Tag: Mental Health Trust

What is a Mental Health Trust (UK)?

Published on by Andrew MarshallLeave a comment

Introduction

A mental health trust provides health and social care services for people with mental health disorders in England.

There are 54 mental health trusts. They are commissioned and funded by clinical commissioning groups (CCG).

Patients usually access the services of mental health trusts through their general practitioner (GP; primary care medical doctor) or via a stay in hospital. Most of the services are for people who live in the region, although there may be specialist services for the whole of the UK or services that accept national referrals. Mental Health Trusts may or may not provide inpatient psychiatric hospital services themselves (they may form part of a general hospital run by a hospital trust). The various trusts work together and with local authorities and voluntary organisations to provide care.

Services

Services provided by mental health trusts vary but typically include:

  • Counselling sessions – one-to-one or in a group.
  • Courses – such as on how to deal with stress, anger, and bereavement. Courses may also be available for carers of those with mental health disorders.
  • Resources – such as leaflets and books on mental health issues.
  • Psychotherapy – treatment sessions with a therapist. Commonly cognitive behavioural therapy.
  • Family support – providing support to the family, friends, and carers of those with a mental health problem.
  • Community drug and alcohol clinics – helping people to cope with addiction.
  • Community mental health houses – supported housing to help people live in the community.
  • Day hospitals and day centres – short-term outpatient sessions with a psychiatrist, clinical psychologist or other mental health professional, and drop-in centres for peer support and therapeutic activities.

If more specialist hospital treatment is required, Mental Health Trusts will help with rehabilitation back into the community (social inclusion). Trusts may operate community mental health teams, which may include Crisis Resolution and Home Treatment, assertive outreach and early intervention services.

The Mental Health Act 1983, Mental Health Act 2007 and Mental Capacity Act 2005 cover the rights, assessment and treatment of people diagnosed with a mental disorder who are judged as requiring to be detained (“sectioned”) or treated against their will. A mental health trust will typically have a Mental Health Act team responsible for ensuring that the Act is administered correctly, including to protect the rights of inpatients, or of service users in the community who may now be under community treatment orders. The Care Quality Commission is the body with overall national responsibility for inspecting and regulating the operation of the mental health act by the regional trusts.

Capacity

According to the British Medical Association (BMA) the number of beds for psychiatric patients was reduced by 44% between 2001 and 2017. An average of 726 mental health patients were placed in institutions away from their home area in 2016.

Children of school age are normally treated through Child and Adolescent Mental Health Services (CAMHS), usually organised by local government area. Young people who become psychiatric in-patients frequently are treated in adult wards due to lack of beds in wards that are suitable for people of their ages. Young people frequently stay in hospital wards when they are fit for discharge because the mental health support facilities they need are not available where they live.

List of MHTs
These are the mental health trusts in the NHS in England in 2017 (note that many have NHS Foundation Trust status – a type of trust that has more independence from government):

  • 2gether NHS Foundation Trust.
  • 5 Boroughs Partnership NHS Foundation Trust.
  • Avon and Wiltshire Mental Health Partnership NHS Trust.
  • Barnet, Enfield and Haringey Mental Health NHS Trust.
  • Berkshire Healthcare NHS Foundation Trust.
  • Birmingham and Solihull Mental Health NHS Foundation Trust.
  • Bradford District Care Trust.
  • Cambridgeshire and Peterborough NHS Foundation Trust.
  • Camden and Islington NHS Foundation Trust.
  • Central and North West London NHS Foundation Trust.
  • Cheshire and Wirral Partnership NHS Foundation Trust.
  • Cornwall Partnership NHS Foundation Trust.
  • Coventry and Warwickshire Partnership NHS Trust.
  • Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust.
  • Derbyshire Healthcare NHS Foundation Trust.
  • Devon Partnership NHS Trust.
  • Dorset HealthCare University NHS Foundation Trust.
  • Dudley and Walsall Mental Health Partnership NHS Trust.
  • East London NHS Foundation Trust.
  • Greater Manchester Mental Health NHS Foundation Trust.
  • Humber NHS Foundation Trust.
  • Isle of Wight NHS Trust.
  • Kent and Medway NHS and Social Care Partnership Trust.
  • Lancashire Care NHS Foundation Trust.
  • Leeds and York Partnership NHS Foundation Trust.
  • Leicestershire Partnership NHS Trust.
  • Lincolnshire Partnership NHS Foundation Trust.
  • Mersey Care NHS Trust.
  • Norfolk and Suffolk NHS Foundation Trust.
  • North East London NHS Foundation Trust.
  • North Essex Partnership University NHS Foundation Trust.
  • North Staffordshire Combined Healthcare NHS Trust.
  • Northamptonshire Healthcare NHS Foundation Trust.
  • North Cumbria Integrated Care NHS Foundation Trust.
  • Nottinghamshire Healthcare NHS Trust.
  • Oxford Health NHS Foundation Trust.
  • Oxleas NHS Foundation Trust.
  • Pennine Care NHS Foundation Trust.
  • Rotherham Doncaster and South Humber NHS Foundation Trust.
  • Sheffield Health & Social Care NHS Foundation Trust.
  • Somerset Partnership NHS Foundation Trust.
  • South Essex Partnership University NHS Foundation Trust.
  • South London and Maudsley NHS Foundation Trust.
  • South Staffordshire and Shropshire Healthcare NHS Foundation Trust.
  • South West London and St George’s Mental Health NHS Trust.
  • South West Yorkshire Partnership NHS Foundation Trust.
  • Southern Health NHS Foundation Trust.
  • Surrey and Borders Partnership NHS Foundation Trust.
  • Sussex Partnership NHS Foundation Trust.
  • Tavistock and Portman NHS Foundation Trust.
  • Tees, Esk and Wear Valleys NHS Trust.
  • West London NHS Trust.
  • Worcestershire Health and Care NHS Trust.

What are Child and Adolescent Mental Health Services (CAMHS)?

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Introduction

Child and Adolescent Mental Health Services (CAMHS) is the name for NHS-provided services in the United Kingdom for children, generally until school-leaving age, who are having difficulties with their emotional well-being or are deemed to have persistent behavioural problems.

CAMHS are organised locally, and the exact services provided may vary, often by local government area.

Brief History

In Europe and the United States child-centred mental health did not become a medical specialty until after World War I. In the United Kingdom children’s and young people’s mental health treatment was for decades the remit of the Child Guidance Movement increasingly working after World War II with local educational authorities and often influenced by psychoanalytic ideas. Provision in NHS hospitals was piecemeal across the country and disconnected from the youth justice system. However opposition to Psychoanalysis with its pioneering research work into childhood and adolescence, which was poorly understood by proponents of the Medical model, caused the service to be abandoned in favour of evidence-based medicine and evidence-based education. This led to the eclipse of the multidisciplinary child guidance approach in the 1990s and a public policy-motivated formal take-over by the NHS.

The development of CAMHS within a four-tiered framework started in 1995. In 1998, 24 CAMHS Innovation Projects started, and the Crime and Disorder Act 1998 established related youth offending teams. In 2000 the NHS Plan Implementation Programme required health and local authorities to jointly produce a local CAMHS strategy.

In November 2008 the independent CAMHS Review was published.

From about 2013 onward major concerns have been expressed about reductions in CAMHS, and apparently increasing demand, and in 2014 the parliamentary Health Select Committee investigated and reported on provision. In 2015 the government published a review, and promised a funding increase of about £250 million per year. However the funds were not ring-fenced and as of 2016 only about half of England’s Clinical commissioning groups had increased local CAMHS funding. CAMHS funding remains a popular topic for political announcements of funding and the current aim is to increase funding to the level that 35% of young people with a disorder are able to receive a specialist service. Different models of service organisation are also advocated as part of this transformation.

In Scotland, between 2007 and 2016 the number of CAMHS psychologists had doubled, reflecting increased demand for the service. However in September 2020, 53.5% of CAMHS patients in Scotland had waited for an appointment longer than the 18 weeks target, and in Glasgow the average waiting time was 26 weeks.

131 new CAMHS beds were commissioned by NHS England in 2018, increasing the existing 1,440 bed base by more than 10%. 56 will be in London, 12 at Bodmin Hospital and 22 at St Mary’s Hospital in Leeds.

Service Framework

In the UK CAMHS are organised around a four tier system:

TierDescription
1General advice and treatment for less severe problems by non-mental health specialists working in general services, such as GPs, school nurses, social workers, and voluntary agencies.
2Usually CAMHS specialists working in community and primary care, such as mental health workers and counsellors working in clinics, schools and youth services.
3Usually a multi-disciplinary team or service working in a community mental health clinic providing a specialised service for more severe disorders, with team members including psychiatrists, social workers, board certified behaviour analysts, clinical psychologists, psychotherapists and other therapists.
4Highly specialist services for children and young people with serious problems, such as day units, specialised outpatient teams and in-patient units.

Specialist CAMHS – Tiers 3 and 4

Generally patients cannot self-refer to Tier 3 or 4 services, which are sometimes called specialist CAMHS. Referrals can be made by a wide range of agencies and professionals, including GPs and school nurses.

The aim is to have a team led by a consultant psychiatrist, although other models exist and there is limited evidence of what system works best. It is suggested that there should be a consultant psychiatrist for a total population of 75,000, although in most of the UK this standard is not met.

The Tier 4 service includes hospital care, with about 1,450 hospital beds provided in England for adolescents aged 13 to 18. Typical conditions that sometime require hospital care include depression, psychoses, eating disorders and severe anxiety disorders.

The service may, depending on locality, include:

  • Art therapy.
  • Child psychiatry.
  • Clinical psychology.
  • Educational psychology.
  • Family therapy.
  • Music therapy.
  • Occupational therapy.
  • Psychiatric nursing.
  • Social worker interface.
  • Speech therapy.
  • Child psychotherapy.
  • Forensic CAMHS, working with young offenders or those at risk of offending.

Performance

As of December 2016, some young English people with eating disorders were being sent hundreds of miles away to Scotland because the services they required were not available locally. Not withstanding good care in Scotland it was said that being away from friends and family compromised their recovery. In response the government had adopted a policy of ending such arrangements by 2021, and had allocated a cumulative £150M to improve local availability of care. There are concerns that not enough is being done to support people at risk of taking their own lives. 1,039 children and adolescents in England were admitted to beds away from home in 2017-2018, many had to travel over 100 miles (160 kilometres) from home. Many had complex mental health issues frequently involving a risk of self-harm or suicide, like severe depression, eating disorders, psychosis and personality disorders.

In 2017-2018 at least 539 children assessed as needing Tier 3 child and adolescent mental health services care waited more than a year to start treatment, according to a Health Service Journal survey which elicited reports from 33 out of the 50 mental health trusts.