COVID-19: Community mental health settings

Page last updated: 21 April 2020

Explore our guidance for psychiatrists and their colleagues working in community mental health settings. 

Where possible, and in line with national and regional government guidelines, IAPT services should offer face to face appointments for those for whom the clinical need is indicated and/or they would fail to receive appropriate interventions remotely.

Services should utilise their local risk assessment processes to enable use of Covid secure accommodation for patients requiring face to face appointments.

More detail on approaches to communications and care planning are set out in the IAPT guide for delivering treatments remotely during the coronavirus pandemic.

NHS England and NHS Improvement have written to all mental health trust chief executives and mental health leads across clinical commissioning groups and sustainability and transformation partnerships to confirm a request that all areas should have established an open access 24/7 urgent NHS mental health telephone support, advice and triage service by 10 April. This is almost one year ahead of the original schedule in the NHS Long Term Plan of March 2021.

Children and young people and their parents/carers should have access to the service, either through all ages option or as a dedicated access point. Trusts have also been asked to confirm the following is in place by 10 April:

  • Ensure: 24/7 open access crisis line telephone numbers and contact details are publicly available online (including a specific CYP number if necessary); accessibility for people with intellectual disability and/or autism has been considered; and contact details for other support such as IAPT and voluntary sector helplines are provided.
  • Ensure: trust's website and literature no longer direct people to A&E, 999 or NHS111 as the default (unless it is part of a properly resourced and planned urgent mental health pathway within or via NHS111); information is provided online about when A&E/999 is appropriate; 
  • In areas where these services are established, consideration has been made to any additional capacity that might be required and redeployed not only for the telephone service but also to services that can provide all-ages follow-up care.

An annex to the letter also offers a set of further considerations in establishing the 24/7 services, with points including:

Key service principles

  • There should be no restrictions on who can refer and mental health crisis should be self-defined.
  • While it is expected that a substantial proportion of care needs will be met through telephone or video consultations, provision for urgent face-to-face assessments must also be in place. 
  • Ensuring an age-appropriate response - professionals with competency in meeting needs of CYP or older adults should ideally be responding to presentations from those groups. Trust websites should clearly display where there are separate teams/services for different age groups.
  • Ensuring equity in access - while open access urgent services may not be able to provide specialist support across a range of needs, they must not reject calls from people with mental health needs because they have other conditions, e.g. intellectual disability, autism, dementia, substance misuse problems.

Potential options for increasing capacity

  • Redeploy staff from other services with reduced activity or deemed less essential during COVID-19 period
  • Ask qualified staff who are well but self-isolating to conduct telephone and video support
  • Consider establishing a combined CYP and adult service support offer to cover 24/7 where bespoke CYP services are in place but yet to be operating at 24/7
  • Work with voluntary and community sector services to provide a complementary and integrated helpline offer.

Funding

  • All areas have resources confirmed for these services through transformation funding
  • NHSE/I are clear that 'Financial constraints must not and will not stand in the way of taking immediate and necessary action.'

NHS.UK website - crisis service postcode finder

  • A national service finder for urgent mental health support will be compiled by NHSE/I and NHS Digital from all trust websites and made available through a postcode search on the NHS.UK website.

During the Coronavirus outbreak, many services are under stress. Work in some psychological therapies services has been temporarily suspended, and staff redeployed to cover absent colleagues. Face to face meetings with trainees have ceased in many places, at the very time that support and space to think is at a premium.

We appreciate the enormous challenges clinicians are facing as they grapple with the threat from COVID-19 and the great work being done to adapt and support your teams, colleagues and trainees.

The Faculty of Medical Psychotherapy has compiled the following guidance for members:

  1. Psychotherapeutic services should not prematurely stop seeing patients. There may be local pressures which make continuing services remotely impossible, and psychotherapy services may be viewed as less essential than other mental health services, but the needs of the patients in treatment should always be weighed against needs elsewhere.
  2. As psychiatrists, medical psychotherapists should be willing to take on additional tasks within their competence as required by the local situation, whilst not neglecting their core service.
  3. The way that patients are assessed and treated, and staff support/supervision is delivered, may need to change, but in many cases these activities can continue with appropriate adjustments.
  4. Clinicians should consider carefully whether the aims of treatment can be delivered remotely, such as by phone or Teams, and in some cases psychotherapy will need to be more supportive and less challenging when carried out remotely rather than in person.
  5. Case discussion (Balint) groups are particularly important at the moment, as trainees are having to negotiate unfamiliar clinical situations, and may be required to exercise their ethical and clinical judgement in more unfamiliar situations. These group meetings should be held remotely.
  6. Consideration will need to be given to replacing lost experience in psychological therapies for trainees who are redeployed during the crisis.
  7. Staff support is more necessary during times of high stress and constrained resources. Existing staff support groups should continue remotely, and medical psychotherapists should take an active role in providing additional resources. The College has produced a list of messages for supporting healthcare staff during the epidemic.
  8. Other RCPsych guidance on COVID-19 includes ethical considerations and guidance on remote consultations.  
  9. A group of organisations involved in psychological therapies have drafted guidance for psychological professionals during the outbreak which members may find useful.
  10. Training: There is a new ARCP outcome 10 in response to the pandemic impact on trainee progression assessments which states: ‘Achieving progress and the development of competences/capabilities at the expected rate but acquisition of some capabilities delayed by impact of COVID 19. Can progress to next stage of training as overall progress may be satisfactory. Any additional training time will be reviewed at the next ARCP.’

     

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