NHS England proposes new mental health access standards

The NHS is set to take another major step towards improving patient access to mental health services with the introduction of five new waiting time guarantees, under plans set out today.

The proposals could ensure that patients requiring urgent care will be seen by community mental health crisis teams within 24 hours of referral, with the most urgent getting help within four hours. Mental health liaison services for those who end up in A&E departments would also be rolled out to remaining sites across the country.

The NHS is consulting on the new standards, which have been piloted by mental health providers in collaboration with acute NHS trusts, and are backed by clinical and patient representatives.

They are part of overall service expansion and improvement for mental health outlined in the NHS Long Term Plan.

NHS Chief Executive Simon Stevens said: “Together with the guarantee that mental health investment will increase each year as a share of the growing NHS budget – as has been the case each year since 2015 – these new waiting times standards are another key milestone in the journey to putting mental health on an equal footing with physical health, so-called ‘parity of esteem’.”

Claire Murdoch, the NHS’s National Mental Health Director, said: “These new standards represent another major step towards parity of esteem, ensuring people who need care know when they can expect to receive it and will support more rapid access to evidence-based treatment and support.

“They will help with work already underway with the NHS turning the tide in mental health for a range of conditions as part of the Long Term Plan.

“This includes thousands of women benefitting from specialist perinatal mental health care last year and improvements to our children and young people’s services meaning more children and young people are accessing treatment than ever before, including timely, evidence-based care for eating disorders.”

Mark Winstanley, the Chief Executive of Rethink Mental Illness, said: “These standards act as building blocks on which we can build a potentially first class model of mental health care and recognise the universal truth that the quicker we can step in to provide high quality treatment, close to home for someone living with mental illness, the more we improve prospects of recovery. While they will depend on the right staff being in post they will also set the bar for something similar in social care, where so much of someone’s support for their mental illness actually takes place.”

Dr Adrian James, President of the Royal College of Psychiatrists, said: “These proposed new standards for community and liaison mental health services are an important step to delivering parity of esteem for mental illness. Access standards can make a real difference for patients by providing a clear set of priorities for services and commissioners.

“Improving care for our patients so they’re seen quickly and close to home is key to their recovery. We look forward to engaging with the consultation to ensure that these standards are introduced in the most effective and clinically appropriate way.”

Paul Farmer, Chief Executive of Mind, said: “A huge number of people have developed a mental health problem since the start of the pandemic and some groups have been hit particularly hard, including young people, those on low incomes and people from racialised communities, but not got help early on. With increasing numbers of people reaching crisis point, it is critical that they get the right mental health support quickly, which these standards would help to achieve.

“Many thousands of people will be left with long term impacts from this period, whether because of bereavement, unemployment, trauma or the weathering effect of life during lockdown. Knowing that the NHS is committed to timely access to support could make all the difference as we emerge from the pandemic and plan for the future.”

Imelda Redmond CBE, national director at Healthwatch England, the patient champion, said: “The COVID-19 pandemic has seen a significant rise in the number of people struggling with their mental health. The unpredictability of day to day life – combined with a personal loss and pain that so many of us have experienced in the past year – has had significant knock-on effects on our wellbeing.

“Good mental health is important to us all so we need concerted action to address and meet the increased demand for mental health services.

“The proposed standards will help people understand what level of care to expect and will help NHS track progress. Crucially, this will surface the performance of mental health services and give them the same sort of attention as emergency care and elective care backlogs. Ultimately, the true test is whether or not these standards improve experiences for patients.

“We’ll be encouraging people to tell NHSE exactly how mental health services work for them to help ensure their voices are heard.”

Minister for Mental Health, Nadine Dorries, said: “I am absolutely committed to supporting everyone’s mental health and these proposals are a crucial step forwards in ensuring vital treatment can be accessed quickly.

“This work complements our mental health recovery action plan – supported by £500 million – which ensures we offer the right support over the coming year to help people with a variety of mental health conditions. We have also provided £2.3 billion a year – the largest increase in mental health funding in NHS history – to expand and transform services in England, which will help 2 million more people to access mental health services by 2023/24.”

The proposed new standards are:

• For an ‘urgent’ referral to a community based mental health crisis service, a patient should be seen within 24 hours from referral, across all ages;
• For a ‘very urgent’ referral to a community based mental health crisis service, a patient should be seen within four hours from referral, for all age groups;
• Patients referred from Accident and Emergency should be seen face to face within one hour, by mental health liaison or children and young people‘s equivalent service;
• Children, young people and their families/carers presenting to community-based mental health services, should start to receive care within four weeks from referral. This may involve immediate advice, support or a brief intervention, help to access another more appropriate service, the start of a longer-term intervention or agreement about a patient care plan, or the start of a specialist assessment that may take longer and,
• Adults and older adults presenting to community-based mental health services should start to receive help within four weeks from referral. This may involve the start of a therapeutic intervention or a social intervention, or agreement about a patient care plan.
• The NHS Long Term Plan, which sees investment in mental health rise by at least £2.3 billion a year in real terms by 2023/24, is delivering real improvements for patients.
• The world-leading programme of talking therapies for adults with common mental illnesses sees more than one million patients per year, with more than half of those finishing treatment recovering, and there are 24/7 liaison services in 80% of general hospitals, up from only 39% in 2016.
• The new standards come on top of existing measures of mental health access which are:
• 75% of people referred to the Improving Access to Psychology Therapies (IAPT) programme should begin treatment within six weeks of referral and 95% of people referred to the IAPT programme should begin treatment within 18 weeks of referral; and
• More than 60% of people experiencing a first episode of psychosis will start treatment within a NICE-recommended package of care with a specialist early intervention in psychosis service within two weeks of referral; and
• 95% of children and young people referred for assessment or treatment for an eating disorder should receive NICE-approved treatment with a designated healthcare professional within one week for urgent cases and four weeks for every other case.

Background

Responses can be submitted through the consultation form on the NHS England website or by email to England.reviewofstandards@nhs.net. The consultation period will run from 21 July to 1 September 2021.