In the past, there was often a clear distinction between 'frontline' primary care for mental health conditions, such as GPs and community mental health nurse (CMHN), and more specialised services, such as psychiatrists or clinical psychologists, who often only worked out of psychiatric units.
However, following the recommendations made in the national service framework (NSF) report, there has now been a shift to providing some of these specialised services in a community setting, such as a day centre, or in your own home.
As hospitalisation for a mental health condition can be traumatic it is only used when it is thought to be absolutely necessary.
Whenever possible, mental health services are now delivered using a multi-disciplinary approach, calling upon the skill and expertise of a number of different departments and teams.
Mental health trusts
In many parts of the country, mental health services are organised by specialist mental health trusts. Mental health trusts provide inpatient care, community and rehabilitation services, residential care centres, day clinics, and drop-in centres.
There are currently over 40 mental health trusts in England and Wales.
Community mental health teams
Community mental health teams (CMHTs) focus on working to help people with complex mental health conditions, such as schizophrenia and bipolar disorder (manic depression).
They aim to provide the day-to-day support that is needed to allow a person to remain living in the community.
Crisis resolution teams
Crisis resolution teams (CRTs) treat people with serious mental health conditions who are currently experiencing an acute and severe psychiatric crisis which, without the involvement of the CRT, would require hospitalisation. Psychotic episodes, or suicide attempts, are examples of acute psychiatric crises.
Due to the nature of their work, CRTs offer a 24 hour service, and cases are often referred to them via accident and emergency (A&E) departments or the police service.
The CRT will aim to treat a person in the least restrictive environment possible, ideally near the person's home. This may be in a person's own home, in a dedicated crisis residential home or hostel, or in a day centre.
CRTs are also responsible for planning after-care once the crisis has passed in order to prevent a further crisis occurring.
Assertive outreach teams
Assertive outreach teams (AOTs) aim to help people who have had a previous history of serious mental health problems, but are no longer in regular contact with mental health services.
The concern is that a person may still require regular treatment but, for a number of possible reasons, they are no longer seeking it and therefore might become a risk to themselves or others.
AOTs will work in cooperation with other agencies in trying to locate people who are thought to be at risk. Once they have been located, a member of the team will try to persuade them to resume their contact with mental health services, and also find out why they lost contact in the first place.
After these issues have been resolved, the person's treatment can then usually be transferred to a community mental health team.
If the person still refuses treatment, and it is thought that they pose a significant risk to themselves, or others, the AOT may have to liaise with social services in order to get the person sectioned under the Mental Health Act.
Early intervention in psychosis teams
Psychosis is a term that is used to describe a mental condition where someone is unable to distinguish between their imagination and reality. An episode of psychosis is usually caused by an underlying serious mental health condition, such as schizophrenia or bipolar disorder, or as a result of drug or alcohol misuse.
The early intervention by the psychosis team (EIPT) is designed to work with people who are between 18-35 years of age, and who have experienced their first episode of psychosis. In the past, it could take up to two years after the onset of psychotic symptoms before someone started receiving treatment and help.
However, the EIPT now focuses on the early detection and assessment of psychotic symptoms, and then provides support and counselling in order to treat the underlying causes.
Early intervention is often crucial because it is during the first few years that people with psychotic symptoms are at greatest risk of harm to both themselves and to others. Also, the earlier a serious mental condition is treated, the better the long-term outcomes tend to be.
Forensic mental health services
Forensic mental health services work with people who have mental health conditions and have committed a criminal offence, or are thought to be at high risk of committing an offence.
Forensic mental health services are delivered in secure hospitals and prisons because most of the people who are in need of such services are thought to be a risk to both themselves and others.
An important goal of forensic mental health is to treat any mental health problems that may have contributed to a pattern of criminal behaviour and, whenever possible, release a person back into the community after they have completed their sentence, if it is thought safe to do so.
However, a small number of people are held indefinitely in secure hospitals because they are thought to pose a serious and immediate threat to the public, due to a previous history of physical and/or sexual violence.
Services for children and young people
Mental health services for children and young people in England are organised in a four tier system. The tiers are described below.
Tier 1 - provides treatment for less severe mental health conditions, such as mild depression, while also offering an assessment service for children and young people who would benefit from referral to more specialist services.
Services at this level are not just provided by mental health professionals, but also by GPs, health visitors, school nurses, teachers, social workers, youth justice workers, and voluntary agencies.
Tier 2 - provides assessment and interventions for children and young people with more severe or complex health care needs, such as severe depression.
Services at this level are provided by community mental health nurses, psychologists, and counsellors.
Tier 3 - provides services for children and young people with severe, complex and persistent mental health conditions, such as obsessive compulsive disorder (OCD), bipolar disorder, and schizophrenia.
Services at this level are provided by a team of different professionals working together (a multi-disciplinary team), such as a psychiatrist, social worker, educational psychologist, and occupational therapist.
Tier 4 - provides specialist services for children and young people with the most serious problems, such as violent behaviour, a serious and life-threatening eating disorder, or a history of physical and/or sexual abuse.
Tier four services are usually provided in specialist units, which can either be day units (where a patient can visit during the day), or in-patient units (where a patient will need to stay.) Depending on the nature of the condition this could be a stay of several days to several months.
