Most treatment for people with severe and enduring mental illnesses already takes place in community settings. People are hospitalised only in periods where they are a danger to themselves or others. This trend is likely to continue in the future due to a range of reasons including economic factors, and improving patient care. For example, there is consensus that secure inpatient provision is costly and money would be better invested in improving community services. Additionally, NICE guidance recommends talking therapies for many severe mental illnesses.

The current political movement to shift care from inpatient to community-based settings has a positive effect on the medical stigma behind mental health, especially for patients with chronic co-morbid physical illnesses. Cost factors, and the need for patients to return to their community for normalisation, mean patients no longer stay in hospitals any longer than required.

There is more demand for integrated mental health services, focusing on the delivery of physical, mental and social care in the community, especially to people with long-term conditions in the over-60 age group.

Proposed workforce impact

• Growth in community care leads to increased demand for complex interventions
• The mental health team is fully trained to provide outreach services
• Changes to the required competencies for a mental health team
• Increased number of clinical psychologists and talking therapists

Sources or references

• RCPsych, (2011), Community Mental Health Teams
• The Centre for Social Justice, (2011), Completing the Revolution: Transforming mental health and tackling poverty

Additional research questions

• How is training delivered to ensure the shift of care into the community?
• How can the NHS ensure the mental health services people need are available in the community?
• What is the role of a psychiatrist in primary care?
• How would this impact on psychiatrists?

Some of the information in this section is provided by stakeholders and expert groups, and does not necessarily represent the views of the CfWI.