The vision in Lancashire and South Cumbria is to make our region a mentally healthy place to live. A place where everyone is empowered to look after their own mental health, and able to access the right kind of compassionate support when required. Everyone will have the same opportunity to lead a mentally healthy life, no matter where they live, or who they are.
However, we know there are some people with mental health needs who don’t always receive the right care, at the right time, and in the right place. We know we need to work differently to make sure we support these people in the best possible way.
The NHS Long Term Plan and the NHS Mental Health Implementation Plan 2019/20 – 2023/24 have also highlighted a need for change. They have set expectations for health and care systems to develop new and integrated models of primary and community mental health care.
Primary care services provide the first point of contact in the healthcare system, acting as the ‘front door’ of the NHS. Primary care includes general practice, community pharmacy, dental, and optometry (eye health) services. Find out more about Primary Care on the NHS England website.
Community health services cover a wide range of services and provide care for people from birth to the end of their life. Community health teams play a vital role in supporting people with complex health and care needs to live independently in their own home for as long as possible. Services also include health promotion services such as school health services and health visiting services. Many services involve partnership working across health and social care teams, made up of a wide variety of professionals including community nurses, allied health professionals, district nurses, mental health nurses, therapists and social care workers.
Services are mainly delivered in people’s homes (this includes care homes) but also in community hospitals, intermediate care facilities, clinics and schools.
Find out more about community health services on the NHS England website.
As such, we are changing the way we care for adults with complex mental health needs in Lancashire and South Cumbria. We are calling it, ‘community mental health transformation’.
What do we mean by complex mental health needs?
Complex mental health needs can cover a range of needs and diagnoses, including, but not limited to, psychosis, bipolar disorder, personality disorder diagnosis, eating disorders, severe depression and mental health rehabilitation needs. Some of these may be co-existing with other conditions such as frailty, cognitive impairment, neurodevelopmental conditions or substance use.
Why change?
You may already be familiar with community mental health teams, often shortened to 'CMHTs'. CMHTs have been around for more than 30 years and have played a crucial role in delivering mental health care. They have given people with mental health problems vital support closer to their homes and communities.
However, services haven’t always worked in the most coorindated way – and this is very much needed for those people who would benefit from coordinated input from across professional groups and multiple agencies.
The aim of the community mental health transformation programme is to remove barriers to organisations working together to improve people’s experiences and support recovery. No one organisation can meet all the needs of the population it serves. A truly holistic and person-centred approach can only be achieved through partnership working with colleagues in the NHS, adult social care, and voluntary, community, faith and social enterprise (VCFSE) sector.
It is important to note people can still access existing services they might be used to, such as community mental health teams, but this new way of working offers better support for those people who need it.
People will receive care which is made for their individual needs – often called personalised care. It gives people easier access to the mental health support they need, as well as support in other areas of their life. This may be employment support or support for their physical health, factors which we know can negatively impact a person’s mental health.
This new way of working as one multi-agency team allows people to move through the health and care system more easily. People will be assigned to a key worker who will provide a single key point of contact throughout their care, meaning people shouldn’t have to repeat their story.
It stops people from being transferred from one service to the next, and means that care can be stepped up, or stepped down, in response to their changing needs in a seamless way. It allows people to manage their own condition better with support from their families, social networks, and local community.
- Collaborative working across agencies - people will receive the care they need first time, by the most appropriate service and organisation, stopping people from falling between the service gaps between GPs and specialist care, meaning that any person referred by their GP will be reviewed by the enhanced multi-disciplinary team and seen by the most appropriate service, breaking down barriers to care and support.
- People will be proactively supported to not reach crisis point, with early intervention and preventative support - we will do this by providing timely evidenced-based treatments in the community, offering holistic care and support for mental health problems. Using a strengths-based approach to work alongside the person to achieve outcomes that are meaningful to them.
- We will support people to live with long-term health conditions with the right support in the community.
- A directory of local mental health support is being built, this work is being undertaken by Lancashire Mind, Empowerment and Cumbria CVS.
- Local people will have easier access to specialist mental health care without needing to meet secondary care thresholds and face long waiting lists by the removal of thresholds and multiple assessments.
The community mental health transformation programme has been driven by a range of partner organisations working together. These include:
- Lancashire and South Cumbria NHS Foundation Trust
- Lancashire and South Cumbria Integrated Care Board
- GP practices and primary care networks
- People with lived experience
- Healthwatch
- The voluntary, community, faith and social enterprise sector (VCFSE)
- Unitary councils in the region.
What is personalised care?
Watch this video from NHS England to understand more about personalised care and what that might look like for you.