This briefing summarises reflections from mental health trust leaders on the development of neighbourhood health services in England. It draws on engagement since the publication of the 10-year health plan (10YHP) to explore how the government’s ambition for integrated, community-based care is being interpreted locally, its implications for mental health services, and the opportunities and challenges trusts face as policy evolves. Neighbourhood health is defined as a patient-centred approach that brings professionals together in teams, strengthens primary and community care, and reduces avoidable hospital admissions.
The 10YHP positions neighbourhood health at the centre of shifting care from hospitals to communities, with general practice playing a leading role and NHS trusts—including mental health, community, and acute providers—being essential for service coordination. Recent policy frameworks outline national goals for integrated care boards (ICBs), emphasizing routine care, proactive support, and alternatives to hospital-based services. For mental health, this includes 24/7 neighbourhood care models, modern service frameworks for severe and enduring conditions, and community mental health centres aimed at reducing fragmentation and improving patient experience. Despite these commitments, mental health trusts report feeling less visible in neighbourhood policy discussions.
Emerging population-based delivery models, such as single or multi-neighbourhood provider contracts and integrated health organisation contracts, aim to support community care. Mental health providers’ experience in delivering community-based alternatives to hospital services is highly relevant, with MHLDA provider collaboratives offering examples of joint planning, budget management, and pathway transformation. Trust leaders emphasize that lessons from these collaborations are increasingly important as the system shifts to community-focused provision.
Trust leaders highlight the need for parity of esteem for mental health, noting that policy ambitions often lack clear expectations and dedicated funding. Early progress has depended heavily on staff goodwill rather than structural investment, which is unsustainable. Leaders call for strategic funding allocation, including support for voluntary and community organisations, to ensure neighbourhood models genuinely shift care into communities while addressing inequalities and integrating mental and physical health needs.
There is significant variation in how neighbourhood working is interpreted. Trusts stress the importance of tailoring services to local population needs, including children and young people, and integrating learning from existing frameworks and pilots. Systematic evaluation of past community mental health initiatives is needed to build on evidence and avoid repeating mistakes. Trusts view themselves as anchor institutions capable of driving system-wide change, emphasizing that neighbourhood models should reflect the full spectrum of mental health, physical health, and community support.
Governance remains a key challenge, with complex structures and unclear accountability across ICBs and primary care networks. Strong governance frameworks, clear roles, and recognition of cross-organizational care delivery are critical. Integration with partners, including voluntary organisations, is essential to address social determinants of health and ensure services are community-led, equitable, and responsive to local populations. Early involvement, strong relationships, and shared vision across sectors are vital for meaningful collaboration.
Neighbourhood 24/7 mental health pilots offer opportunities to refine integrated, place-based care, though challenges remain in aligning teams, preventing siloing, and managing care for complex cases. Trust leaders highlight the need for both primary and secondary expertise, stepped-care models, and integration of mental and physical health services to reduce premature mortality and system costs. Workforce development is crucial, requiring cultural shifts, training, and embedding mental health and learning disability expertise within neighbourhood teams.
Digital and data infrastructure remain obstacles, with inconsistent platforms and complex information-sharing arrangements limiting integration. National digital standards and interoperable systems are needed to support coherent care and reduce administrative burdens. Trusts caution that data-driven planning must not exclude underserved populations or exacerbate inequalities.
Rising demand across adult and children’s mental health services underscores the need for sustainable investment and system alignment. Leaders caution that reducing hospital admissions should not be the sole success metric; outcomes should reflect recovery, community priorities, and health equity.
In conclusion, mental health trusts play a pivotal role in shaping neighbourhood health services. Their expertise, community links, and collaboration with voluntary organisations make them essential to designing integrated models. Where mental health is embedded from the outset, pilots show stronger multidisciplinary teams, coherent pathways, and collaborative problem-solving. Achieving the full potential of neighbourhood health requires treating mental health as integral, providing dedicated resources, and building services around local needs, existing provision, and lived experience.
