The Community Mental Health Framework for Adults and Older Adults

The Community Mental Health Framework for Adults and Older Adults: Support, Care and Treatment full guidance documents were commissioned by NHS England to support the delivery of The NHS Long Term Plan.

They present the best available evidence and outline a new structure for providing integrated community-based mental health care. This new way of working will help more people receive higher-quality care when and where they need it. 

Rolling out the framework and eight key messages for 2021/22

The College has developed eight key messages on the Community Mental Health Framework (PDF). Clinicians can use these to help inform their work in community mental health care transformation. The College originally developed these messages in 2020, but has refreshed them for 2021 to help support clinical engagement in ongoing planning for the rollout of the framework.

The community mental health transformation programme is already well under way across the country, based on the short guide, published by NHS England in 2019. That document is a summary of this full guidance. At the NCCMH, we are certain that the Community Mental Health Framework full guidance will be of huge benefit to services and service users across the country, with this work already proving to be influential. We hope that these documents will support people as they develop their new community models.

The three full guidance documents were developed and prepared in 2018/19. Prior to publication, some sections were updated to include developments that have taken place since then, including the impact of and responses to COVID-19. However, it is still expected that the documents will still be relevant post-pandemic. 

Over the last 20 years, community mental health care teams have taken a central role in delivering mental health services. The increasing range of mental health services has resulted in some fragmentation of services and discontinuity of care in local communities. This has created barriers for people trying to access care and more variation in the care they receive.

This framework will enable health and social care providers and commissioners to move towards a new place-based community mental health model that provides more effective support, care and treatment for adults within a community network. The guidance explains how to implement the framework and evaluate its impact on the overall quality of care.

The framework promotes an approach in which people with mental health problems are active participants in making positive changes, rather than passive recipients of disjointed, inconsistent and episodic care.

Implementing the framework will also lead to:

  • more effective allocation of resources
  • improved integration of services
  • better support for the primary care workforce 
  • development of people’s personal skills, and building of resources and available assets
  • access to support, care and treatment that meets people’s needs within their communities and across all organisations and sectors.

Community traditionally means the geographical space in which people live. People also form their own communities based around ethnicity, gender, sexual orientation, socioeconomic status, occupation or interests. Whether community is a geographical location or a group in which people find or place themselves, it’s the context for people’s lives.

Delivering effective mental health support, care and treatment to people in the community can only be achieved if all parts of the health and social care system, including VCSE organisations, work together.

This framework focuses on integrated care, bringing all the services and agencies that support people with different mental health needs much closer together. People using the services need to be kept at the centre of service provision, with services tailoring their work and support around the individual’s possibly changing needs. 

This is a representation of a person (A) who has a good connection with their community, showing their proximity to

different parts of the community:

Figure 1. Community layers

"In light of the huge social and economic changes that have taken place in England over the past 18 months, I’m delighted that the NCCMH is now publishing the full documents for The Community Framework for Mental Health for Adults and Older Adults. People around the country are already using the NHS short guide to implement the framework – but these complete documents show the full rationale and evidence behind it.

The full framework documents are indispensable to anyone working in community mental health care, mapping out a clear standard of what good mental health care in the community can and, if done right, will be like."

Dr Adrian James
President of the Royal College of Psychiatrists

Download the framework documents

Part 1 – Setting out the framework

Part 1 defines the community and presents the case for change. It reframes the delivery, functions and commissioning of community mental health services as community-based support, care and treatment. It includes:

  • what we mean by community 
  • scope and aims of the framework
  • the impact of the community on mental health 
  • advancing mental health equality in the community
  • improving engagement with community assets
  • guidance on commissioning the framework.

Part 2 – The framework in practice

Part 2 contains practical guidance on how to apply the framework to community mental health services. It uses example personal histories and model communities to show how community mental health support, care and treatment can be delivered in line with the framework. It includes:

  • the core community mental health service
  • the framework applied to a community 
  • key stages of implementation
  • outcomes 
  • challenges and solutions.

Appendices

The appendices contain information on standards and quality of care. They include personal experiences of support, care and treatment, and describe services around England that deliver elements of care in line with the framework. There are summaries of the evidence reviews that informed the development of this work, and more information on how the framework was developed. 

The Community Mental Health Framework for Adults and Older Adults (short guide)

A summary version of the above documents, published by NHS England and NHS Improvement in 2019, with key information on how to implement the framework. 
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