Community Mental Health Services

Timely access to mental health care is not just a matter of convenience— it is a matter of safety, dignity, and equity. Delays in care can lead to preventable crises, greater distress, poorer outcomes, and higher costs to the system. The severity gap, where people fall between high and low intensity services, reflects an unacceptable failing of the system to support people with SMI. High-quality care must be available when it is needed, not only when a person reaches crisis point. (Conclusion, Paragraph 29)

Continuity of care is a necessity for people with severe mental illness. It is essential to the delivery of high-quality care. When it is present, it prevents crisis, builds trust, and supports recovery. When it is absent, it fragments support, burdens families, and puts lives at risk. This continuity must be built into the design of mental health services, not left to chance. At the moment it is too easy for people to fall out of care, in some cases being discharged when there is a need for ongoing support. The approach to providing continuity of care must reflect the enduring nature of SMIs and the impact this has on people’s lives. (Conclusion, Paragraph 39)

Service users, their families, carers and loved ones have been clear: high- quality care must be person-centred, responsive to the full range of needs individuals experience, and ensure involvement of their wider networks. Current services too often fall short—focusing narrowly on diagnosis, overlooking physical health, and failing to support people with housing, employment, and social connection. People are more than a diagnosis and the support they are given must reflect this through integrated approaches that take account of the whole person, the enduring nature of severe mental illness, and recognise the vital role played by families and carers. (Conclusion, Paragraph 49)

Experiences of stigma, discrimination, and lack of culturally appropriate or personalised support were frequently reported, particularly by racialised communities, neurodivergent individuals, and those with disabilities. 74 Where care was described as high-quality, it was inclusive, responsive, and tailored to individual needs. Equity must be integral to the delivery of high- quality community mental health services. (Conclusion, Paragraph 55)

Services shaped and delivered with, and by, people with lived experience of mental illness are more trusted, accessible, and effective. Meaningful co-production—where power is shared and lived experience is valued—is essential to high-quality care. Peer support, in particular, is a vital part of recovery both for service users and peer support workers, offering connection, understanding, and dignity in ways that clinical services often cannot. (Conclusion, Paragraph 59)

Our conclusions in this Chapter try to reflect what service users told us they wanted. This must be reflected in service design. As new models of care are commissioned and implemented, these must be co-designed with experts by experience to ensure services deliver the high quality care such users need and deserve. (Recommendation, Paragraph 60) Recent reforms to Community Mental Health Services

We believe the Community Mental Health Framework sets out the right vision for Community Mental Health Services. However, evidence submitted to this inquiry reveals significant gaps between its ambitions and its implementation across England. We want to see a renewed commitment by the Government to realise the Framework’s ambitions. As the Government seeks to further transform services, it must avoid repeating past mistakes and ensure lessons from previous reforms are fully learned. We believe that refusing to evaluate progress in the round is at best complacent and at worst irresponsible. (Conclusion, Paragraph 73)

We recommend that the Government changes its current approach and commission an independent and comprehensive evaluation of how the Community Mental Health Framework has been implemented and its impact by the end of the financial year. This should not be seen as drawing a line under the Framework, but as a necessary step in ensuring that the Government and NHS England deliver on its commitment of integrated, personalised, and coordinated care. Without such evaluation, there is a risk that gaps in implementation will persist and that future transformation efforts will lack the insight and learnings needed to succeed in all areas of the country. (Recommendation, Paragraph 74)

Delivering real change and achieving parity of esteem in mental health care requires dismantling the current fragmented system and reimagining service design and delivery. The 24/7 Neighbourhood Mental Health Centre 75 pilots seem to be genuinely transformative. The experience from Trieste, and early evidence from Barnsley Street, show that radically different, individualised, community-based care gets results. We also heard that the model shows possible cost savings for the wider system. Realising large- scale reform will depend on sustained and ringfenced investment to enable stretched Integrated Care Boards to take the action needed. This must be matched by a profound cultural shift across the system from clinicians to commissioners to government. (Conclusion, Paragraph 91)

We believe there should be a 24/7 Neighbourhood Mental Health Centre in every community. (Recommendation, Paragraph 92)

The design of these centres must be informed by the learnings from the pilot programme so they can be tailored to the needs of their communities. In order for the learnings to be robust, the 24/7 Neighbourhood Mental Health Centre pilot programme must be extended by at least 12 months beyond April 2026, with additional service development funding to allow all sites to become fully operational and generate sufficient data for analysis. This will require NHS England to finalise the outcome measures and evaluation metrics for the pilots without further delay. (Recommendation, Paragraph 93)

The Government should develop and publish a clear roadmap for the national scale-up of the pilot programme. In its response to this report, we expect the Government to state how the roadmap will be developed and the timeframe for publication. (Recommendation, Paragraph 94)

We welcome the commitment in the 10 Year Health Plan to develop a Modern Service Framework (MSF) for mental health, with a focus on the needs of people with severe and enduring mental illness in particular. However, without a clear timeline for publication, this work risks slipping down the political agenda. To ensure progress and accountability, the Government should set a deadline, in its response to this report, for when in 2026 the MSF for mental health will be published. (Recommendation, Paragraph 98)

We would also like the Government to set out how people with lived experience will be involved in its development and how the MSF will be integrated with wider systems of support including those provided by the VCFSE sector and local authorities. It is essential that the MSF takes full account of the learnings and insights from the 24/7 Neighbourhood Mental Health Centre pilots. (Recommendation, Paragraph 99) 76 Creating the foundations for high-quality community-based care

Community Mental Health Services (CMHS) are integral to supporting people with severe mental illness across health, social care, and with their wider social needs. Evidence to this inquiry shows that integrated models of support within multi-disciplinary teams—such as co-located teams and Individual Placement and Support—can improve outcomes and reduce system pressures. However, fragmentation across services persists. Without sustained investment and joined-up delivery, CMHS will not enable the ambitions of the Government’s ‘Health’ and ‘Growth’ missions. (Conclusion, Paragraph 107)

In some areas, the emphasis on care coordination may have been lost through the rollout of the CMHF. We recommend that NHS England publish clear guidance on the role of key workers to ensure all service users have access to a named individual responsible for coordinating their care. (Recommendation, Paragraph 110)

Despite nearly a decade of commitments, the transition from Children and Young People’s Mental Health Services (CYPMHS) to Adult Mental Health Services (AMHS)—including Community Mental Health Services (CMHS)— remains a cliff edge and continues to fall short of what young people need. The Government, NHS England, and Integrated Care Boards must treat this issue as a national priority. We recommend that they create a clear, actionable plan as part of the formal response to the report, to deliver the promised “comprehensive offer for 0–25 year olds.” (Recommendation, Paragraph 114)

We heard that one way to track progress on integration would be through the establishment of national access and waiting time standards. The absence of national standards contributes to inconsistent access and undermines parity with physical health. NHS England should publish and implement these standards as a matter of urgency. (Recommendation, Paragraph 120)

NHS England should reinstate the annual physical health check target for people with severe mental illness (SMI) in operational planning guidance. This target has driven significant progress and remains essential for accountability, monitoring co-morbidities, and reducing preventable deaths. Building on this, the Modern Service Framework must include physical health outcomes and interventions for people with SMI as a core component. This should cover annual checks, tailored follow-up care, and mechanisms for monitoring and improvement. (Recommendation, Paragraph 133) 77

Six months on from our Adult Social Care: The Cost of Inaction report, we are frustrated the Government is yet to review the structure and level of NHS investment in the Better Care Fund (BCF). Whilst we welcome a commitment to reform the BCF in the coming 2026–27 financial year, we believe this must become a priority if the Government is to ensure it is fully capable of meeting its renewed focus on prevention and provision in the community. This should also address the misalignment of funding cycles between the NHS and local authorities. We urge the Government to do so before another six months passes, and we expect a timeline for reform in response to this report. (Recommendation, Paragraph 138)

The Government should expand the use of Section 75 of the NHS Act 2006 by enabling and encouraging more widespread pooling of budgets between NHS bodies and local authorities. This expansion should support the inclusion of a broader range of services—such as housing and education— within Section 75 arrangements to facilitate integrated commissioning and service delivery. Clearer governance and greater cross-cutting oversight of these arrangements would allow funding to follow need rather than organisational boundaries, enabling more person-centred, coordinated support for people with SMI. (Recommendation, Paragraph 143)

VCFSE organisations make a vital contribution to integrated, person-centred care for people with severe mental illness, yet they are not consistently treated as equal third partners by commissioners and providers. This must change. Genuine partnership requires co-production from the outset and equitable access to funding, including for smaller and peer-led organisations trusted by communities underserved by statutory services. (Conclusion, Paragraph 149)

The Department and NHE England should support ICBs to move away from short-term commissioning cycles to multi-year contracts for VCFSE organisations supporting the delivery of CMHS. The publication of the Strategic Commissioning Framework presents an opportunity to enable the bold action needed by ICBs to harness the value and potential of community assets and transform how service are delivered—but this must be matched by practical support and accountability to ensure the ambition is realised amid ongoing system pressures. (Recommendation, Paragraph 154)

NHS England and Integrated Care Boards should prioritise the development of alliance models that embed voluntary, community, faith and social enterprise (VCFSE) organisations in the design and delivery of community mental health services. This should include clear expectations for co- production from the outset and mechanisms to ensure smaller and peer- led organisations are actively included in decision-making and funding arrangements. (Recommendation, Paragraph 158) 78

In order for the neighbourhood pilots to realise the potential of the innovative model of care they are trialling, the Government should support the pilot sites to address challenges with digital interoperability, for example through sharing of learning and best practise. These learnings should then be collated to support future systems to implement the model, in the event of future scaling-up. (Recommendation, Paragraph 169)

We echo Lord Darzi’s assessment that there is a fundamental problem in the distribution of resources between mental and physical health. While we recognise the welcome increase in real-terms mental health spend this year, we were disappointed to see the overall share go down. We hope this is a one-off and we would ask for a clear commitment from government towards parity of esteem between mental and physical health. (Conclusion, Paragraph 175)

While integrating Service Development Funding into core funding may offer flexibility, we believe it also introduces uncertainty around continued prioritisation and investment in these services, and could have a detrimental impact upon the progress of the transformation of services. We urge the Government and NHS England to monitor this impact, and would like a formal update on this in their response to this report. (Recommendation, Paragraph 178)

We recommend the Mental Health Investment Standard be retained beyond 2025–26. The Government should commit to the Standard by the end of this calendar year to give systems greater certainty. Then, the Government should legislate to make the Standard a statutory requirement, clearly defining its scope, measures for evaluation and accountability for systems in meeting it. (Recommendation, Paragraph 185)

Staff retention is important for continuity of care for people with SMI. As part of the forthcoming 10 Year Workforce Plan, the Government should set out specific measures to reduce burnout, including action on caseload management and access to supervision; improve pay and progression opportunities for CMHS staff, including those in the VCFSE sector delivering equivalent roles; and ensure comprehensive training and continued professional development is available. (Recommendation, Paragraph 194)

It is vital that the Government ensures the 10 Year Workforce Plan delivers for Community Mental Health Services. Workforce growth must be aligned with service transformation to ensure that new roles are sustainable and integrated across settings. This must take account of all of the partners involved in the delivery of CMHS, ensuring alignment of workforce planning across the NHS with local authorities and the VCFSE sector, to support integrated service delivery and reduce fragmentation. (Recommendation, Paragraph 195) 79

Social workers make an essential contribution to tackling the broader determinants of health and mental health outcomes, yet we heard they are often deprioritised when budgetary pressures arise. The Government should recognise the important role of mental health social workers by including them in the upcoming 10 Year Workforce Plan. This should include projections for increases to the workforce to ensure that every person with an SMI has a named mental health social worker. (Recommendation, Paragraph 200)

The sector has called for a Mental Health Commissioner to address concerns about a lack of accountability across the mental health system. The Government has said it does not want to take this approach. We ask it to set out proposals to strengthen accountability, including for implementing the Patient and Carer Race Equality Framework in full. (Recommendation, Paragraph 206) 80