The Community Mental Health Framework: Implementation Guidance

The Community Mental Health Framework for Adults and Older Adults was published in 2019 ahead of the rollout of work in England to transform community mental health services as part of the NHS Long Term Plan.

The framework has served as the guide for 12 local areas in reorganising community mental health services during an NHSE/I Early Implementer phase over the last year.

Now all Integrated Care Systems (ICSs) in England are rolling out the new models of community mental health, NCCMH have recently published this detailed implementation guidance, which should underpin the delivery of these models across ICSs and STPs in England. For early implementer sites, this guidance should help develop their work already underway.

• The framework introduced in the guide represents a new approach to situating and providing place-based integrated support, care and treatment in the community for people with mental health problems whatever their level of need, including those with more complex need. Adoption of this framework will enable more and higher-quality care to be provided at a local (‘neighbourhood’) community level by making better use of resources including community assets.
• The framework offers a structure for doing this by dissolving the barriers that currently exist between (1) mental health and physical health, (2) health, social care, voluntary and community social enterprise (VCSE) organisations and local communities, and (3) primary and secondary care, to deliver integrated, personalised, place-based and well-coordinated care for adults and older adults. In addition, a key component of this vision of more efficient and effective mental health care is setting out a method for coordination of care that replaces the Care Programme Approach.
• Central to this will be a ‘core community mental health service’. This will bring together and enhance the mental health care, support and treatment provided in primary care with that provided by secondary care community mental health teams, and in residential settings (including supported housing and care homes).
• Stigma and inequalities in access to mental health care, for adults and older adults, and for whole communities, need to be addressed and reduced. Access to mental health support, care and treatment should be based on a person’s needs, and where and which services are best placed to meet them. The framework will help local systems address inequalities in mental health care.

Part 1 defines 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.

Part 2 contains practical guidance on how to apply the framework to community mental health services. It uses example histories and model communities to show how the framework can be delivered.

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, and information on how the framework was developed.

The pilot phase of the College Engagement Network is focusing on the implementation of the CMHF, and will also be working to support the use of this guidance.

For more information, please contact rosanna.flury@rcpsych.ac.uk.

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