serve.