How the system works
This section of the website will help you find your way around the mental health system. It describes the sort of support that is likely to be available. It should help you understand what your options are.
We suggest you use this section in combination with our links page. The links page will help you find groups and organisations that can support you or advise you on local sources of help.
There are some variations in how mental health services are organised in different parts of the UK. In general, this section of the website refers to how services are organised in England, because that is where Together’s services are based. But people who live in other parts of the UK should still find it useful. And remember, our links page gives details of organisations that can help in all parts of the UK.
|Top| What mental health services are available to me?
It can be confusing trying to understand how the mental health system works. Mental health services are provided by different agencies and for a wide range of needs. The rules for contacting services can also vary from one part of the country to another.
Most mainstream mental health services are provided by the NHS or by local authorities. Increasingly, services are provided by the NHS and local authorities working together, as in the case of community mental health teams. Some services are also provided by local or national charities. And some services are available privately.
Statutory services
Statutory services are those provided by the NHS or your local authority. So services provided by your GP or family doctor, by your community mental health team, by NHS hospitals and Trusts, and by your local authority's social services department, are all examples of statutory services.
Most people with mental health needs use some form of statutory mental health service. This will be so whether they have short-term problems that last just a few weeks or months, or longer-term problems that may need support for a number of years.
Services run by charities
Services and support are also provided by the voluntary sector – in other words, by charities or not-for-profit organisations. Some services provided by the voluntary sector – by organisations such as Together, for example – are paid for by statutory agencies such as local authorities. This means that in order to use them, you will probably have to be assessed as in need of them by an agency (such as your local authority’s social services department).
Other support services provided by charities, such as drop-in services, support networks or telephone helplines, are normally open to anyone. You can refer yourself without having to go through your GP or anyone else. Many of these services are free, but occasionally you may be asked to make a payment towards the cost of using some of them. (See 'Can I be charged for any of the services I use?').
Private services
Some mental health services and therapies, such as counselling and psychotherapy, are widely available in the private or independent sector. If you use private services, you will have to pay for them yourself (or someone else will have to pay for them on your behalf).
National Service Framework
In response to variations in services around the country, the government developed what it calls the national service framework for mental health. This sets out standards of treatment and support that all people who use statutory mental health services can expect to receive, no matter where they live. This means that to a large extent, most statutory services now resemble each other, although there is scope for local discretion in how services are organised.
But it is difficult to generalise about what other kinds of support are likely to be available near where you live. If you live in a large city, for example, there are likely to be more informal services available to you than there are to people who live in the countryside. The important thing is to find out as much as you can about what sort of support is available in your area.
More information
- You can find information about government policy and the national service framework for mental health online at the Department of Health website.
|Top| Who can I see about a mental health issue?
If you think that you or someone you know might have a mental health need, then think first about talking to your GP or family doctor.
Most people with mental health problems receive their care from primary health-care services; in other words, from their GP, or a mental health nurse (or perhaps even a counsellor or therapist) attached to the GP’s practice. About one in four visits to a GP are by people experiencing mental health problems. So there's no need to worry that your GP will think your problem is not the sort of thing you should talk to them about.
Also, you may find that you need a referral from your doctor to use some other mental health services. It will certainly help if you have one. Many community mental health teams require a referral from a GP, although most accept referrals from other professionals too, such as a social worker, health visitor or mental health nurse. In some parts of the country, you can approach your mental health team direct (see 'How do I contact my community mental health team?') without having to go through your GP.
Your GP will be able to advise you what to do next. They may refer you to your community mental health team. Or they may refer you to a counsellor or some other form of talking therapy. Or they might suggest another service that is available locally.
If for any reason you don't want to talk to your own doctor, then you could ask to see another doctor at the same practice. Or you could even think about changing your doctor or asking to see another GP locally. The Rethink National Advice Service can help you find or transfer to another doctor.
GPs vary in how much they know about mental health problems and treatments. So if you think you might like to try a talking therapy, for instance, or indeed any other form of therapy, then try to make your preference clear to your doctor. Many GP practices now have counselling services available. Even if yours doesn’t, your GP should be able to refer you to someone locally.
More information
|Top| Can I see someone else instead of my GP?
Yes, there are other options if you don't want to talk to your GP.
If you have one, you can talk to your social worker, health visitor or community mental health nurse, for example. Ask them about services in your area and how those services might help. Discuss the sort of support you think you might like, particularly if you want to try a talking therapy, for example.
In some parts of the country, you can approach your mental health team direct without having to go through your GP or anyone else (see 'How do I contact my community mental health team?').
Many charities and voluntary organisations around the country also have services that you can use without going through your GP. Lots of drop-in services are open to anyone who has a mental health need, so you can refer yourself to them. The mental health charity Mind has local groups that provide a wide range of support and services. Their website explains how to get in touch with the group nearest to you.
There is also a wide range of national and local telephone helplines, including many that can offer specialist information or advice for particular groups of people. You will find many of these organisations listed on our links page.
You can also contact local and national support groups, service-user groups and other networks. Some of these are quite informal. Our links page lists organisations that can offer you support or put you in touch with a local support group. There will almost certainly be at least one that is right for you.
If you can afford it, some of the so-called 'talking therapies', such as counselling or psychotherapy, should be available privately in your area. Find out more on the website of the British Association for Counselling and Psychotherapy. Some therapists charge lower rates for people on limited incomes.
Many people also find that complementary therapies, such as homeopathy, acupuncture, massage and traditional Chinese medicine are helpful, as well as meditation and yoga.
You could also think about using an advocacy service. Advocacy services help people using mental health services to get their views heard. These are generally open to everyone. (See 'Can someone help me get my views across?'.)
More information
|Top| What is a community mental health team?
Community mental health teams support people with mental health problems who are living in the community. Teams include a range of professionals drawn from the local NHS and social services. This reflects government policy of integrating health and social care for people using mental health services.
Community mental health teams typically include community mental health nurses (who may also be called community psychiatric nurses), social workers, psychologists, psychiatrists, occupational therapists and support workers. Everyone in the team is trained to help and support people who are experiencing mental health problems.
Unlike primary-care services (such as your GP), community mental health teams are secondary services. By and large, they support people with more serious problems, although this can include people who have short-term difficulties.
Community mental health teams provide advice, support and training on mental health issues to professionals working in primary-care services. Teams also work closely with hospitals so that they can support people when they leave hospital and return home.
|Top| How do I contact my community mental health team?
Many people are referred to their local community mental health team by their GP. Some community mental health teams only accept referrals from a GP, but most accept referrals from other professionals too; for example, from social workers, health visitors or mental health nurses.
In some parts of the country you can contact the community mental health team yourself. This means you don't have to go through your GP or anyone else. You might have to phone and make an appointment. Or your community mental health team may even run a drop-in or walk-in service, so you can just turn up.
If you don't know where your local community mental health team is, look in your local phone book under the name of your local authority or council. If you don't see your community mental health team listed, there should be an information line or a number for the social services department. Ring them and ask. They will be able to tell you about mental health services in your area, and explain how to make contact or get a referral.
Or if you prefer, you could try doing a search on the internet. Search using the name of your local authority and 'community mental health team', and you'll probably find the contact details.
|Top| What will happen when I see my community mental health team?
If you are referred to your community mental health team (or if you refer yourself), someone from the team will meet with you to talk through your problems. Together, you can discuss what help and support you need. If you want, you can take someone with you to this meeting. You could take a friend or someone from your family. Or you could take an advocate to help you explain how you feel (see 'Advocacy', below).
If it's agreed that your needs can best be met by the community mental health team, then this means that your needs will be assessed and met under a system called the care programme approach. One person from the team will be nominated as your care coordinator. Together, you and your care coordinator will draw up a plan of how your needs will be met.
The care programme approach applies to everyone who is accepted for treatment by secondary mental health services – in other words, by community mental health teams and other specialist mental health services.
The criteria for being accepted on to the care programme approach can vary slightly in different parts of the country. People who are referred on to some other agencies, such as a counsellor or a drug misuse service for example, may not fulfil the criteria for the care programme approach. But whichever agency you are referred to should be the one best placed to provide support for your particular needs.
|Top| How does the care programme approach work?
There are four elements to the care programme approach. These are:
- appointment of your care coordinator
- a full assessment of all your needs
- a care plan to meet all your needs
- regular review of your care plan.
Care coordinator
A member of the community mental health team will be nominated as your care coordinator or key worker. This is the person you will see most often. Their role will be to make sure that all your needs are being met, that your care plan reflects all your needs, and is properly implemented.
Assessment
Your care coordinator will arrange for a full assessment of all your needs to be carried out. This will be done with your involvement. The assessment will consider all your needs and those of your family or anyone caring for you.
Care plan
Together, you and your care coordinator will draw up an individual care plan tailored to your needs. The care plan should cover all your needs – health, social care, housing, employment, and any financial problems. It will set out your needs clearly and say what services will be provided to meet them. You will be given a copy of your care plan.
Review
Your care plan will be reviewed regularly, usually every six months. Your care coordinator will arrange the review. The purpose of the review is to make sure that your plan is meeting all your needs effectively. You will be fully consulted and involved. If any changes need to be made to improve your care, they will be.
Standard or enhanced care programme approach
There are two levels or care programme approach: standard or enhanced. Which one is right for you will depend on your circumstances and the extent of your needs. Broadly speaking, people on the enhanced care programme approach have more complex needs. Whether you are on the standard or enhanced care programme approach, your care plan will be reviewed regularly.
More information
- Read the relevant pages on the website of mental health charity Rethink.
|Top| How can I talk to other people in my situation?
Many people find it helpful to talk to someone who has been through, or who is going through, similar problems to themselves.
On our links page, we list some of the support groups and networks that you might find useful, including survivor groups and groups run by people with experience of using mental health services themselves. Some organisations dealing with specific mental health problems also have support networks, including online discussion groups for people using services and their carers.
The mental health charity Mind has local groups around the country. Their website explains how to get in touch with the group nearest to you.
Many of the organisations listed on our links page have up-to-date information about specific mental health problems. The website of the Mental Health Foundation has information and resources relating to more than 60 specific types of mental health problem.
|Top| What if I need help in a crisis?
If you are feeling depressed or suicidal, then some of the crisis services listed on our links page can offer you immediate support.
The mental health charity Mind also keeps a list of local crisis services around the country that accept self-referrals.
You can also contact the duty social worker at your local social services department. To find the telephone number, look in the phone book under the name of your local authority. They will assess the situation and advise you what to do.
If you (or the person you care for) are being supported by your community mental health team under the care programme approach, then your care plan should already set out what to do in a crisis and who to contact.
Most parts of the country now have 24-hour crisis intervention teams as part of the overall package of mental health services. The names of these teams will vary from one part of the country to another. They may be called a crisis resolution service, or a crisis and home treatment team, for example.
Whatever the service is called, the basic aim is to support people through a crisis, usually in their own home. Some local teams have access to crisis accommodation where people can stay for a short time if their home environment has contributed to the onset of their crisis. Crisis intervention teams have been successful in reducing the number of admissions to hospital in many parts of the country.
Crisis intervention teams accept referrals from a range of professionals – for example, GPs, community mental health teams, hospital accident and emergency (casualty) departments, emergency social work duty officers, and the police. Teams will work intensively with clients for a limited period to support them through the crisis. They will visit frequently, liaise with doctors, and set up or re-establish links with community services to meet the client's needs. They might provide practical help (with shopping, for example), accompany clients to appointments, and help maintain social contacts with friends and family.
More information
|Top| Can I make plans in advance in case a crisis happens?
If you can, it is a good idea to think in advance about what you would like to happen if a crisis were to occur.
If you think that you might face a crisis at some time in the future, or you have faced a crisis in the past, then it is a good idea to make sure those around you know your wishes. You can do this by making what is known as an advance statement or advance directive. The charity Mind produces a factsheet, ‘Advance Directives’ which tells you how to go about making such a directive.
If you are being supported by your community mental health team under the care programme approach, then your care-plan should already include details of what to do if you become unwell or if the care arrangements you have break down. For example, this may involve attending an outpatients clinic or day hospital.
If you are caring for someone with a mental health problem, it can be helpful to write down in advance of any possible crisis a plan agreed between you and the person you care for, saying what you will do and which services you will contact if an emergency occurs. Write down this plan and details of the necessary telephone numbers (and contact names if known) and keep them handy. This kind of preparation can help you both through what can be a difficult time.
More information
|Top| What is assertive outreach?
Assertive outreach is a way of working intensively with people who have serious long-term mental health needs but who can't or won't engage with mainstream mental health services. Most mental health services now have some sort of assertive outreach team.
The people who use assertive outreach teams' support often have a history of erratic use of mental health services. They are likely to have had many unplanned psychiatric admissions to hospital. They may have a history of failure to take prescribed medication, which has resulted in them becoming unwell. They may have become involved with the police because of erratic behaviour.
Assertive outreach teams support people in the community wherever those people feel most comfortable or least threatened – this may be in someone's own home, for example, or on the street, or in a café. Teams work only with a very small number of people. They aim to build an ongoing trusting relationship with their clients so that they can meet their clients' health and social care needs.
Assertive outreach teams help people with practical issues, such as finding accommodation, money management, and social relationships. There is evidence that assertive outreach leads to fewer admissions to hospital and fewer compulsory admissions.
More information
- Read the relevant pages on the website of the mental health charity Rethink.
|Top| What if I need somewhere to live?
Our links page lists organisations that can help you find accommodation, including specialist accommodation for people with mental health problems. Remember that in order to receive funding for a place in supported housing, you must be assessed as needing residential care by the local authority who will pay for your place.
If you (or someone you know) has mental health problems and is looking for suitable housing, talk to the local housing department at your local authority, or discuss the problem with your social worker or community mental health team.
If you find yourself with nowhere to live, the housing department at your local authority should have an emergency housing section. If you need to contact them outside normal office hours because you have nowhere to go for the night, ring the emergency housing number or duty social worker.
If you are being supported by your community mental health team under the care programme approach, then your housing needs should have been assessed when your care plan was drawn up. If your housing situation has changed since then, talk to your care coordinator about your new housing needs.
More information
|Top| What can I do if I am unhappy with services or treatment I have received?
Any organisation providing mental health services, or any other form of health or social service, should have a complaints procedure. This includes charities or not-for-profit organisations, as well as community mental health teams, NHS Trusts and hospitals, and social services departments.
For example, if you are unhappy about the treatment you have received within the NHS, then you should use your hospital or NHS trust’s local complaints procedure. To do this contact the complaints officer or the hospital manager.
If you are not satisfied with the response you get, then the ‘How to make a complaint’ section on our links page explains what the procedures are and what your options are if you want to pursue a complaint further, for example through the Ombudsman scheme.
|Top| Can anyone help me get my views across?
Yes, you can ask an advocate to help you get your views across.
Mental health advocates can help people in hospital or living in the community who are using mental health services to have their say and to get their views across.
There are a number of different types of advocacy services. If you contact UKAN (the United Kingdom Advocacy Network) on 0114 272 8171, they can provide you with contact details of any local mental health advocacy services in your area.
More information
|Top| Can I be charged for any of the services I use?
Although mental health services now tend to be provided by health (the NHS) and local authorities (social services) working closely together, there is one important difference.
Like all health services, mental health services provided by the NHS are free at the point of delivery. This means you won't have to pay for them. Local authority social services departments, on the other hand, can charge for some of the community care services they provide. So you may have to pay towards the cost of some of their services.
However, there are restrictions on how much they can charge and what services they can charge for. Local authorities are not allowed to charge for making an assessment of your needs, or for providing information and advice.
But local authorities can make charges for the use of daycentres and for some services provided to carers, for example. They can also charge for other forms of practical support, such as physical or nursing care, home helps, meals on wheels and laundry services.
If those services are provided by a charity or voluntary organisation, rather than the local authority, you may still have to pay a charge. This is because charities are often contracted by local authorities to provide those services, and it may be a condition of the contract that the charity will charge for the service.
You cannot be expected to pay more than is 'reasonable' for such services, although it is up to your local authority to decide what 'reasonable' charges are. Nor should you be asked to pay more than you can afford.
However, local authorities cannot charge for any 'aftercare' services that are provided under section 117 of the Mental Health Act. Section 117 places a duty on local authorities and health services to provide services in the community to people who have been discharged from hospital after having been held on a treatment order. That duty continues until the aftercare services are no longer needed.
More information
|Top| Where can I go if I need support to care for someone with a mental health need?
Our links page includes details of many organisations providing different levels of advice, information and support, including respite care, for people caring for someone with a mental health need.
More information
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