Creating Neighbourhood teams to integrate and improve community mental health services

Introduction: Often primary and specialist care providers work disjointedly, providing sub-optimal support to people with mental health difficulties.  In England, these people often fall through gaps in care.  England`s Community Mental Health Framework (CMHF) policy (2019) creates an impetus to address these challenges by integrating systems including primary and specialist care alongside voluntary/community providers.



Method: Researchers in residence were embedded in four care systems, interviewing NHS and Voluntary sector staff, observing meetings and reviewing case notes to create and test realist programme theories of change.  Also, we hosted national and regional knowledge exchange networks to learn more about implementation.  We used the analyses to develop a set of theories about how to effectively integrate services locally for people with mental health difficulties.



Results: Organisations worked together to create neighbourhood teams that included primary care, specialist services and the voluntary sector.  The sizes of these teams and the populations covered varied by location (30,000-150,000).  People with mental health difficulties asking for help in these systems were generally offered something but how decisions were made and the interventions available varied ( most but not all included social and psychological support, a few included medication advice).  Few teams actively approached people with the most severe problems.  Barriers to good integration included power imbalances between organisations, different approaches to flexible delivery, inadequate supervision and differences in working practices/cultures.  Agreeing flexible arrangements for joint working, relationship building amongst practitioners and liaison roles in primary care were important enablers for change.



Conclusion: Integrating across and within primary care, specialist care and the voluntary sector is possible in neighbourhood teams.  Addressing the different approaches and cultures between organisations is essential to create efficient team working.  Further reserach is needed to understand how service users experience these changes