Improving support for people with complex mental health difficulties

The Talking Therapies Taskforce, of which UKCP is a member, has launched the report, Improving support for people with complex mental health difficulties, in parliament. 

Commissioned by the Talking Therapies Taskforce*, the Health Economics and Relational Disorder (HEARD) study examined the clinical characteristics and costs associated with people using services who have severe and complex mental and physical health needs. The study also assessed the effectiveness of an intensive psychotherapeutic community service designed to support their needs. This report makes the clinical and economic case for a national programme of intensive therapeutic services specifically for people with complex mental health needs, promoting the shift from the hospital to the community. 

People with some of the most complex mental health difficulties are currently poorly served by existing mental health, physical health and social care provision. Without good psychotherapeutic pathways many end up in hospitals long-term not receiving the right therapeutic support. 

The cost of people with highly complex mental health needs are hidden in the NHS system. They may have multiple diagnoses - sometimes linked to childhood trauma - which is often overlooked in routine data collection. Their difficulties are poorly understood so they experience high levels of stigma - even within NHS systems. 

Current pathways lead to high costs

Many of these people using services have ended up in long-term inpatient care with little therapeutic support due to NHS oversights in providing an effective care pathway. The HEARD study looked at health and social care records of nearly 30,000 people using services in two NHS Trusts. They found that the current pathways led to high costs and ineffective long-term hospitalisation. The study specifically highlighted that a small proportion (1.5%) of people account for nearly a third of total cost. Interviews with people in these Trusts with highly complex needs revealed that they often experience delayed discharges and poor clinical outcomes. The data found that those who received multiple referrals from the community mental health teams to other services were more likely to end up in hospital long-term if they weren’t given access to the right care. 

The HEARD study followed a new psychotherapy pathway in Devon. This pathway included intensive day treatment in the community and outpatient therapeutic treatment. This service significantly reduced the need for emergency services, the number and duration of hospital admissions - both locally and out of area - and received positive feedback from people using the service. 

Based on the results of this pilot study, we are calling for the government to fund pilot sites in other areas of England to ensure that people with complex mental health difficulties are given access to the care that they need.