Primary care services provide the vast majority of NHS mental health support yet their role has been ignored in successive national policies and strategies, says a report published today by Centre for Mental Health and the University of Birmingham.
The report, Filling the chasm: Reimagining primary mental health care, explores the role of primary care services in supporting people with a range of mental health needs. It finds that primary care services in many areas of England have developed a number of different approaches to addressing mental health needs that other services do not meet. The report describes promising approaches in eight local areas.
The services aim to meet a range of needs in different ways. In Catterick, North Yorkshire, a psychologist offered direct help and support to anyone visiting the practice they worked in. In Bradford, a bespoke service works with people with medically unexplained symptoms and complex long-term conditions. And in Norfolk and Suffolk, a wellbeing service works in communities to link people up with social groups and activities.
Filling the chasm concludes that the emerging new models of primary care are seeking to fill a large and in places growing gap in mental health support in many local areas. Some combine the provision of psychological therapy services with peer support, practical help and physical health care for people with mental health difficulties. But what is offered is dependent on local initiative and in many areas there remain big gaps in services.
The report calls on NHS England to make primary mental health care a central strand of the long-term NHS plan, due to be published later this month. The NHS needs to identify effective models of primary mental health care and invest in local services to help them meet the needs of their communities. The report also calls on Health Education England to invest in the workforce for primary mental health care.
Centre for Mental Health chief executive Sarah Hughes said: “GP services are for most of us the first port of call in the NHS. As demand for mental health services continues to rise, many people will rely entirely on primary care for mental health support. Yet primary mental health care has been ignored in successive NHS policies and strategies.
“The Improving Access to Psychological Therapies (IAPT) programme has ensured many more people than ever before now get psychological support for depression or anxiety. But people with more complex problems are too often excluded from IAPT services or do not find them helpful, but many still do not meet the thresholds for community mental health services. So we urgently need to invest in support that fills the chasm in between. The services we visited for this report provide the starting points for a renewed focus on primary mental health care. We hope the long-term NHS plan will give them the best possible chance to succeed.”
People with more complex problems are too often excluded from IAPT services... but many still do not meet the thresholds for community mental health services. So we urgently need to invest in support that fills the chasm in between.
Dr Emma Tiffin, GP, Cambridgeshire and Peterborough STP Clinical Mental Health Lead and National Adviser, Community Mental Health Framework, said: “From a GP perspective it is essential that both physical and mental health care are organised around the patient. This is why primary care mental health is such an important area. Good community mental health services are key to ensuring sustainable mental health services long term and seamless care pathways for patients with mental health problems. For too long there has been fragmentation and primary/secondary care interface issues. We absolutely need to prioritise primary care mental health to ensure quality services and good outcomes for our patients and carers."
Dr Karen Newbigging, Senior Lecturer from the Health Services Management Centre at the University of Birmingham commented: “There have been various initiatives to address the gap between primary care and specialist mental health services over the past thirty years, but the invaluable role of primary care in supporting people experiencing poor mental health has largely been ignored in policy. We have been working with leaders in this area to share ideas and good practice and we hope that by calling for primary care mental health to be included in the NHS long term plan to make a tangible difference to people experiencing poor mental health. This would mean that people would get the right sort of help earlier, reducing the number of people presenting in a crisis and enabling them to manage their mental health, address the underlying difficulties and carry on with their lives.”