Evolving our services

Community Mental Health Transformation (CMHT)

The NHS Long Term Plan and NHS Mental Health Implementation Plan 2019/20 – 2023/24 set out to improve community health care for people with serious mental illness. There has been a national £2.3 billion investment programme, and changes are being made around the country.

What are we doing in Gloucestershire? 

We are developing new community models to provide easier access to support, shorter waiting times, and more personalised care. The approach also includes:

  • A focus on inequalities and the challenges faced by people with mental illness in many aspects of their life.
  • Breaking down barriers to accessing support and services.
  • A focus on physical health checks, housing and employment.
  • There will be a single ‘right door’ to access support. Wherever anyone seeks mental health support there will be an easy process to get it.
  • The introduction of a needs based assessment process.
  • The introduction of a 4 week waiting time target and increased activity targets.
  • A specific focus on specialist areas within new models – Eating Disorders, Personality Disorders, Rehabilitation pathways.

Importantly, this involves a wide range of partners including the Voluntary and Community Sector. It is also heavily focussed on co-production with Experts by Experience – both people who have used services and their carers – involved throughout.

The project is being led by Gloucestershire Health and Care NHS Foundation Trust on behalf of One Gloucestershire. We are working with partners, including the Gloucestershire VCS Alliance, Inclusion Gloucestershire, Forest Voluntary Action Forum, Independence Trust and others.

You can view a video about the national project below, alongside a video about our co-production approach. 


What does this mean to me if I use mental health services?

The programme is about improving the support provided to people with Serious Mental illness. If this includes you or someone you support, it means you should find it easier to get help, you will have better access to physical health checks, more support with housing and employment and a different assessment process. But we are still in the early stages and we want to get your views on how we can improve things for you.

What does Serious Mental Illness (SMI) mean?

SMI refers to people with psychological problems that are often so severe that they are not able to engage in activities that many people take for granted. It includes conditions such as schizophrenia, and bipolar disorder, or psychosis. 

What has happened so far?

So far, we have introduced a new service called the Complex Emotional Needs service for people with personality disorders and related conditions in Gloucester. We have also employed additional mental health staff to work in GP surgeries, giving quicker access to support for those who need it (see below). We have also begun work on reducing waiting times for eating disorders treatment and are making good progress on increasing the number of patients with serious mental illness who receive annual health checks. Another development is the decision to use a new needs-based assessment model called DIALOG. 

We have also started introducing new Locality Community Partnerships (see below) and carried out a huge range of engagement with people who use services and the people who support them, as well as people working in services, to find out what our priorities should be.

What is the Additional Role Reimbursement Scheme (ARRS)?

This is the scheme that enables GP surgeries (primary care) to recruit additional roles into their practices to support people with specific needs. As part of CMHT, we are aimed to employ 15 new mental health professionals to work in GP surgeries across Gloucestershire by the end of March 2023 and many of these professionals are now working in our communities.

GPs, practice staff and patients are finding the development very beneficial, and it provides earlier help from mental health professionals in local surgeries.

This film explains more about it:


What is the Complex Emotional Needs service?

Work started in September 2021 to form a team supporting professionals who were working with people with Complex Emotional Needs. The term Complex Emotional Needs is used when describing people who have a range of trauma responses. These include finding it hard to trust, repeating negative relationships, being overwhelmed by emotions, and causing harm to themselves when feelings are hard to control. Complex emotional needs can have significant and severe impact but recovery is very possible.

The team, which currently covers Gloucester, includes psychologists, a social worker, a mental health nurse and lived experience practitioners. The team is working with the police, paramedics, A&E staff, supported living environments and voluntary care sector agencies.

So what does the CEN team do?

  • Provides free training courses.
  • Runs family and friends 12- week support programmes.
  • Works closely with the voluntary sector providing learning and reflecting, opportunities and jointly run peer led groups.
  • Works towards creating psychologically informed environments through helping staff in a wide variety of settings to think about what drives people’s distress and how to reduce this.
  • Through our FERN Service (frequent engagement response network) we support people who frequently engage with the emergency services to develop their own ‘what helps’ plan.
  • Supports the emergency services when they have concerns about people by checking the support that’s in place and offering more if appropriate.
  • Offers support and training programmes to a wide variety of agencies across the county from tattoo artists to mental health act managers. We are trying to improve awareness and understanding everywhere.
  • Supports social prescribers and all mental health professionals when they have concerns or questions.
  • We employ a brilliant team of lived experience practitioners who are involved in everything we do and additionally meet with people experiencing distress and offer understanding and hope.

There are further developments planned for the service so watch this space!



What are the Locality Community Partnerships?

The Locality Community Partnerships (LCPs) hold meetings to bring together all those in the community who might be able to help someone with
their care. The LCP ensures people get the right service and support based on what the person wants and needs. The LCP might look different in each area but is likely to include healthcare staff such as GPs and mental health professionals, representatives from housing, local authority, social care, drug and alcohol services, and representatives from the voluntary and community sector. The support the LCPs provide will also vary but could include support from charities, social prescribing schemes, employment opportunities, and social support alongside more traditional support from the NHS and other statutory agencies.

This download explains more about the LCPs: LCP Guide

Why are physical health checks for people with serious mental illness important?

Compared with the general patient population, patients with severe mental illnesses are at substantially higher risk of obesity, asthma, diabetes, chronic obstructive pulmonary disease (COPD) and cardiovascular disease. People with a long-standing mental health problem are twice as likely to smoke, with the highest rates among people with psychosis or bipolar disorder.

Annual Physical Health Checks for people with severe mental illness (SMI) are designed to pick up on signs that someone may be at risk of diabetes, stroke or heart problems. This means action can be taken before these issues become more serious.

Watch this film to see how we are encouraging people to access Physical Health Checks in Gloucestershire: 

What is the new assessment model going to be?

The DIALOG scale is a needs-based assessment which asks questions about how satisfied (or dissatisfied) someone is with various elements of their life. This covers:

  • Mental health
  • Physical health
  • Employment
  • Housing
  • Leisure activities
  • Relationships/friendships
  • Personal safety
  • Medication
  • Practical help
  • Meetings with mental health professionals

It is carried out when someone first seeks help and then at various times to track progress.

This leaflet will explain more about the assessment and process: DIALOG leaflet

How do I get involved?

We’re keen to hear from anyone who wants to make suggestions, ask questions or share any thoughts on the project. Please email CMHTransformation@ghc.nhs.uk.