Mental health and new models of care: lessons from the vanguards

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Part of Mental health in the vanguards

While some of the vanguard sites developing new care models report promising early results from adopting a whole-person approach, the full opportunities to improve care through integrated approaches to mental health have not yet been realised.

This report draws on our recent research with vanguard sites in England, conducted in partnership with the Royal College of Psychiatrists. We found that where new models of care have been used to remove the barriers between mental health and other parts of the health system, local professionals saw this as being highly valuable in improving care for patients and service users. But there remains much to be done to fully embed mental health into integrated care teams, primary care, urgent and emergency care pathways, and in work on population health.

Key findings

  • Knowledge and skills around psychology and mental health are important features of integrated care, whatever the client group.
  • Emerging evidence from some vanguard sites suggests that integrated approaches to mental health can help to support improved performance across the wider health system.
  • Despite this, the level of priority given to mental health in the development of new models of care has not always been sufficiently high.
  • Some areas report that new models of care have made it easier for local professionals to obtain informal advice from mental health professionals without making a referral, creating a more seamless experience for patients.
  • Working closely with voluntary sector organisations has allowed integrated care teams in some vanguard sites to better support the mental health and wellbeing of people with complex needs.

Policy implications

  • Testing the mental health components of existing vanguard sites must be a central part of the evaluation strategy for the new care models.
  • Other local areas rolling out multispecialty community providers, primary and acute care systems and related care models should go further than the vanguard sites in four key areas:
    • complex needs: enabling local integrated care teams to draw on and incorporate mental health expertise to support people with complex care needs
    • long-term care: equipping primary care teams to address the wide range of mental health needs in general practice (including among people presenting primarily with physical symptoms)
    • urgent care: strengthening mental health support for people using A&E departments and other forms of emergency care
    • whole-population health: placing greater emphasis on promoting positive mental wellbeing in the population, in particular among children and young people, and during and after pregnancy.
  • All sustainability and transformation plans should set out ambitious but credible plans for improving mental health and integrating mental health into new models of care.


Alun Charles Jones

Professor Psychotherapy,
Comment date
04 October 2018

There are varied antecedents to mental ill-health and often family groups play a part in the genesis, often multi-point, and maintenance of emotional discomfort.

A problem regarding treatment is that people internalise family dynamics and they become played out in different situations- the recapitulation of the family group.Often, removing oneself from toxic social and family dynamic can help enormously and this would complement psychological therapies allowing a person to recognise triggers to anxiety and depression.

I don't think it is possible to standardise treatment and care. in mental health settings. Individualised care, but with an overarching philosophy, understood by all is probably a way forward.

Do away with hierarchies e.g. psychiatrists et al v nurses.Mental health care is often referred to as biopsychosocial. Maybe best thought of as social psychobio. Not of course in every instance but research suggests, treatment hasn't advanced.

However, career pathways for many prominent mental health professionals have, without any significant advancement in service provision.

Academia is often cloistered. the objectives can become blurred and so not necessarily the improvement of treatment and care but an increased research output. Similar to clinical settings where individual and group professional advancement is prioritised over the sensitive delivery of healthcare.

Dorothy Frizelle

Consltant Clinical Health Psychologist,
Mid Yorkshire Hospitals NHS Trust
Comment date
23 May 2017
Clinical Health Psychologists have been promoting and advocating for integrated care for many years but have always remained a cinderella service in favour of medical models of care (and in many acute Trusts, clinical health psychology services have been decommissioned in recent years). There is a wealth of evidence to show the wider systems benefits of holistic care where psychological interfaces with biological/medical; typical examples include psychology input with people with cardiac anxiety, dyspnoea management, diabetes - which positively impacts A&E outcomes, let alone benefits to patients and families.
An important consideration is our conceptualisation of 'mental health' - that there are widely differing care needs for someone with severe and enduring psychosis who is also physically ill and requiring self-management support vs. a person who is experiencing psychological distress and difficulty coping with a physical health challenge.
Clinical health psychology would typically work within an acute and/or primary care setting whereas clinical psychology per se sits more within mental health and associated services. There is a need for psychological services across this continuum of health and social care need, with liaison with OT, physio, social work etc colleagues.
Dorothy Frizelle
Vice Chair, Faculty for Clinical Health Psychology, British Psychological Society

Dr Umesh Prabhu

Medical Director for 16 years in NHS,
Comment date
21 May 2017
Vangaurd, 5 years plan, STP and Devomanc are all good ideas but sadly has same old leaders saying same old things. Good ideas do not generate good outcomes until the ideas converted in to action and proof of the pudding is in eating.

Some Vaguards are doing well and some STPs are doing well but one swallow doesn't make summer! All NHS leaders must be good, kind, caring and compassionate and with courage!

Sadly courage is something missing in NHS because of culture of bullying, harassment, victimisation and club culture and old boys network. In such a culture patients, staff and NHS suffer! When NHS suffers the nation suffers! This is Brexit!

Please wake up and let us transform Health and social care and let us get leadership, accountability, integration, workforce planning, governance, staff and patient engagement right and let us make the whole of NHS and social care safest and the best and the most vibrant in the world!

Pearl Baker

Independent Mental Health Advocate & Advisor/Carer/DWP Appointee/Deputy to COP,
Comment date
20 May 2017
It is impossible to 'integrate' Health and Social Care if you have no idea who your Partners are to enable a 'seamless' system that allows allows those suffering from Mental Illness a 'quality' of life without any interruptions?

EXAMPLE: Living in Housing Association accommodation 'Supported Accommodation'?? subject to section 117 FREE aftercare??

Welfare Benefits:'Fit for Work' 45 questionnaire arrives to complete. (time scale) or ALL your Benefits will be withdrawn.

Welfare Benefits DLA/PIP another form: invited to interview by somebody with 'set questions' failure to 'turn up' NO AWARD.

MANY suffering from a 'severe mental illness' have become 'invisible to the system.

No Social Worker! despite Statutory Guidance 'Care Plan' at least once a year.

ACCOMMODATION; not able to keep the accommodation 'Habitable' .

RESULTS on the above.
HA takes 'severely Mentally Ill' to Court? why? No contact number with Social Services on this individuals file. FOUND GUILTY for NOT paying RENT, because their Welfare Benefits had 'STOPPED' because they were unable to complete a 45page Questionnaire. Housing Benefit 'STOPPED' paying their RENT.


Ellen Brookes

Senior nurse practitioner,
Greater Manchester mental health trust
Comment date
18 May 2017
Need to fully integrate health and social care if we are going to make long term gains

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