What is the Community Mental Health Framework?

The CMHF has changed the expectations for how mental health services are to be delivered in the community.  This includes:  

• Removing gaps in care and services for people with significant challenges to their mental health and wellbeing.

• Different providers working together – linking up primary care, acute care, voluntary sector provision, secondary mental health services and social care (local authority).

• Making changes to the Care Programme Approach (CPA).

• Making changes to commissioning.

• Reduction in the number of duplicate or unnecessary assessments.

• Recognition that patients are active participants in a system.

• Recognition that personalised care is crucial and co-production underpins the framework’s approach to design and planning of provisions, as well as delivery of care.

• A focus on addressing inequalities and meeting the needs of communities currently poorly served by local mental health provision.

There are few details as to how to implement this framework, with freedom for providers and commissioners to try out different local models and approaches. This is why evaluations learning from local innovation are important and why we have decided to share findings via a Knowledge Exchange. There is much we can learn from each other.

This illustration from NHS England highlights the lack of provision, focus and investment both locally and nationally within community mental health services for adults (people aged 18 and over) with severe mental health needs.

This diagram shows what this approach might look like in a community. It includes self-help and an enabling approach to address inequalities. While recognising the wide range of constituents, it also shows there is no set design for this courageous ambition.

People would be able to present at any point in the system – from pharmacies, advisory services or community groups to education, social services, the criminal justice system or primary care – and be guided to the right support without delay (a ‘no wrong door’ approach). Services could meet people in the spaces where they already are and where they feel comfortable, which for some people will include via digital media. This means working more effectively with the community and with VCSE organisations, schools and non-healthcare providers. It might also mean ensuring that both online and face-to-face options are available, so that people can access the support they need without delay and no one misses out because of digital exclusion. A single trusted assessment would unlock a pathway to care that works for the individual with their physical and mental health needs met together. People with mental health problems would be enabled as active participants to make positive changes, rather than remain passive recipients of disjointed, inconsistent and episodic care. A collaborative approach to decision making and care delivery would enable a more joined up approach between those who need services and those who provide them. 

2019 saw the beginning of the roll out of the CMHF. It began with the selection of 12 Early Implementer sites, one from each of the 12 regions in England. These 12 sites acted as trailblazers for the implementation of the CMHF and were often ICS areas that had demonstrated evidence of transforming community services. Some had established primary care mental health provision or were already developing neighbourhood services. This meant that these 12 pilot sites were further ahead in their journey to transform existing services and were likely to be able to create further learning, which might be helpful for future implementation. 

Implementation incorporating principles of co-production