Community mental health services

Community mental health teams (CMHTs) support people living in the community who have complex or serious mental health problems. Patients are able to step down to primary care as their circumstances improve.
CMHTs are multidisciplinary; staff can include psychiatrists, social workers, nurses, allied health professionals, psychologists, pharmacists and peer workers (Davidson, 2021).
Since 2020, the number of people referred to core community mental health services has increased in Cambridgeshire and Peterborough. This is matched by an increase in waiting times: in July 2023, 43% of people referred to core community mental health services were waiting for 4 weeks or more since their last contact.

Overview

Core community mental health teams include mental health experts from the NHS, social care and voluntary sectors. Core teams deliver and coordinate care for adults with mental health problems, including those with co-existing conditions. This involves assessment, specific psychological and pharmacological interventions, and support to access community assets.

Increasing demand

The number of people accessing community mental health services with serious mental illness who received two or more care contacts in the rolling 12-month period increased from December 2022 to July 2023.

Figure 8: Number of people accessing community mental health services for adults and older adults with serious mental illness who received 2 or more care contacts (any contacts that were clinically meaningful or to support the mental health of the person referred) within the 12 month rolling reporting period, September 2022 to June 2023. Image source: Mental Health Services Monthly Statistics Dashboard

The number of open referrals and caseload of core community services increased from October 2021 to July 2023.

Figure 9: Open referrals and caseload of core community mental health services, Cambridgeshire and Peterborough ICS, October 2021 – July 2023. Data source: Workbook: CMH Dashboard (england.nhs.uk)

Note that ‘caseload’ is a measure of referrals that have had at least one attended contact and are still open at the end of the month whilst ‘open referrals’ is a count of all referrals, including those yet to be seen.

The proportion of contacts that were not attended (DNA or ‘did not attend’) declined overall from October 2021 (17%) to July 2023 (12%).

Waiting times

In July 2023, over half (55%) of people referred to community mental health services had 2 or more contacts (defined as any contacts with this service that were clinically meaningful or to support the mental health of the person referred) within the past 4 weeks; similar to 52% from August 2022 to July 2023.

Figure 10: Proportion of people referred to core community mental health services with two or more contacts recorded in the past 4 weeks, Cambridgeshire and Peterborough ICS, October 2021 – July 2023. Data source: Workbook: CMH Dashboard (england.nhs.uk)

The proportion of referrals waiting four weeks or more shows an increasing trend since October 2021. In July 2023, a high proportion (43%) of referrals were waiting for 4 weeks or more since the last contact. The proportion of referrals waiting less than one week also shows a slight increase over time: in July 2023, about 27% of referrals had been waiting less than one week since the last contact.

Figure 11: Time since last contact in core community mental health services, Cambridgeshire and Peterborough ICS, October 2021 – July 2023. Data source: Workbook: CMH Dashboard (england.nhs.uk)Duration of contacts

In March 2023, 41% of referrals closed without any contacts being offered or attended. The proportion of referrals that closed with one contact shows a decrease from 29% in October 2021 to 21% in March 2023.

Figure 12: Referrals to core community mental health services that closed within the time period, by number of contacts, Cambridgeshire and Peterborough ICS, October 2021 – March 2023. Data source: Workbook: CMH Dashboard (england.nhs.uk)

The number of referrals that closed in the reporting period with no contacts shows a shift (a run of 7 consecutive data points falling above the mean).

Figure 13: Referrals to core community mental health services that closed within the time period with no contacts, Cambridgeshire and Peterborough ICS, October 2021 – Ma 2023. Data source: Workbook: CMH Dashboard (england.nhs.uk)

Over a third of (36%) of closed referrals in July 2023 had a referral length (time between the start and end of the referral) between 1 and 6 months. A declining trend is seen in the proportion of referrals with lengths less than a week and 1-2 weeks, while the length of referrals ranging from 2 weeks to 6 months shows an increasing trend.

Figure 14: Length of referral to core community mental health services (lighter colours indicate shorter referrals), Cambridgeshire and Peterborough ICS, October 2021 – July 2023. Data source: Workbook: CMH Dashboard (england.nhs.uk)

How many people are referred to these services?

Referrals to community mental health teams may be ‘stepped up’ or ‘stepped down’ care, such as from crisis teams, inpatient wards, liaison psychiatry, or the Primary Care Mental Health Service (PCMHS) (CPFT, 2023a). The number of referrals accepted by local community mental health services per 100,000 of the total population in Cambridgeshire and Peterborough is substantially higher than other areas in the East of England.

Figure 15: Total referrals accepted into community mental health teams per 100,000 resident population, East of England, 2022/23. Image source: NHS Benchmarking report 2022/23

Note: Cambridgeshire and Peterborough ICS is shown in red (MH063).

Almost everyone who was referred to the generic community mental health teams in Cambridgeshire and Peterborough in 2022/23 were accepted.

Figure 16: Percentage acceptance rates for referrals into generic community mental health teams, East of England, 2022/23. Image source: NHS Benchmarking report 2022/23

Note: Cambridgeshire and Peterborough ICS is shown in red (MH063).

Adult locality teams

Adult Locality Teams support people aged 17 and over who are ‘experiencing symptoms of moderate to severe mental illness’. These community mental health teams accept referrals from the Primary Care Mental Health Service (PCMHS), First Response Service (FRS), crisis team, inpatient wards, liaison psychiatry, other mental health teams or other health professionals (CPFT, 2023a).

This service introduced brief psychological interventions (BPI) for anxiety and depression, initial evaluations of which suggested they had a positive impact on patients in terms of wellbeing, anxiety and mood (Roberts et al., 2021).

Arts Therapy

CPFT Arts Therapy connects and engages people by offering groups and one-to-one sessions with art, music and dramatherapy practitioners (CPFT, 2023b).

Early intervention in psychosis

Early intervention in psychosis (EIP) services are multidisciplinary community mental health services that provide treatment and support to people experiencing or at high risk of developing psychosis, typically over three years (Public Health England, 2019).

CAMEO (Cambridgeshire and Peterborough Assessing, Managing and Enhancing Outcomes) provides support for people who are experiencing their first episode of psychosis or those at risk of developing psychosis. This service is open to people aged 14 to 65. Support is provided by:

CAMEO North, which covers Peterborough, Huntingdon and Fenland.
CAMEO South, which covers East Cambridgeshire, South Cambridgeshire and Cambridge City.

Evidence base

There is a wide range of international evidence of highlighting the importance of early intervention in psychosis (EIP) services, including:

Impact on individuals: cognitive behavioural therapy for psychosis (CBTp) has been shown to reduce rehospitalisation rates, length of hospital stay and symptom severity; and to improve social functioning (NHS England, 2023e).
Early intervention: people experience improved outcomes when receiving care from an EIP service, compared to standard care (NHS England, 2023e).
Economic benefits: the reduction in crisis and inpatient services associated with EIP services, as well as improved employment outcomes, leads to estimated net cost savings of £7,972 per person after the first four years of starting treatment (NHS England, 2023e).

An evaluation of CAMEO, carried out between 2013 and 2019, found that 60% of patients had a ‘good outcome’ and were discharged to primary care. The remaining 40% required follow-up in secondary mental health services, which may suggest they had a poorer outcome (Osimo et al., 2021).

Referrals

The number of open referrals and caseload of CAMEO declined by 25% in July 2023, compared to March 2019.

Figure 17: Open referrals (light blue) and caseload (dark blue) in EIP services, Cambridgeshire and Peterborough ICS, March 2019 – May 2023. Image source: EIP Triangulation Tool – Mental Health, Learning Disability and Autism Resource Hub – FutureNHS Collaboration Platform

Waiting times

The NHS Long Term plan continued the ambition from the Five Year Forward View for Mental Health that at least 60% of all people with first episode psychosis should be accepted into a specialist EIP service and start a NICE-recommended package of care within 2 weeks from referral (National Institute for Health and Care Excellence et al., 2016). By 2023/24, this should increase to 95%.

Waiting times are decreasing in CAMEO. The proportion of referrals waiting for more than 4 weeks since the last contact has decreased since March 2019, while wait times of less than 1 week show an increasing trend.

Figure 18: Time since last contact in EIP services, Cambridgeshire and Peterborough ICS, March 2019 – May 2023. Image source: EIP Triangulation Tool – Mental Health, Learning Disability and Autism Resource Hub – FutureNHS Collaboration Platform

Bed days

The average ‘in month’ bed days for people in the EIP caseload was 26.3 in May 2023, similar to May 2019 (26.9).

Figure 19: In month bed days for people on CAMEO caseload, May 2019 to May 2023. Image source: EIP Triangulation Tool – Mental Health, Learning Disability and Autism Resource Hub – FutureNHS Collaboration Platform

How does this service compare to national guidelines?

NICE guidelines have seven key quality statements for EIP services, which are used to inform the national annual EIP self-assessment.
In 2022/23, CAMEO was graded level 2 overall in this assessment (Early Intervention In Psychosis Scoring Matrix), which indicates that this service ‘needs improvement’. However, as shown below, CAMEO is top performing (level 3) is many areas.
The reason this service does not meet level 3 is due to a relatively low proportion of service users with first episode psychosis (FEP) being recorded as having a physical health checks and interventions. This may reflect data issues rather than the true proportion of patients accessing physical health checks.

Table 2: National Clinical Audit of Psychosis scoring matrix for CAMEO, 2022/23

Recovery services

The Recovery Coach Team provides coaching and peer support sessions for people transitioning from secondary community mental health services back to their GP (93).

The RCE Wellbeing Hub (formerly known as Recovery College East) offers short courses to support people’s wellbeing and the wellbeing of those around them. It is based on the key principles of hope in recovery, empowering people to be in control of their wellbeing and supporting them to find opportunities to ‘live well’. Courses are open to anyone over the age of 17.

How many people use this service?

From September 2022 to July 2023 in the RCE Wellbeing Hub:

There were 283 unique student registrations and 733 student attendances.
There were 2946 hours of teaching delivery.
On average, there were 4.5 students per session and 86% of student registrations were attended.
The majority of students had previously accessed CPFT services; and had heard about services from a CPFT staff member or the CPFT website.

Figure 20: Groups accessing the RCE Wellbeing Hub, September 2022 to July 2023

What do people say about this service?

97% people who used this service would recommend it to others. One individual stated that: ‘what I like about the RCE Wellbeing Hub is that it’s reminded me that I love to learn. I feel this strange thing now that I think might be happiness creeping in. This has really been quite life changing. The tutors are amazing, and they make the courses. The Hub has really helped me get a hold of my life again’.

Psychological Skills Service

The Psychological Skills Service was introduced as part of the Exemplar. This service offers group interventions, brief psychological interventions, psychological support work and advanced individual therapy for people who previously fell between the gap of Talking Therapies and secondary care. People can be referred in from a range of services, including Primary Care Mental Health Services (PCMHS) and Talking Therapies.

Figure 21: Services provided by the Psychological Skills Service (PSS). Image source: Psychological Skills Service (PSS) September 2023

Additional Resources

References

Full list of references is included at the end of this chapter.