NHS community support for complex mental health needs

• The care programme approach (CPA) was used by NHS specialist mental health services.
• These services would support you under CPA if you had a severe mental illness and had:
  • A wide range of needs from different services, or
  • you were thought to be a high risk.
• In 2021 the NHS said that CPA has been superseded by something called The community mental health framework for adults and older adults.
• CPA is still used in prisons.
• You might have a mental illness and need support and treatment. You should be supported in line with the NHS community mental health framework for adults and older adults.
• The Framework aims to:
  • put you the centre of your care, with choice
  • have one care plan for you, shared by people who support you
  • prevent problems, treat illness, and improve your quality of life
  • focuses on joined-up, fair, and continuous support - especially if you have complex needs.

CPA was a package of care that was used by NHS specialist mental health services. It was used if you lived with a mental illness, and:  

• you have a wide range of needs from different services, or
• you are thought to be a high risk.

Under CPA you had a care plan  and someone to coordinate your care.  

In 2021 the NHS said that CPA has been superseded by something called The community mental health framework for adults and older adults. 

CPA is still used in prisons. 

A document the NHS followed when arranging CPA was Department of Health - Refocusing the care programme approach: Policy and positive practice guidance.  

On our webpage you can find out more about NHS mental health teams - Community, crisis, and early intervention support.

The Framework is an NHS plan to improve mental health care in the community. 

If you need mental health support the Framework aims to:

• put you at the centre of your care, with choice,
• give you one care plan, shared by people who support you,
• prevent problems, treat illness, and improve your quality of life,
• focus on joined-up, fair, and continuous support - especially if you have complex needs.

This 5-minute NHS community mental health transformation video tells you more about the Framework. 

NHS mental health services and teams should use the Framework when supporting you.

On our webpage you can find out more about NHS mental health teams - Community, crisis, and early intervention support.

The key aims of the Framework are:

• You should be part of making decisions about your care.
• Support should focus on staying healthy and stopping problems early.
• Treatment should be proven to work, safe, and based on one clear care plan.
• Care should help you enjoy life, join in with your community, and follow your goals.
• Support should be continuous, with no sudden loss of help.
• Services should work together and include everyone, especially people with complex needs.

The NHS say they moved from the Care programme approach (CPA) to the Framework because:

• Mental health care of people with serious mental illnesses was often split between lots of teams.
• Split care caused confusion, repeat assessments, delays, and people dropping out of care.
• CPA was inconsistent and did not always work well.
• Moving between services is risky and many people lose support.
• Young people and those with drug or alcohol problems were especially affected.
• Lack of joined-up care can make mental health worse.

On our web page you can get more information about Drugs, alcohol, and mental health

Better assessments

Assessments should not only cover your mental health. They should cover your physical health and life situation too.

Care closer to home

• Your mental health care should be based in local communities, not just hospitals.
• Your support should be built around GP surgeries and neighbourhoods.
• You should get help that fits your daily life and community.

On our webpage you can get more information about GPs and your mental health

One joined-up service

• Primary care, like your GP practice, and NHS mental health services should work together.
• You should have fewer referrals and repeat assessments.
• It should be easier for you to move between levels of support when your needs change.

Support for everyone

• The Framework is not only for people who live with severe mental illness. It is for people who live with mild and moderate mental health problems too.
• If you have complex needs, there should be extra support for you, like crisis care or long-term help.
• There should be no gaps when moving between services.
• You should be offered digital tools to help, if appropriate.

‘No wrong door’

You should be able to get support, care and treatment in from wherever you ask for it. 

Personal care plans

• You should have a single, clear care plan
• It should be made with you and your family or carers, if you agree.

Complex needs - one named professional who coordinates your care

• If you have complex needs, you should have one named professional who coordinates your care.

More than medical care

• If you need it, you should get help with:
  • employment, education, housing, money, and physical health, and
  • supported to connect with community activities and groups.
• Social prescribing should help you use appropriate local services.

Your support can include:  

• Talking therapy and medication
• Advocacy services
• Assessment, advice and consultation for mental health problems
• Community support. Things like libraries, leisure and social activities, and faith groups
• Care and treatment for drug and alcohol-use
• Employment, volunteering, education, and training services
• Help and advice on money, including benefits
• Housing support
• Social care services
• Physical health care
• Digital support and information
• Support groups for your situation
• Tailored support if you have a disability

On our webpages below you can find more information on the following things:

• Talking therapies
• Advocacy for mental health - Making your voice heard
• Drugs, alcohol, and mental health
• Work, volunteering, and mental illness
• Studying and mental health
• Housing options - For adults who live with mental illness
• Social care assessment - Under the Care Act 2014
• Physical activity and mental health
• Severe mental illness and physical health checks
• Social inclusion and mental illness - How can I become more connected
• Recovery and mental illness

You can get advice and information on money and welfare benefits from Mental Health and Money Advice

You might need extra mental health support because your needs are complex.

When thinking about whether your needs are complex professionals should not only look at your mental health diagnosis. They should also consider things like: 

• If you have other mental or physical health conditions,
• If you have drug or alcohol problems,
• If you have any problems associated with ageing, such as frailty,
• Your level of support from family and friends,
• How successful your care and treatment is.

Your care and support could include things like:

• crisis help,
• specialist residential care, and
• specialist services for particular mental illnesses, like eating disorder services.

These services should work closely with NHS mental health services and social services. So, care feels joined up.
 
You should get continuous care, without being passed around or forgotten.

If you have a very serious mental health condition you should get long-term, intensive support.

Support should be available for people at risk of being excluded, like:

• rough sleepers,
• people leaving prison,
• people involved with the police, and
• people who live with psychotic disorders or personality disorders.

On our following webpages you can read more about:

• Get help now – how to get urgent or crisis help for your mental health
• Going into hospital for mental health treatment
• Prison release information
• Police custody and mental health - What happens if you are arrested
• Psychosis
• Personality disorders 

The following case studies show you examples of how you might be supported under the Framework.

Case study 1: Sam – Who lives with schizophrenia

• Sam is 32 and lives with schizophrenia. He also has problems with drug use and alcohol.
• Under the Framework, Sam gets one joined up care plan made with him and his support worker.
• His GP, mental health nurse, and drug and alcohol team work together, so he does not have to repeat his story.
• Sam gets regular home visits, medication support, and therapy to help him manage voices and stress.
• He’s linked to local activities, like a walking group, to build confidence.
• A named worker checks in weekly, helping him to stay safe, avoid crisis, and work towards stable housing.

Case study 2: Aisha – Who lives with anxiety disorder

• Aisha is 27 and had anxiety so severely she could not work anymore.
• Under the Framework, she gots a single care plan focusing on confidence, wellbeing, and long-term goals.
• Her GP, therapist, and employment coach work together so support feels smooth and joined up.
• She receives talking therapy, help with sleep, and exercises to manage panic.
• She’s encouraged to join local groups to reduce loneliness.
• With gradual support and workplace advice, Aisha builds confidence and returns to her job, part time.
• She now feels supported, not alone.

On our following webpages you can find out more about: 

• Schizophrenia
• Anxiety disorders
• How do I manage a panic attack?
• How do I manage hearing voices?

Mental health care on the NHS is usually free of charge. 

But if you receive social care, depending on your circumstances: 

• It might be free a charge,
• You might have to pay some money towards it, or
• You might have to pay the full cost.

On our webpages you can find out more about:

• Paying for care - Do I have to pay for social care?
• Social care assessment - Under the Care Act 2014

What are social care direct payments? 

If you qualify for social care you can choose to get direct payments from social services. These payments mean you can pay and arrange care yourself. This is instead of social services arranging the care for you. 

You can spend direct payments on services, equipment, or activities. That meet your social care needs. 

On our webpage you can find out more about:

• Social Care - Direct payments - Under the Care Act 2014

What is section 117 aftercare?

You might have been detained in hospital under one of the following sections of the Mental Health Act: 3, 37, 45A, 47, or 48.  If you have you should be entitled to section 117 aftercare.  

This means that the community services you get for your mental health are free.  This includes any social care that you get.

On our webpage you can find out more about:

• Section 117 aftercare - Under the Mental Health Act 1983

If you are not happy with your care or treatment, you can: 

• talk to your doctor about your care and treatment options,
• ask for a second opinion,
• get an advocate to support you,
• contact your local Patient Advice and Liaison Service (PALS), or
• make a complaint.

On our following webpages you can find out more about: 

• Advocacy for mental health - Making your voice heard
• How do I complain about my NHS care or treatment? A quick step-by-step guide
• How do I complain about the NHS or social services? In depth guide
• Second opinions - About your mental health diagnosis or treatment

You may lose the ability to make a decision for yourself. This is known as losing mental capacity. 

You could make an advance statement or advance decision. They explain to professionals and loved ones what you would like to happen in future with your care and treatment. They only kick in if you lose mental capacity.

You may want to make an advance statement or advance decision to feel in control of what happens to you.

See our following webpages for more information on:

• Advance statements and advance decisions - Planning your future care
• Mental capacity and mental illness - The Mental Capacity Act 2005

The NHS say that from 2021/22 to 2023/24, all local NHS services have received funding. And this was enough to put the changes in place brought in by the Framework. 

When we last reviewed this information in 2025 we could not find any other information to confirm that the Framework is fully rolled out.

But a 2025 report by the Centre for Mental Health and Mind says:

• There are rising levels of mental distress, and
• mental health services that are finding it hard to meet people’s needs.

In 2025 some NHS services are evaluating services brought in by the Framework changes. 

From what we understand, in 2025 the Framework is being rolled out, tested and built into local NHS plans.