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A guide to mental health services in England

Glossary of mental health services, teams and care pathways

Mental health services in England deal with a wide range of issues, such as:

This means mental health services have to be able to cater for people from all walks of life and with very different needs. Mental health services in England are generally run in the following categories:

  • adult services
  • child and adolescent services
  • forensic services
  • learning disability services
  • older adult's services
  • substance misuse services

How these services are organised in each local area may differ. This means some may not cover all mental health conditions, or only deal with people of a certain age. For example, some areas offer services for young people between the ages of 16 and 25 to help with transitions from children to adult services. Your GP, local mental health care provider or relevant clinical commissioning group (CCG) should be able to tell you what services are available in your area. 

Mental health care pathways

How people access services will depend on individual circumstances, such as their age, the specific problem, or how urgently care is required. This means that in addition to the different services, there are also different care pathways. 

Again, depending on how services are arranged in a local area, you may find specific teams that only deal with one particular care pathway – for example, an eating disorders team. But there are also teams that address a variety of disorders in one common pathway, such as community care for anxiety and depression. Some pathways will work across teams and settings.

The website NHS Emotional Wellbeing has detailed information about the different care pathways available under each mental health service specialist area.  

Overview of mental health teams

Note: names of services may differ slightly in some areas

Community services

  • mother and baby services
  • services for deaf people
  • substance misuse (drugs and alcohol)
  • forensic community services

Adult services

  • assessment and brief intervention teams
  • community mental health teams for adults
  • early intervention for psychosis teams
  • assertive outreach teams
  • recovery and rehabilitation
  • eating disorders team
  • crisis home treatment teams
  • community forensic team
  • community alcohol team

Older people's services

  • community mental health team for older adults
  • memory services for dementia assessment and care

Children and young people's services

  • child and adolescent mental health team
  • eating disorders team specifically for young people

Learning disability service

  • learning disability services for adults
  • learning disability services for young people

National specialist centres

  • these may have both community clinics and inpatient facilities

Liaison psychiatry teams

  • these teams mainly work in general hospitals and primary care
  • watch the Central and North West London NHS Foundation Trust's video, What is liaison psychiatry?

Hospital services

  • acute, crisis and triage wards
  • psychiatric intensive care units
  • open and intensive rehabilitation units
  • inpatient eating disorder units
  • mother and baby units
  • respite and crisis houses
  • other mental health hospitals or units for adults
  • specialist mental health hospitals for children and young people
  • forensic mental health hospitals

What are assessment and brief intervention teams?

These are teams dedicated to seeing people quickly, assessing their needs and providing either a brief treatment, such as short courses of talking therapy, or referring them on to other services, such as community mental health teams or early intervention teams. They work closely with primary care services such as GPs and pharmacists, as well as more specialist mental health services.

What are psychological therapy services?

The Improving Access to Psychological Therapies (IAPT) programme aims to put more trained therapists into GP surgeries. This should provide easier access to talking treatments on the NHS. The service is already available in some parts of England.

You can ask your GP what psychological therapy services are available locally, or use the search facility on NHS Choices to find a counselling IAPT service in your area. Although some IAPT services allow self-referrals, most will need a referral from a GP or another specialist mental health team.

The therapy offered will usually be a course with a fixed number of sessions of a particular type of therapy, such as cognitive behavioural therapy (CBT). You can also read the page about types of therapies in our Moodzone for more information.

What are community mental health teams (CMHT)?

Community mental health teams (CMHTs) are multidisciplinary, multi-agency teams offering specialist assessment, treatment and care to adults with mental health problems, both in their own homes and in the community.

They work with people often described as having complex needs – for example, in relation to housing and homelessness, benefits, unemployment, use of drugs or alcohol, or those who have had contact with the criminal justice system.

CMHTs aim to provide the day-to-day support needed that allows a person to live in the community. Teams may provide a whole range of community-based services themselves, or be complemented by one or more teams providing specialist functions.

What are crisis resolution and home treatment services (CRHT)?

Crisis resolution and home treatment teams (CRHTs) treat people with severe mental health conditions who are currently experiencing an acute and severe psychiatric crisis that, without the involvement of the CRHT, would require hospitalisation. Psychotic episodes, severe self-harm and suicide attempts are examples of acute mental health crises.

Because of the nature of their work, CRHTs offer a 24-hour service, and cases are often referred to them through accident and emergency (A&E) departments or the police service.

CRHTs will usually review a person in their own home, but they may also see people in other community settings, such as dedicated crisis houses or a day centre. They may also see people who are in psychiatric hospitals and are ready to go on leave or be discharged. CRHTs will help them manage getting back into the community, as people can be particularly vulnerable in the time shortly after leaving hospital.

CRHTs are also involved in the planning of care for someone who has had a crisis to prevent any relapse in the future. This will usually involve working with the local community mental health team.

What are crisis houses?

Crisis houses offer safe short-term accommodation and support to people experiencing a mental health crisis. They are used when home treatment is not suitable, or as a short-term alternative to hospital admission.

Crisis homes usually have a small number of beds. They generally offer support for a particular group of people, such as people in danger of committing suicide or vulnerable people from black ethnic minority communities.

Some crisis houses accept self-referrals, but often referrals are taken from secondary mental health services. 

What is an assertive outreach team (AOT)?

Assertive outreach teams (AOTs) are community treatment teams that look after adults with severe mental health conditions and personality disorders. These people may find it difficult to work with services, have been admitted to hospital a number of times, and may have other problems such as violence, self-harm, homelessness or substance abuse.

AOTs provide a patient-centred approach, offering an intensive and long-term relationship that builds trust. This is so they can help identify a person's needs, career aspirations and strengths. They also support families and carers where neccessary.

The team is made up of very experienced staff from a range of disciplines and agencies that can best meet the person's needs. This can include specialists and sessions from housing, financial and employment agencies, as well as psychiatrists, community psychiatric nurses, psychologists and occupational therapists.

You normally have to be referred by the community mental health team to receive outreach support. However, AOTs no longer exist in all areas as some have been disbanded. You should still be able to get the level of support you need from local mental health services.

Download Rethink's fact sheet about assertive outreach teams (PDF, 647kb).

What are rehabilitation and recovery teams?

Rehabilitation and recovery teams are multidisciplinary teams that focus on the needs of people with long-term severe mental illness. The teams provide ongoing care and support, particularly focused on:

  • maintaining health
  • preventing relapses
  • developing social networks
  • establishing meaningful activities in people's lives

These teams are not available in all areas, but you should still be able to get the level of support you need from local mental health services.

What are early intervention for psychosis teams (EIPTs)?

People with psychosis can experience changes in thinking and perception severe enough to significantly alter their experience of reality. Learn more about psychosis.

An episode of psychosis is usually caused by an underlying mental health condition such as schizophrenia or bipolar disorder, and may be complicated or caused by drug or alcohol misuse.

Early intervention for psychosis teams (EIPTs) work with people between the ages of 18 and 35 who may be experiencing their first episode of psychosis. In some areas, they work with people who are younger than 18. They may then work with them for two or three years after they first presented with psychotic symptoms. Sometimes these symptoms may go back many years, or they can come on very abruptly.

EIPTs focus on the early detection and assessment of psychotic symptoms, and provide support and treatment to treat the underlying causes and prevent relapse.

Early intervention is crucial because the condition causes such distress and disability both to the person and their carers, but treatment can be very effective. During the first few years, people with psychotic symptoms are at greatest risk of harm to both themselves and others, and the earlier a severe mental condition is treated, the better the long-term outcomes tend to be.

What are liaison psychiatry teams?

Liaison psychiatry teams are multidisciplinary teams that provide mental health assessments in hospitals, A&E and clinics for patients experiencing distress during their stay. They function as a liaison between mental and physical health teams. The co-occurrence of mental and physical health problems is common among patients, often leading to poorer health outcomes, delayed discharges and the increased use of resources.

Teams are able to assess and treat a range of mental health problems, including dementia. Some problems that may be referred to liaison psychiatry teams include:

  • psychological reactions to physical illness
  • self-harm
  • medically unexplained symptoms
  • organic mental disorders such as delirium and dementia
  • alcohol and substance misuse
  • mental illness related to childbirth
  • diagnostic difficulties
  • abnormal illness behaviour
  • behavioural disturbance
  • medicolegal decisions
  • assessment of capacity to refuse medical treatment

Some teams will deal with patients from all ages, while others just look after adults or children. The liaison teams also help people get the care they need at home rather than in hospital, where that is safe and the best for the patient.

How the service is provided depends on the hospital, and not all hospitals will provide it. Contact your local hospital to find out if they provide the service.

The Royal College of Psychiatrists offers a detailed guide about liaison psychiatry teams. Find out more by watching the video What is liaison psychiatry?.  

What are eating disorder services?

Eating disorder services are there to help adults and children who have moderate to severe eating disorders. They are multidisciplinary teams of psychiatrists, psychologists, psychotherapists, nurse specialists, dietitians, support workers and administrative staff. 

Based in the community, they offer services such as assessment, treatment and counselling for individuals and their families and carers. Some services also offer help with meal planning and shopping.

How and if a service is provided depends on your local mental health trust. Some mental health trusts offer them as community services, while others are provided in the form of specialist clinics. If you would like to find out about services in your area, you can either speak to your GP or contact the trusts directly.

Alternatively, the eating disorder charity BEAT offers a directory where you can search for services in your area.

Eating disorder clinics often provide a combination of occupational and talking therapies, as well as feeding for patients with serious malnutrition. Staff in clinics include doctors, dietitians, psychotherapists, occupational therapists, social workers, family and relationship therapists, and specialist nurses. 

Types of eating disorders

Common types of eating disorder are anorexia nervosa and bulimia nervosa. But there are also atypical eating disorders, sometimes referred to as EDNOS (eating disorder not otherwise specified). These include binge eating, atypical anorexia nervosa and atypical bulimia nervosa.

Find out more by clicking the following links:

What are perinatal mental health services?

Perinatal mental health teams provide specialist services for women with mental health problems. They also provide care for women who are at the risk of developing problems during pregnancy and the first year post pregnancy, as well as those considering becoming pregnant. Promoting emotional and physical wellbeing and development of the infant is central to perinatal mental health services.

Specialist multidisciplinary perinatal teams exist in many, but not all, local areas. They provide direct services, consultation and advice to maternity services, other mental health services and community services. They can give specialist expert advice on the risks and benefits of using medications such as antidepressants and antipsychotics during pregnancy and breastfeeding.

Depending on services in your area, perinatal services can be offered in a variety of settings, either at separate clinics or specialist clinics within general community mental health services. If there are no specialist perinatal services in your area, speak to your mental health service provider as there may be consultant psychiatrists or other healthcare professionals with particular expertise in this area who can offer advice or assessment in conjunction with your usual mental health team.

Find out more by downloading the Royal College of Psychiatrists guidance on perinatal mental health services, or read the section about mental health problems in pregnancy on this website. 

Mother and baby units

Mother and baby units provide specialist medical care for mothers with mental health problems, as well as ensuring the mother and infant can remain together. The National Institute for Health and Care Excellence (NICE) states that all women with a child under the age of one who need admission for a mental health illness should be offered a place in a specialist mother and baby unit. 

Most units offer inpatient and outpatient services, but you need a referral from your GP, community mental health team, or midwife.

What is meant by forensic mental health services?

Forensic mental health services work with people who have mental health conditions and have committed a serious criminal offence, or are thought to be at high risk of committing an offence.

Forensic mental health services may care for people in secure hospitals or prisons. Most of the people who are in need of such services are thought to be a risk to both themselves and others.

Community forensic mental health services can also care for people out in the community following discharge from a secure hospital or prison. These community services may also be asked to review patients who are known to other mental health services, where there is a concern that someone may be at high risk of committing a criminal offence. 

An important goal of forensic mental health is to treat any mental health problems that may have contributed to a pattern of criminal behaviour, and discharge a person back into the community with the right level of support when it is thought safe to do so.

Forensic mental health services in hospitals are often classified by how secure they are. This refers to factors such as the level of staffing, or the controls placed on how freely patients can move around the hospital. The three levels of security are:

  • high – at national specialist hospitals Ashworth, Broadmoor and Rampton
  • medium – these are located in each region of the country
  • low – these provide rehabilitation before transfer to local services

What are memory assessment services?

Memory assessment services are specialist teams that assess memory problems or similar cognitive impairments. They advise on the support patients and their carers may need from their GP or older people's mental health services.

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Page last reviewed: 23/06/2014

Next review due: 23/06/2016

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