Supporting adults with serious and long-term mental health needs


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Increase proactive community support for people with serious and long-term mental health needs, and improve their physical health to help them live full and healthy lives in their communities.

Delivery date:

  • ongoing

To do this we will:

  • offer more intensive GP support to address the physical health issues of people with serious and long-term mental health needs
  • support people, with their families and carers, to manage their own mental health and wellbeing in the community
  • fully coordinate health and social care mental health teams to offer multi-disciplinary support for all levels of need
  • put in place community-based alternatives to hospital mental health beds
  • have a 24/7 single-point-of-access for support and assessment for people in crisis.

It is better for people because:

  • service users say they prefer being looked after in the community
  • people will receive more appropriate, tailored and personal care
  • service users will spend less time in hospital, and not lose contact with community life
  • people’s social care needs will be met, with a massive impact on mental health and wellbeing.

It is better for the health and care system because:

  • health facilities and social care expertise will be used more efficiently
  • improving people’s mental health improves their ability to manage their own physical health, reducing demand on other services.

Key facts:

  • over 23,000 people in NW London have been diagnosed with schizophrenia, bipolar disorder and/or psychosis -  rates that are double the national average
  • around 60 per cent of people diagnosed with a serious mental illness in NW London, such as schizophrenia or psychosis, are not receiving multi-disciplinary support.

Expected outcomes:

  • better physical health for people with serious and long-term mental health needs
  • shorter stays in,  and less demand for, mental health hospital beds for people with serious and long-term mental health needs.