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A guide to mental health services in England

How to access mental health services

Mental health, emotional wellbeing and resilience is all about how we cope with what life throws at us. It concerns the way we feel about ourselves, conduct relationships, handle stress or deal with loss.

Good mental health and resilience are fundamental to good physical health, relationships, education and work, as well as being key to achieving our potential.

Common mental health problems such as anxiety, depression, panic disorders, phobias and obsessive compulsive disorder can cause great emotional distress, and can affect how you cope with day-to-day life and your ability to work.

Less common conditions, such as psychosis, can make you experience changes in thinking and perception severe enough to significantly alter your experience of reality. These conditions include schizophrenia and affective psychosis, such as bipolar disorder, and can have the same lifelong impact as any long-term physical condition.

Admitting you are struggling does not mean you are "mentally ill", that doctors will automatically put you on medication, or you will have to immediately tell your employer you are mentally unwell. Many issues can be managed without the help of a GP by using the variety of sources of help now available, whether it's through books, local organisations or online.

Even if you need professional help, there are choices you can make along the way. Providing support and services is all about helping you take back control of your life; it is not about taking it away from you.

Mental illness is treatable and, with appropriate support and treatment, people do recover. Many move on with their lives and are able to care for their family, contribute to the local community, and get back into employment or training.

But this may not always be a straightforward journey. Many people only need a short course of psychological therapy or six months of medication, while others will need much more support and intensive treatment, be it medication or extended therapy.

Recognising and continuing to do what helps you stay as well as you can should be a key part of the plan for your treatment and care. In this way, learning to be more expert about yourself is part of this process, and health professionals should support you in this.

Where to start?

Life's issues and problems can take many forms. Sometimes you may feel down for a few days, or you could be having a stressful time at work, causing you to feel worried and anxious. The best way to work out where to go next is to take the mood assessment quiz.

If you want to talk to someone right away, the mental health helpline page has a list of organisations you can call for immediate assistance. These are helplines with specially trained volunteers who'll listen to you, understand what you're going through, and help you through the immediate crisis. The Samaritans operates a service 24 hours a day, 365 days a year for people who want to talk in confidence. Call them on 08457 90 90 90. 


What to do in a mental health crisis or emergency

The nature of a mental health crisis always depends on the particular circumstances of a person. There is no one-size-fits-all approach, and people experience a wide variety of symptoms.

Some people feel highly agitated, anxious, in despair, experience suicidal impulses or the need to self-harm, are immobilised by depression, or are frightened when they are in the changed reality of psychosis.

Others feel confused or delirious because of an infection, overdose, illicit drugs or intoxication with alcohol. Confusion may also be associated with dementia.

The crisis may be a sudden deterioration of an existing mental health problem, or a person may be experiencing mental health problems for the first time.

Crisis means they need immediate expert assessment to identify what the best care should be and prevent further worsening of their mental wellbeing.

Acute emergencies

If you or someone you know experiences an acute emergency, you should call 999 and ask for the ambulance service or the police.

These are cases where there is immediate danger to life or physical injury. For example, this could be if someone has taken an overdose of medication and is showing signs of its effects, such as slurred speech or sleepiness.

When someone is threatening aggression, holding a weapon, or committing or about to commit a serious assault, ask for the police.

Crisis

If you, a family member or friend require urgent care but it is not life threatening, you could call NHS 111.

You should call NHS 111 in the following circumstances:

  • if a person with an existing mental health problem is suffering a relapse in their symptoms
  • if a person is experiencing a mental health problem for the first time
  • if someone has self-harmed in a way that clearly does not immediately threaten their life, or is talking about wanting to self-harm
  • if a person shows signs of onset of dementia
  • if a young person leaves care
  • if a person is experiencing domestic violence or physical, sexual or emotional abuse

However, if you've already been given a Crisis Line number by your GP or local CCG, you should call them instead.

If you are under the care of a mental health team and have a specific care plan that states who to contact when you need urgent care, you should follow this plan.

If you have urgent concerns about someone's social circumstances, such as children and young people, vulnerable adults or people with learning difficulties, it may be more appropriate to call social services.

Local government services such as housing services and social care services often run out-of-hours duty provision. Search for your local council and find out how your social care service deals with emergencies out of office hours.

Social care services may also be involved in the assessment of people in crisis through the legislation of the Mental Health Act.

How your GP can help

You should make an appointment to see your GP if you've been feeling depressed for a few weeks or your anxiety is having an impact on your daily life, such as stopping you from going to work or shopping.

Mental health services are free on the NHS, but you will usually need a referral from your GP to access them. There are some mental health services that will allow people to refer themselves for help. This commonly includes services for drug and alcohol problems, as well as some psychological therapy services.

Your GP will assess your circumstances and offer appropriate advice or treatment. They can also refer you to a psychological therapy service or a specialist mental health service for further advice or treatment.

These services may be provided by your GP surgery, a large local health centre, a specialist mental health clinic, or hospital. The treatment may be provided on a one-to-one basis or in a group with others with similar difficulties, and therapy sometimes also involves partners and families.

If your mental health difficulty is related to stress in your workplace, you can ask your employer what occupational health services are available to you. Check out the Time to change website, which has a section dedicated to employers.

If you are at school or college, mental health care may be arranged for you.

See the section Services and care pathways explained for more details about the different services available.

Your choice of service

Patients have a choice about who to go to for help with their mental health. This means that if you and your GP agree you need to be referred for an assessment by a mental health service, you can choose which provider and which team you want to see for your first assessment and treatment.

You should discuss with your GP which providers offer a service that will meet your needs and check what other people have said about it before you make your choice. Information should be available to you about:

  • the name of the service and the professionals in the team
  • waiting times
  • what the assessment process involves
  • what choices of treatment they offer
  • what the service's key values are and how they demonstrate them
  • what clinical guidelines they follow and the evidence-based treatments they offer
  • what other patients and carers say about the service
  • what the quality of this service is, including reports of inspections by bodies such as the Care Quality Commission (CQC)
  • what patient outcomes they are achieving
  • contact details, including crisis contact details during the day and out of hours

You can compare providers in your area using the Find services near you function on this site.

You can also visit the Care Quality Commission (CQC) website for detailed information about mental health services and how they perform.

Comments

The 4 comments posted are personal views. Any information they give has not been checked and may not be accurate.

Hawkmoth said on 20 November 2014

I have severe anxiety and depression and am unable to take care of myself, I rely on my mum to remind me to eat and drink (sometimes having to physically bring me food) and go with me whenever I go outside if nobody else is available, answer calls for me, etc. But recently I've been getting much worse and she still has to look after my much younger brother so I haven't been reminded to eat properly or take care of my personal hygiene and I haven't been outside for nearly a month (I have had a visitor once) and I honestly think that the way things are going, I'm not going to be able to be taken care of here anymore. What can I do?

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thecomeback said on 18 October 2014

7 years ago I was suffering from a panic disorder and I was have panic attacks everyday. Now I have it again! I get to the point where I ring 999 to get medical attention. Its becoming a big problem for me leaving the house. The anxiety symptoms what I have make me believe im drying! Is they anyone out there who can help me?

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cuttsi88 said on 15 October 2014

Lets see: my wife had NHS GP referral to a CPN, who she has only seen once, and been discharged and referred to a Psychiatrist, then after 6 week wait has finally seen him had her medication changed to which is still unstable.. anyway just found out her Psychiatrist has now discharged her after 2 months from his care with no notice and apparently referred her for CBT well no body will tell her where or give her a phone number for CBT, no crisis team in our area has funding so my wife is left with manic depression and no health care service to help her only me how is some one supposed to get better when all she get is!" your not under our care any more" and the Psychiatrist wont even have a quick chat!!! NHS sort it out, mental health is a serious issue what needs dealing with.. I'm not a doctor there is only so much I can do for my wife!!!!!!!

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abbie85 said on 10 August 2014

you are right I told my doctor some things what need complete opposite treatment puts me on depression tablets instead of the cure for my reason..

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Page last reviewed: 23/06/2014

Next review due: 23/06/2016

Mental health facts

At least one in four people experiences a diagnosable mental health problem in any one year, and one in six experiences this at any one time.

More than half of those with a common mental health problem have both depression and anxiety.

There are approximately 570,000 people with dementia in England, a figure that could double in the next 30 years.

Nearly 850,000 children and young people aged five to 16 years have a mental health problem – about 10% of the population. Fewer than one in 10 accesses treatment.

 

Carers: mental health services

Read about the support on offer if you look after someone who has a mental health problem

Moodzone

Feeling stressed, anxious or depressed? NHS Choices Moodzone can help you on your way to feeling better

Attitudes to mental health

Four people who've had mental health issues, including bipolar disorder, paranoid schizophrenia and personality disorder, talk about the negative reactions they faced and how they overcame them.

Media last reviewed: 29/08/2013

Next review due: 29/08/2015

The Stand Up Kid

Nearly one in 10 young people in the West Midlands think that classmates with a mental health problem should not be at their school. This video is aimed at stamping out stigma faced by young people affected by mental health problems in the West Midlands. The Stand Up Kid is a campaign run by Time to Change, England’s leading national anti-stigma programme.

Media last reviewed: 04/09/2014

Next review due: 04/09/2016