Psychological health and well-being: A new ethos and a new service structure for mental health. A report of the Working Group on Psychological Health and Well-Being.

The National Service Framework for Mental Health ? NSF ? (Department of Health, 1999) outlined a clear and positive framework for the provision of mental health care. With a 10-year timeframe for implementation of the original NSF, however, it is appropriate to consider what a new service framework should contain. This paper is intended to help that process by outlining the particular perspective and distinctive contribution offered by psychology. We conclude (inter alia) that continued investment in mental health services should remain a priority for Government, but services should be planned on the basis of need and functional outcome rather than diagnostic categories. Mental health services should fully embrace the recovery approach, and services should be commissioned on the basis of individual social need and functional outcome as much as on the basis of ?treatment? and clinical outcome. New assessment and evaluation frameworks should be developed to match these priorities. There should be an emphasis on and investment in preventative and health promotion work, with particular attention to adolescent mental health. Psychologists should see their roles develop and strengthen as clinical leaders in psychological therapies and the scientific evidence base for psychological models. It is essential to continue to invest in high-quality, evidence-based psychological therapies. Delivery models for such therapies need to incorporate ?stepped care? principles, but guided by expert assessments and based on psychological formulations addressing a person?s wider well-being. People have a right to expect the NHS to deliver those evidence-based, effective psychological therapies recommended by NICE ? and for these to be delivered by competent therapists. Mental health services, together with JobcentrePlus, and independent sector employment providers should help clients to return rapidly to work wherever possible, and to keep them in work. Discrimination against people with mental health problems should be as unacceptable as racism or sexism, and services should adhere to the principles of Fairness, Respect, Equity and Dignity ? the FRED principles to help ensure human rights compliance. Services need to facilitate genuine service user involvement; service users and carers should be involved at the outset in setting strategies for mental health services, and in the production and monitoring of all component policies. To implement this vision, we recommend that Centres for Psychological Health and Well-being should be established in all major UK towns. These would be new entities, but would largely incorporate services already present (or planned) within the NHS and related social care and educational services, as well as the agencies of the Department for Work and Pensions. They would therefore predominately constitute a re-organisation of existing services; although investment in new provision is also proposed. Such centres should be integral elements of the National Health Service, and would be one-stop-shops for: mental health care, employment support, educational support, forensic mental health services, and liaison with mainstream healthcare services.