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Service user experience in adult mental health services

About

What is covered

This interactive flowchart is about ensuring that users of adult mental health services have the best possible experience of care from the NHS.
Despite initiatives to improve the service user's experience of healthcare, further work is needed to deliver the best possible experience of care to adults using mental health services. This interactive flowchart recommends how health and social care professionals and providers can achieve this within the NHS.

Updates

Updates to this interactive flowchart

9 September 2019 Suicide prevention (NICE quality standard 189) added.
30 July 2019 Service user experience in adult mental health services (NICE quality standard 14) updated.

Person-centred care

People have the right to be involved in discussions and make informed decisions about their care, as described in your care.
Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations, and has information about prescribing medicines (including off label use), professional guidelines, standards and laws (including on consent and mental capacity), and safeguarding.

Your responsibility

Guidelines

The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian.
Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Technology appraisals

The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, health professionals are expected to take these recommendations fully into account, alongside the individual needs, preferences and values of their patients. The application of the recommendations in this interactive flowchart is at the discretion of health professionals and their individual patients and do not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.
Commissioners and/or providers have a responsibility to provide the funding required to enable the recommendations to be applied when individual health professionals and their patients wish to use it, in accordance with the NHS Constitution. They should do so in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Medical technologies guidance, diagnostics guidance and interventional procedures guidance

The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take these recommendations fully into account. However, the interactive flowchart does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.
Commissioners and/or providers have a responsibility to implement the recommendations, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this interactive flowchart should be interpreted in a way that would be inconsistent with compliance with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Short Text

Everything NICE has said on improving the experience of care for people using adult NHS mental health services in an interactive flowchart

What is covered

This interactive flowchart is about ensuring that users of adult mental health services have the best possible experience of care from the NHS.
Despite initiatives to improve the service user's experience of healthcare, further work is needed to deliver the best possible experience of care to adults using mental health services. This interactive flowchart recommends how health and social care professionals and providers can achieve this within the NHS.

Updates

Updates to this interactive flowchart

9 September 2019 Suicide prevention (NICE quality standard 189) added.
30 July 2019 Service user experience in adult mental health services (NICE quality standard 14) updated.

Sources

NICE guidance and other sources used to create this interactive flowchart.
Suicide prevention (2019) NICE quality standard 189
Service user experience in adult mental health services (2011 updated 2019) NICE quality standard 14

Quality standards

Suicide prevention

These quality statements are taken from the suicide prevention quality standard. The quality standard defines best practice for reducing suicide and helping people bereaved or affected by suicide and should be read in full

Service user experience in adult mental health services

These quality statements are taken from the service user experience in adult mental health services quality standard. The quality standard outlines the level of service that people using the NHS mental health services should expect to receive and should be read in full.

Quality statements

Multi-agency suicide prevention partnerships

This quality statement is taken from the suicide prevention quality standard. The quality standard defines best practice for reducing suicide and helping people bereaved or affected by suicide and should be read in full.

Quality statement

Multi-agency suicide prevention partnerships have a strategic suicide prevention group and clear governance and accountability structures.

Rationale

By working together, local organisations can combine their expertise and resources to implement a range of interventions to prevent suicide including addressing risk factors such as self-harm.
Partnerships should have a strategic suicide prevention group to identify priorities and manage the overall strategic direction. Organisations that have a key role in suicide prevention should have senior level representation on the strategic suicide prevention group. Although local structures are likely to vary, the group may coordinate the work of a wider network of representatives from specific services and organisations to implement the local suicide prevention strategy.
To promote understanding, partnerships should involve people with personal experience of a suicide attempt, suicidal thoughts and feelings, or a suicide bereavement. Clear terms of reference and governance and accountability structures will improve effectiveness and sustainability.

Quality measures

Structure
a) Evidence that multi-agency suicide prevention partnerships have a strategic suicide prevention group attended by senior level representatives.
Data source: Local data collection, for example, membership list including job titles and responsibilities and attendance registers.
b) Evidence that multi-agency suicide prevention partnerships have clear governance and accountability structures.
Data source: Local data collection, for example, terms of reference.
c) Evidence that multi-agency suicide prevention partnerships support people with personal experience of a suicide attempt, suicidal thoughts and feelings, or a suicide bereavement, to be involved in the partnership.
Data source: Local data collection, for example, programme of induction and support for people with personal experience who are involved in the partnership.
Outcome
a) Rate of emergency hospital attendance or admission for intentional self-harm.
Data source: Public Health England’s Suicide Prevention Profile includes data on the age-standardised rate of emergency hospital admissions for intentional self-harm in local authority areas. NHS Digital’s Hospital Episode Statistics includes data on A&E attendances for self-harm.
b) Rate of self-harm in the community.
Data source: Local data collection, for example, community or school surveys. NHS Digital’s survey of the mental health of children and young people in England includes questions on self-harm and attempted suicide. Data on episodes of self-harm in primary care are likely to be available from primary care electronic health care record systems.
c) Suicide rate.
Data source: Public Health England’s Suicide Prevention Profile includes data on the rate of suicide in local authority areas for different population groups (based on Office for National Statistics source data).

What the quality statement means for different audiences

Lead organisations such as local authorities and residential custodial or detention providers set up a multi-agency suicide prevention partnership with a strategic suicide prevention group that includes senior representatives from key organisations. Lead organisations ensure that representatives on the group can make decisions and commit resources on behalf of their organisation, and have skills and knowledge in line with Health Education England’s Self-harm and suicide prevention competence frameworks.
Lead organisations ensure that people with personal experience of a suicide attempt, suicidal thoughts and feelings, or a suicide bereavement who are involved in the partnership can access a programme of induction and support. They identify clear leadership for the partnership and ensure it has clear terms of reference, based on a shared understanding that suicide can be prevented. The terms of reference should:
  • clarify local partnership structures, including working arrangements between the strategic suicide prevention group and any wider network or partnership subgroups
  • identify clear governance and accountability structures, including oversight from local health and care planning groups such as the health and wellbeing board
  • clarify links between suicide prevention partnerships in the local community and those in custodial settings, particularly in relation to managing prisoners and detainees in the community.

Source guidance

Preventing suicide in community and custodial settings (2018) NICE guideline NG105, recommendations 1.1.1, 1.1.2 and 1.1.4

Definitions of terms used in this quality statement

Multi-agency suicide prevention partnership
Suicide prevention requires work across a range of settings targeting a wide variety of audiences. Given this complexity, the combined knowledge, expertise and resources of organisations across the public, private and voluntary sectors is essential. A wide range of representatives working with adults, children and young people may be brought together to contribute to a multi-agency suicide prevention partnership.
Strategic suicide prevention group
A strategic suicide prevention group in the community could include representatives from the following:
  • clinical commissioning groups
  • local public health services
  • healthcare providers
  • social care services
  • voluntary and other third-sector organisations, including those used by people in high-risk groups
  • emergency services
  • criminal justice services
  • police and custody suites
  • employers
  • education providers
  • people with personal experience of a suicide attempt, suicidal thoughts and feelings, or a suicide bereavement.
A strategic suicide prevention group in a residential custodial or detention setting could include representatives from the following:
  • governors or directors
  • healthcare staff (including physical and mental health)
  • other staff
  • pastoral support services
  • voluntary and other third-sector organisations
  • escort custody services
  • liaison and diversion services
  • emergency services
  • offender management and resettlement services
  • people with personal experience of a suicide attempt, suicidal thoughts and feelings, or a suicide bereavement, to be selected according to local protocols.
[NICE’s guideline on preventing suicide in community and custodial settings, recommendations 1.1.3 and 1.1.5 and expert opinion]

Equality and diversity considerations

Multi-agency suicide prevention partnerships should make reasonable adjustments to ensure that people with additional needs such as physical, sensory or learning disabilities, and people who do not speak or read English, or who have reduced communication skills, can participate in the strategic suicide prevention group. People should have access to an interpreter (including British Sign Language) or advocate if needed.

Reducing access to methods of suicide

This quality statement is taken from the suicide prevention quality standard. The quality standard defines best practice for reducing suicide and helping people bereaved or affected by suicide and should be read in full.

Quality statement

Multi-agency suicide prevention partnerships reduce access to methods of suicide based on local information.

Rationale

Reducing access to common methods of suicide and to places where suicide may be more likely to occur can be an effective way of preventing suicide. A range of measures can be used to interrupt people’s plans, giving them time to stop and think, or making it more difficult for them to put themselves in danger. An understanding of local information will help suicide prevention partnerships prioritise the methods and places to focus on locally.

Quality measures

Structure
a) Evidence that multi-agency suicide prevention partnerships collect and analyse local information on methods of suicide and locations.
Data source: Local data collection, for example, data sharing protocols and a rapid intelligence gathering process.
b) Evidence that multi-agency suicide prevention partnerships identify how they will reduce access to methods of suicide.
Data source: Local data collection, for example, local suicide prevention action plan.
c) Evidence that multi-agency suicide prevention partnerships review progress in reducing access to methods of suicide at least annually.
Data source: Local data collection, for example, local suicide prevention action plan progress reports.
Outcome
a) Number of suicides by methods identified in the local suicide prevention action plan.
Data source: Local data collection, for example, rapid intelligence gathering. Detailed information on methods should not be included in the published suicide prevention action plan.
b) Number of suicides in high-frequency locations.
Data source: Local data collection, for example, rapid intelligence gathering. Detailed information on locations should not be included in the published suicide prevention action plan.
c) Suicide rate.
Data source: Public Health England’s Suicide Prevention Profile includes data on the rate of suicide in local authority areas for different population groups (based on Office for National Statistics source data).

What the quality statement means for different audiences

Multi-agency suicide prevention partnerships gather and analyse information from a range of sources to understand local patterns in suicide method and location. The partnership uses this information to prioritise the methods and locations to focus on. It includes these priorities in the suicide prevention action plan, identifies actions and regularly reviews progress.
The partnership supports partner organisations to ensure that they comply with national guidance on issues such as providing and maintaining safer cells in residential custodial or detention settings and restricting access to painkillers. The partnership also facilitates data sharing protocols between organisations to support timely analysis of data and actions to reduce access to methods of suicide for people in high-risk groups.
People in the community and in custody know that organisations are working together to prevent suicide.

Source guidance

Preventing suicide in community and custodial settings (2018) NICE guideline NG105, recommendations 1.6.1, 1.6.2 and 1.6.3

Definitions of terms used in this quality statement

Reducing access to methods of suicide
Suicide prevention partnerships should ensure local compliance with national guidance:
Reduce the opportunity for suicide in locations where suicide is more likely, for example by erecting physical barriers (see Public Health England's Preventing suicide in public places: a practice resource). Also consider other measures such as:
  • providing information about how and where people can get help when they feel unable to cope
  • using CCTV or other surveillance to allow staff to monitor when someone may need help
  • increasing the number and visibility of staff, or times when staff are available
  • working with planners who have responsibility for designing bridges, multi-storey car parks and other structures that could potentially pose a suicide risk.
[NICE’s guideline on preventing suicide in community and custodial settings recommendations 1.3.2, 1.6.2, 1.6.3 and 1.6.4]
Local information
Suicide prevention partnerships should use local data including audit, Office for National Statistics and NHS data, as well as rapid intelligence gathering, to:
  • identify emerging trends in suicide methods and locations
  • understand local characteristics that may influence the methods used
  • determine when to take action to reduce access to the methods of suicide.
[NICE’s guideline on preventing suicide in community and custodial settings recommendation 1.6.1]

Media reporting

This quality statement is taken from the suicide prevention quality standard. The quality standard defines best practice for reducing suicide and helping people bereaved or affected by suicide and should be read in full.

Quality statement

Multi-agency suicide prevention partnerships have a local media plan that identifies how they will encourage journalists and editors to follow best practice when reporting on suicide and suicidal behaviour.

Rationale

Irresponsible reporting of suicide and suicidal behaviour may have harmful effects, including potentially increasing the risk of suicide. By promoting best practice, partnerships can encourage responsible reporting, which can help prevent suicide clusters and avoid further distress being caused to those bereaved or affected by suicide.

Quality measures

Structure
a) Evidence that multi-agency suicide prevention partnerships have a local media plan that identifies how they will encourage best practice in reporting on suicide and suicidal behaviour.
Data source: Local data collection, for example, a partnership media plan.
b) Evidence that multi-agency suicide prevention partnerships have a named lead for the local media plan.
Data source: Local data collection, for example, description of partnership roles and responsibilities.
c) Evidence that multi-agency suicide prevention partnerships work with other organisations such as the Samaritans to give feedback to local media journalists and editors about reporting on suicide and suicidal behaviour.
Data source: Local data collection, for example, a feedback log. This may include information on feedback given by other organisations such as the Samaritans.
Outcome
a) Number of local media reports of suicide or suicidal behaviour that do not meet best practice criteria.
Data source: Local data collection, for example, monitoring records.
b) Suicide rate.
Data source: Public Health England’s Suicide Prevention Profile includes data on the rate of suicide in local authority areas for different population groups (based on Office for National Statistics source data).

What the quality statement means for different audiences

Multi-agency suicide prevention partnerships in the community develop a plan for liaising with local media organisations that encourages a positive relationship and promotes best practice when reporting on suicide and suicidal behaviour. Partnerships identify a lead to coordinate the local media plan. Partnerships work with organisations such as the Samaritans to provide feedback to editors and journalists if a report is not consistent with best practice guidelines.
Multi-agency suicide prevention partnerships in residential custodial and detention settings liaise with local media through the Ministry of Justice, if relevant, and encourage Ministry of Justice press officers to follow best practice when reporting on suicide and suicidal behaviour.
Local media journalists and editors work with the local suicide prevention partnership and other organisations such as the Samaritans to increase awareness of best practice and improve reporting standards.

Source guidance

Preventing suicide in community and custodial settings (2018) NICE guideline NG105, recommendations 1.10.1, 1.10.2 and 1.10.4

Definitions of terms used in this quality statement

Best practice when reporting on suicide and suicidal behaviour
This includes:
  • using sensitive language that is not stigmatising or in any other way distressing to people who have been affected
  • reducing speculative reporting
  • avoiding presenting detail on methods
  • providing stories of hope and recovery including signposting to support.
[NICE’s guideline on preventing suicide in community and custodial settings recommendations 1.10.2 and expert opinion]

Involving family, carers or friends

This quality statement is taken from the suicide prevention quality standard. The quality standard defines best practice for reducing suicide and helping people bereaved or affected by suicide and should be read in full.

Quality statement

Adults presenting with suicidal thoughts or plans discuss whether they would like their family, carers or friends to be involved in their care and are made aware of the limits of confidentiality.

Rationale

Families, carers and friends can help to support a person who has suicidal thoughts or plans. They can also provide valuable input to an assessment of the person’s needs to help keep them safe. Involving families, carers or friends can be complex so, providing the person has mental capacity, it is important for them to discuss who they would or would not like to be involved if there is a concern over suicide risk. The person should have the opportunity to discuss information sharing and their right to confidentiality so that they are aware of the circumstances in which confidential information may need to be disclosed to family, carers or friends.

Quality measures

Structure
a) Evidence of local arrangements to provide training on information sharing and confidentiality based on the Department of Health and Social Care's consensus statement on information sharing and suicide prevention to practitioners in contact with adults presenting to health or care services with suicidal thoughts or plans.
Data source: Local data collection, for example, staff training records.
b) Evidence of local processes to ensure that adults presenting with suicidal thoughts or plans discuss whether they would like their family, carers or friends to be involved in their care.
Data source: Local data collection, for example, local service protocol.
c) Evidence of local processes to ensure that adults with suicidal thoughts or plans are made aware of the limits of confidentiality.
Data source: Local data collection, for example, local service protocol.
Process
a) Proportion of adults presenting with suicidal thoughts or plans who discuss whether they would like their family, carers or friends to be involved in their care.
Numerator – the number in the denominator who discuss whether they would like their family, carers or friends to be involved in their care.
Denominator – the number of adults presenting with suicidal thoughts or plans.
Data source: Local data collection, for example, audit of patient records.
b) Proportion of adults presenting with suicidal thoughts or plans who are made aware of the limits of confidentiality.
Numerator – the number in the denominator who are made aware of the limits of confidentiality.
Denominator – the number of adults presenting with suicidal thoughts or plans.
Data source: Local data collection, for example, audit of patient records.
Outcome
a) Proportion of assessments for adults who presented with suicidal thoughts or plans who wanted their family, carers or friends involved, that involved family, carers or friends.
Numerator – the number in the denominator that involved family, carers or friends.
Denominator – the number of assessments for adults who presented with suicidal thoughts or plans who wanted their family, carers or friends involved.
Data source: Local data collection, for example, audit of patient records.
b) Proportion of family members, carers or friends of adults who presented with suicidal thoughts or plans who are satisfied with information sharing about suicide risk.
Numerator – the number in the denominator who are satisfied with information sharing about suicide risk.
Denominator – the number of family members, carers or friends of adults who presented with suicidal thoughts or plans.
Data source: Local data collection, for example, survey of family members, carers or friends of adults who presented with suicidal thoughts or plans.
c) Suicide rate.
Data source: Public Health England’s Suicide Prevention Profile includes data on the rate of suicide in local authority areas for different population groups (based on Office for National Statistics source data).

What the quality statement means for different audiences

Service providers (such as general practices, hospitals, ambulance services, mental health trusts, prisons and social care providers) ensure that processes are in place for adults presenting with suicidal thoughts or plans to discuss whether they would like their family, carers or friends to be involved in their care, and to make them aware of the limits of confidentiality.
Providers ensure that if the person wants their family, carers or friends involved in their care, the nature of their involvement, including how and when information is shared with them, is agreed. Providers ensure that staff are trained and aware of the Department of Health and Social Care’s consensus statement on information sharing and suicide prevention.
Health and social care practitioners (such as A&E practitioners, paramedics, first responders, GPs, nurses, social workers, mental health professionals and allied health professionals) discuss with adults presenting with suicidal thoughts or plans whether they would like their family, carers or friends to be involved in their care. They also make them aware of the limits of confidentiality. If the person wants their family, carers or friends involved, health and social care practitioners ensure they agree how they will be involved and when information will be shared with them.
Commissioners (such as local authorities, clinical commissioning groups and NHS England) commission services that discuss with adults presenting with suicidal thoughts or plans whether they would like their family, carers or friends to be involved in their care. They also make them aware of the limits of confidentiality.
Adults who contact a health or care service and feel suicidal discuss whether they would like their family, carers or friends to be involved in their care. If they want their family, carers or friends to be involved, they agree how they will be involved and when information will be shared with them. They are also told about confidentiality and when it may be necessary to share information with their family, carers or friends.

Source guidance

Definitions of terms used in this quality statement

Adults with suicidal thoughts or plans
Adults who disclose suicidal thoughts or plans when asked about suicide ideation and intent.
[Expert opinion]
Limits of confidentiality
If a person is at imminent risk of suicide, there may be sufficient doubts about their mental capacity to consent to information about their risk of suicide being shared. In these circumstances, a professional judgement will need to be made, based on an understanding of the person and what would be in their best interest. This should take into account the person’s previously expressed wishes and views in relation to sharing information with their family, carers or friends.
The judgement may be that it is right to share critical information. If the purpose of the disclosure is to prevent a person who lacks capacity from serious harm, there is an expectation that practitioners will disclose relevant confidential information, if it is in the person’s best interest to do so. Disclosure may also be in the public interest because of the far-reaching impact that a suicide can have on others.

Equality and diversity considerations

Services that support adults with suicidal thoughts or plans should make reasonable adjustments to ensure that people with additional needs such as physical, sensory or learning disabilities, and people who do not speak or read English, or who have reduced communication skills, can use the service. People should have access to an interpreter (including British Sign Language) or advocate if needed.
Health and social care practitioners should ensure that adults who temporarily lack mental capacity to consent to information sharing are asked if they want their family, carers or friends to be involved in their care as soon as they are able to give consent.

Supporting people bereaved or affected by a suspected suicide

This quality statement is taken from the suicide prevention quality standard. The quality standard defines best practice for reducing suicide and helping people bereaved or affected by suicide and should be read in full.

Quality statement

People bereaved or affected by a suspected suicide are given information and offered tailored support.

Rationale

Children, young people and adults who are bereaved or affected by a suspected suicide are themselves at increased risk of suicide. Providing support after a suspected suicide can reduce this risk, especially when tailored to the person’s needs. It is important to identify people who may need support as soon as possible so that they can be given practical information and access support if, and when, they need to.

Quality measures

Structure
a) Evidence of local arrangements to use rapid intelligence gathering to identify people who may be bereaved or affected by a suspected suicide.
Data source: Local data collection, for example, data sharing agreements and reporting arrangements.
b) Evidence of local processes to give information to people bereaved or affected by a suspected suicide and to ask if they need help.
Data source: Local data collection, for example, a local protocol.
c) Evidence of local services that can provide support to people bereaved or affected by a suspected suicide.
Data source: Local data collection, for example, service specifications and a local directory of information on the services available.
Process
a) Proportion of people bereaved or affected by a suspected suicide who are given information.
Numerator – the number in the denominator who are given information.
Denominator – the number of people bereaved or affected by a suspected suicide.
Data source: Local data collection, for example, audit of case records.
b) Proportion of people bereaved or affected by a suspected suicide who are asked if they need help.
Numerator – the number in the denominator who are asked if they need help.
Denominator – the number of people bereaved or affected by a suspected suicide.
Data source: Local data collection, for example, audit of case records.
c) Proportion of people bereaved or affected by a suspected suicide who access tailored support.
Numerator – the number in the denominator who access tailored support.
Denominator – the number of people bereaved or affected by a suspected suicide.
Data source: Local data collection, for example, monitoring information from local support services.
Outcome
a) Proportion of people bereaved or affected by a suicide who are satisfied with information and support.
Numerator – the number in the denominator who are satisfied with information and support.
Denominator – the number of people bereaved or affected by a suicide.
Data source: Local data collection, for example, survey of people bereaved or affected by a suicide.
b) Number of suicides among people bereaved or affected by a suicide.
Data source: Local data collection, for example, rapid intelligence gathering.

What the quality statement means for different audiences

Multi-agency suicide prevention partnerships carry out rapid intelligence gathering to identify children, young people and adults who may be bereaved or affected by a suspected suicide. Partnerships ensure that coordinated processes are in place across partner organisations to provide information to people who are bereaved or affected by a suspected suicide, to ask them if they need additional help and to signpost them to support if needed.
Partnerships ensure that information and signposting to support is offered to people who are bereaved or affected by a suspected suicide as soon as possible and then at subsequent opportunities to ensure that people can access support when they need it.
Service providers (such as police, hospitals, ambulance services, prisons, general practices, funeral directors, coroners’ offices, employers and education providers) ensure that processes are in place to provide information to people who are bereaved or affected by a suspected suicide (including health and care practitioners and first responders), to ask them if they need additional help and to signpost them to support if needed.
Providers ensure that information and signposting to support is offered to people who are bereaved or affected by a suspected suicide as soon as possible and then at other opportunities to ensure that people can access support when they need it.
Practitioners (such as police officers, GPs, nurses, paramedics, mental health practitioners, prison staff, funeral directors, coroner’s office staff and human resource managers) provide information to people who are bereaved or affected by a suspected suicide, ask them if they need additional help and signpost them to support if needed. Practitioners who respond to a suspected suicide or provide support to people bereaved or affected by a suspected suicide, are aware of how they can access support to help them cope, if they need it.
Commissioners (such as local authorities, clinical commissioning groups and NHS England) commission services that provide support after a suspected suicide with the capacity and skills to meet the needs of the local population, including children and young people. They also commission services that provide information to people who are bereaved or affected by a suspected suicide, ask them if they need additional help and signpost them to support if needed.
Children, young people and adults who are bereaved or affected by a suspected suicide are given practical information, such as an information booklet, and asked if they want any other help. If they do, they are put in touch with a support service.

Source guidance

Preventing suicide in community and custodial settings (2018) NICE guideline NG105, recommendation 1.8.2

Definitions of terms used in this quality statement

People bereaved or affected by a suspected suicide
Children, young people and adults who are bereaved or affected by a suspected suicide may include relatives, friends, classmates, colleagues, other prisoners or detainees, as well as first responders and other professionals who provided support.
[NICE’s guideline on preventing suicide in community and custodial settings, recommendation 1.8.1]
Information
Practical information expressed in a sensitive way that helps people to cope and signposts to other services, such as Public Health England’s Help is at hand guide.
[Expert opinion and NICE’s guideline on preventing suicide in community and custodial settings, recommendation 1.8.2]
Tailored support
Support that is focused on the person’s individual needs. As well as professional support, it could include:
[NICE’s guideline on preventing suicide in community and custodial settings, recommendation 1.8.3]

Equality and diversity considerations

Information for people bereaved or affected by a suspected suicide should be in a format that suits the person’s needs and preferences. It should be accessible to people who do not speak or read English, and it should be culturally appropriate. For people with additional needs related to a disability, impairment or sensory loss, information should be provided as set out in NHS England's Accessible Information Standard.
Services that provide support after a suspected suicide should ensure that staff have the skills and knowledge to support children and young people who are bereaved or affected. Services should also ensure that they provide support for people from black, Asian, other minority ethnic groups and people with religious beliefs in a culturally sensitive way.
Services that provide support after a suspected suicide should make reasonable adjustments to ensure that people with additional needs such as physical, sensory or learning disabilities, and people who do not speak or read English, or who have reduced communication skills, can use the service. People should have access to an interpreter (including British Sign Language) or advocate if needed.

Empathy, dignity and respect

This quality statement is taken from the service user experience in adult mental health services quality standard. The quality standard defines clinical best practice for service user experience in adult mental health services and should be read in full.

Quality statement

People using mental health services are treated with empathy, dignity and respect.

Rationale

To have a good experience of NHS services, people must be treated with empathy, dignity and respect. This is also fundamental for developing good relationships between people providing services and those having care and treatment. The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 made it a statutory requirement that all people who use services are treated with dignity and respect, and the NHS Constitution for England states that patients have the right to be treated with respect and dignity. There can be stigma around mental health problems, which can act as a barrier to people seeking help and accessing mental health services. Therefore, a sensitive, respectful approach is important to encourage people to get the help they need.

Quality measures

Structure
a) Evidence of local arrangements to ensure that mental health and social care professionals treat people using mental health services with empathy, dignity and respect.
Data source: Local data collection.
b) Evidence of local arrangements to ensure that a strategy is developed with other local organisations to combat stigma in the community and the NHS associated with mental health problems.
Data source: Local data collection.
Process
Proportion of people who felt they were treated with respect and dignity by NHS mental health services in the past 12 months.
Numerator – the number in the denominator who felt that they were treated with respect and dignity by NHS mental health services in the past 12 months.
Denominator – the number of people receiving care from NHS mental health services in the past 12 months.
Data source: Local data collection. Questions on treating people with dignity and respect are contained within the Care Quality Commission (CQC) Community mental health survey. This survey is repeated annually and results are available for NHS trusts providing community mental health services.
Outcome
a) Evidence from experience surveys and feedback that people using mental health services feel they are treated with empathy, dignity and respect.
Data source: Local data collection. Questions on treating people with dignity and respect are contained within the CQC Community mental health survey.
b) Evidence from experience surveys and feedback that people using mental health services feel less stigmatised in the community and NHS.
Data source: Local data collection from local surveys.

What the quality statement means for different audiences

Service providers (such as mental health trusts and community services) ensure systems are in place to give guidance to all staff on how to treat people using mental health services with empathy, dignity and respect; and collect feedback from people using mental health services on their experience of care.
Health and social care staff (such as psychiatrists, mental health nurses, social workers, receptionists and domestic services staff) ensure they treat people using mental health services with empathy, dignity and respect.
Commissioners (such as clinical commissioning groups and NHS England) ensure the mental health services they commission can provide evidence that people feel they are treated with empathy, dignity and respect.
People using mental health services feel they are treated with understanding, dignity and respect.

Source guidance

Service user experience in adult mental health services (2011) NICE guideline CG136, recommendation 1.1.1, 1.1.7 and 1.1.9

Decision making

This quality statement is taken from the service user experience in adult mental health services quality standard. The quality standard defines clinical best practice for service user experience in adult mental health services and should be read in full.

Quality statement

People using mental health services are supported in shared decision making.

Rationale

People using mental health services should have overall responsibility for managing their health. This needs to be recognised when providing services, and in the ways healthcare professionals interact with them. Health and social care professionals and service providers need to recognise that many people want to be active in their own care, although not everyone wants an active role. People should be able to work with services to actively manage their health, rather than passively receive care. Supporting people to be at the centre of decisions about their own treatment and care, including people detained under the Mental Health Act, results in better quality decisions that are more appropriate to the person. Feeling supported to make decisions also helps foster an atmosphere of hope and optimism.

Quality measures

Structure
a) Evidence of local arrangements to ensure that people being assessed by mental health services are given information and have their care explained so they understand the assessment process, their diagnosis and treatment options.
Data source: Local data collection.
b) Evidence of local arrangements to ensure that people using mental health services, including people formally detained under the Mental Health Act, are supported in shared decision making.
Data source: Local data collection.
Outcome
a) Evidence from experience surveys and feedback that people being assessed by mental health services understand the assessment process, their diagnosis and treatment options.
Data source: Local data collection.
b) Evidence from experience surveys and feedback that people using mental health services, including people formally detained under the Mental Health Act, feel supported in shared decision making.
Data source: Local data collection. Questions on involvement in making decisions are contained within the Care Quality Commission (CQC) Community mental health survey.
c) Evidence from experience surveys and feedback that people using mental health services feel optimistic that their care will be effective.
Data source: Local data collection. Questions on feelings of optimism are contained within the CQC Community mental health survey.

What the quality statement means for different audiences

Service providers (such as mental health trusts and community services) ensure that systems are in place to provide information for people using mental health services and support shared decision making.
Health and social care professionals (such as psychiatrists, mental health nurses and social workers) give people using mental health services information and support to enable shared decision making.
Commissioners (such as clinical commissioning groups and NHS England) ensure that the mental health services they commission support shared decision making.
People using mental health services are given information and support to help them understand the choices available and make decisions about their care and treatment. Being at the centre of decisions about their own care can help people feel optimistic about the future.

Source guidance

Service user experience in adult mental health services (2011) NICE guideline CG136, recommendations 1.1.1, 1.1.2, 1.3.3 and 1.6.3

Definitions

Shared decision making
This is when health professionals and patients work together. It puts people at the centre of decisions about their own treatment and care. During shared decision making, it's important that:
  • care or treatment options are fully explored, along with their risks and benefits
  • different choices available to the patient are discussed
  • a decision is reached together with a health and social care professional.
[NICE’s information on shared decision making]

Involvement to improve services

This quality statement is taken from the service user experience in adult mental health services quality standard. The quality standard defines clinical best practice for service user experience in adult mental health services and should be read in full.

Quality statement

People using mental health services are asked about their experiences and their feedback is used to improve services.

Rationale

People who have used services have a unique insight into what works well through their direct experience. People’s experience of services affects whether they continue to use the services, how they use them and whether they will use them again. Capturing this feedback in the review and planning of services is essential. People can become experts through experience and should be involved in the planning, commissioning, delivery and monitoring and review of mental health services to guide improvements.

Quality measures

Structure
a) Evidence of local arrangements to collect and use the views of people who use mental health services to monitor and improve performance.
Data source: Local data collection.
b) Evidence of local arrangements to involve people who use mental health services in monitoring services; for example, using exit interviews undertaken by people who have used services.
Data source: Local data collection.
c) Evidence of local arrangements to provide the executive board with reports on acute and non-acute mental health pathways, with a breakdown of people’s experience of care according to gender, sexual orientation, socioeconomic status, age, background (including cultural, ethnic and religious background) and disability.
Data source: Local data collection.
Outcome
Evidence from surveys and feedback that people using mental health services feel that their views are being used to improve services.
Data source: Local data collection.

What the quality statement means for different audiences

Service providers (such as mental health trusts and community services) ensure that systems are in place to collect the views of people using services and use them in monitoring and improving services.
Health and social care professionals (such as psychiatrists, mental health nurses and social workers) give people using mental health services opportunities to give feedback on their experience.
Commissioners (such as clinical commissioning groups and NHS England) ensure that the mental health services they commission use the views of the people using those services to monitor and improve them.
People using mental health services are asked about their experience of care, and their feedback is used to monitor and improve the service. They are also given the chance to be directly involved in reviewing and improving services.

Source guidance

Service user experience in adult mental health services (2011) NICE guideline CG136, recommendations 1.1.20, 1.1.21 and 1.1.22

Contacts for ongoing care

This quality statement is taken from the service user experience in adult mental health services quality standard. The quality standard defines clinical best practice for service user experience in adult mental health services and should be read in full.

Quality statement

People using mental health services understand the roles of the members of their multidisciplinary team and know how to contact them about their ongoing healthcare needs.

Rationale

Mental health services are provided by different types of professionals in a range of settings, which can be confusing. Understanding the role of all those directly involved in a person’s care and how to contact them can build trust and confidence, reduce concerns and help develop relationships. Maintaining a consistent team can provide familiarity and help improve relationships. This supports a person to more effectively manage their health and the effect it has on their life.

Quality measures

Structure
a) Evidence of local arrangements to ensure continuity of support for people using mental health services.
Data source: Local data collection.
b) Evidence of local arrangements to ensure people using mental health services are given information on the roles of the people involved in their care and how to contact them.
Data source: Local data collection.
Outcome
Evidence from experience surveys and feedback that people using mental health services understand the roles of the multidisciplinary team members and know how to contact them.
Data source: Local data collection. Questions on knowing who the main person in charge of organising a person’s care is and how to contact them are contained within the Care Quality Commission Community mental health survey.

What the quality statement means for different audiences

Service providers (such as mental health trusts and community services) have systems in place to ensure that people using mental health services understand the roles of the multidisciplinary team members and how to contact them.
Health and social care professionals (such as psychiatrists, mental health nurses and social workers) ensure that people using mental health services understand their role in the person’s care team, what they can help with, and how and when they should be contacted.
Commissioners (such as clinical commissioning groups and NHS England) ensure that the mental health services they commission help people using mental health services understand the roles of the multidisciplinary team members and how to contact them.
People using mental health services understand the roles of the different people involved in their care and know how to contact them.

Source guidance

Service user experience in adult mental health services (2011) NICE guideline CG136, recommendation 1.4.7

Access to services

This quality statement is taken from the service user experience in adult mental health services quality standard. The quality standard defines clinical best practice for service user experience in adult mental health services and should be read in full.

Quality statement

People can access mental health services, including crisis support, when they need them.

Rationale

People should be able to access mental health services when they need them. Delays in care and support can have a negative impact on their health and wellbeing. Timely access to mental health services is essential for effective treatment of mental health conditions and can help avert a crisis. For people in crisis, access to support should be available 24 hours a day, 7 days a week. Crisis support includes a comprehensive assessment and crisis plan to identify the right care and treatment.

Quality measures

Structure
a) Evidence of local arrangements to ensure agreed referral methods are in place between primary, community and secondary care services.
Data source: Local data collection.
b) Evidence of local arrangements to ensure people have access to a local 24-hour helpline staffed by mental health and social care professionals.
Data source: Local data collection.
c) Evidence of local arrangements to ensure crisis resolution and home treatment teams are accessible 24 hours a day, 7 days a week, regardless of diagnosis.
Data source: Local data collection.
d) Evidence of local arrangements to ensure that people accessing crisis support have a comprehensive assessment, including a crisis plan.
Data source: Local data collection.
Process
a) Proportion of people with a non-acute referral to mental health services who had a face-to-face appointment that took place within 3 weeks of referral (or within 2 weeks of any change of date).
Numerator – the number of people in the denominator who had a face-to-face appointment that took place within 3 weeks of referral (or within 2 weeks of any change of date).
Denominator – the number of people with a non-acute referral to mental health services.
Data source: Local data collection.
b) Proportion of people being assessed by mental health services who were seen within 20 minutes of the agreed appointment time.
Numerator – the number of people in the denominator who were seen within 20 minutes of the agreed appointment time.
Denominator – the number of people with an agreed appointment time for a mental health assessment.
Data source: Local data collection.
c) Proportion of people in crisis referred to specialist mental health services who were seen within 4 hours.
Numerator – the number of people in the denominator who were seen within 4 hours.
Denominator – the number of people in crisis referred to specialist mental health services.
Data source: Local data collection.
d) Proportion of people admitted to a 'place of safety' who were assessed under the Mental Health Act within 4 hours.
Numerator – the number of people in the denominator who were assessed under the Mental Health Act within 4 hours.
Denominator – the number of people admitted to a 'place of safety'.
Data source: Local data collection.
e) Proportion of people accessing crisis support who have a comprehensive assessment.
Numerator – the number of people in the denominator who have a comprehensive assessment.
Denominator – the number of people accessing crisis support.
Data source: Local data collection.
Outcome
a) Evidence from experience surveys and feedback that people can access a local helpline 24 hours a day.
Data source: Local data collection. Questions on knowing who to contact out of hours in the event of a crisis are contained within the Care Quality Commission (CQC) Community mental health survey.
b) Evidence from experience surveys and feedback that people accessing crisis support were asked about their relationships, their social and living circumstances and level of functioning, as well as their symptoms, behaviour, diagnosis and current treatment.
Data source: Local data collection.

What the quality statement means for different audiences

Service providers (such as mental health trusts and community services) ensure that systems are in place to provide access to mental health services when people need them.
Health and social care professionals (such as psychiatrists, mental health nurses and social workers) ensure that people can access mental health services when they need them.
Commissioners (such as clinical commissioning groups and NHS England) ensure that they commission services that provide access to mental health services when people need them.
People can get support from mental health services when they need them. This might involve calling a telephone helpline, seeing their doctor or nurse, or having an urgent referral if they are having a crisis.

Source guidance

Service user experience in adult mental health services (2011) NICE guideline CG136, recommendations 1.2.1, 1.2.3, 1.3.6, 1.5.3, 1.5.5, 1.5.6, 1.5.7 and 1.8.8

Definitions

Comprehensive assessment
This includes details of the person's:
  • relationships with others
  • social and living circumstances
  • level of functioning
  • symptoms
  • behaviour
  • diagnosis
  • current treatment.
[NICE’s guideline on service user experience in adult mental health, recommendation 1.5.3]

Joint care planning

This quality statement is taken from the service user experience in adult mental health services quality standard. The quality standard defines clinical best practice for service user experience in adult mental health services and should be read in full.

Quality statement

People using mental health services jointly agree a care plan with health and social care professionals, including a crisis plan if they may be at risk of crisis.

Rationale

By jointly agreeing a care plan, people using mental health services can identify how support can help them to live an independent life, and achieve their goals and preferred outcomes. The care plan sets out the care and treatment they need, and a copy is given to the person. A suitable date to review the care plan should be agreed to take account of changes. For people who may be at risk of crisis, a crisis plan should be developed, agreed with their care coordinator and incorporated into their care plan. This helps people plan ahead by identifying possible early warning signs, coping strategies and how to access support to prevent crises. It also includes details of the person’s needs and preferences if they need to be admitted to hospital.

Quality measures

Structure
a) Evidence of local arrangements to ensure that people using mental health services jointly develop a care plan with mental health and social care professionals.
Data source: Local data collection.
b) Evidence of local arrangements to ensure that people using mental health services are given a copy of their care plan.
Data source: Local data collection.
c) Evidence of local arrangements to ensure that people using mental health services have an agreed date to review their care plan.
Data source: Local data collection.
d) Evidence of local arrangements to ensure that people using mental health services who may be at risk of crisis jointly develop a crisis plan with mental health and social care professionals.
Data source: Local data collection.
Process
a) Proportion of people using mental health services who have a jointly agreed care plan with mental health and social care professionals.
Numerator – the number of people in the denominator who have a jointly agreed care plan with mental health and social care professionals.
Denominator – the number of people using mental health services.
Data source: Local data collection.
b) Proportion of people using mental health services given a copy of their care plan.
Numerator – the number of people in the denominator given a copy of their care plan.
Denominator – the number of people using mental health services with a care plan.
Data source: Local data collection.
c) Proportion of people using mental health services with an agreed date to review their care plan.
Numerator – the number of people in the denominator with an agreed date to review their care plan.
Denominator – the number of people using mental health services with a care plan.
Data source: Local data collection.
d) Proportion of people using mental health services who may be at risk of crisis who have a crisis plan.
Numerator – the number of people in the denominator who have a crisis plan.
Denominator – the number of people using mental health services who may be at risk of crisis.
Data source: Local data collection.
Outcome
a) Evidence from experience surveys and feedback that people using mental health services jointly developed a care plan with mental health and social care professionals.
Data source: Local data collection.
b) Evidence from experience surveys and feedback that people using mental health services were given a copy of their care plan.
Data source: Local data collection.
c) Evidence from experience surveys and feedback that people using mental health services have an agreed date to review their care plan.
Data source: Local data collection.
d) Evidence from experience surveys and feedback that people using mental health services who may be at risk of crisis jointly develop a crisis plan with mental health and social care professionals.
Data source: Local data collection.

What the quality statement means for different audiences

Service providers (such as mental health trusts and community services) ensure that care plans are jointly developed with people using mental health services and reviewed regularly. They also ensure that crisis planning is included if needed.
Health and social care professionals (such as psychiatrists, mental health nurses and social workers) work with people using mental health services to jointly develop care plans, ensure that people are given copies of their care plan and agree review dates. They also discuss with the person if a crisis plan would be of benefit.
Commissioners (such as clinical commissioning groups and NHS England) ensure that they commission services that jointly develop care plans with people using mental health services, share copies and agree review dates.
People using mental health services work with mental health and social care professionals to jointly develop and agree a care plan. They keep a copy of their care plan and agree a date to review it. People who may be at risk of crisis also have a crisis plan in their care plan.

Source guidance

Service user experience in adult mental health services (2011) NICE guideline CG136, recommendations 1.1.11, 1.1.12, 1.4.2 and 1.4.5

Definitions

Care plan
This should include the needs of the person using the service, activities promoting social inclusion, such as education, employment and volunteering, and other specified occupations, such as leisure activities and caring for dependants.
[NICE’s guideline on service user experience in adult mental health, recommendation 1.4.2]
Crisis plan
This should contain:
  • possible early warning signs of a crisis and coping strategies
  • support available to help prevent hospitalisation
  • where the person would like to be admitted in the event of hospitalisation
  • the practical needs of the service user if they are admitted to hospital (for example, childcare or the care of other dependants, including pets)
  • details of advance statements and advance decisions
  • whether and the degree to which families or carers are involved
  • information about 24-hour access to services
  • named contacts.
[NICE’s guideline on service user experience in adult mental health, recommendation 1.4.5]

Inpatient contact with staff

This quality statement is taken from the service user experience in adult mental health services quality standard. The quality standard defines clinical best practice for service user experience in adult mental health services and should be read in full.

Quality statement

People in hospital for mental health care have daily one-to-one contact with mental healthcare professionals known to them and regularly see other members of the multidisciplinary mental healthcare team.

Rationale

Staying in hospital for mental health care can be a difficult and worrying experience for some people. Having regular one-to-one contact with known healthcare professionals helps to build trust and confidence, reduce concerns and develop relationships. This supports a person to manage their health and the impact it has on them more effectively. Regularly seeing other members of the multidisciplinary team gives the person the opportunity to discuss any concerns and be actively involved in the coordination and management of their care.

Quality measures

Structure
a) Evidence of local arrangements to ensure that people staying in hospital can see a known mental healthcare professional on a one-to-one basis every day for at least 1 hour.
Data source: Local data collection.
b) Evidence of local arrangements to ensure that people staying in hospital can see their consultant on a one-to-one basis at least once a week for at least 20 minutes.
Data source: Local data collection.
c) Evidence of local arrangements to ensure that people staying in hospital are given an opportunity to meet a specialist mental health pharmacist.
Data source: Local data collection.
Process
a) Proportion of people staying in hospital for mental health care who saw a mental healthcare professional known to the person using services on a one-to-one basis every day for at least 1 hour.
Numerator – the number of people in the denominator who saw a mental healthcare professional known to the person using services on a one-to-one basis every day for at least 1 hour.
Denominator – the number of people admitted as inpatients to mental health services.
Data source: Local data collection.
b) Proportion of people staying in hospital for mental health care who saw their consultant on a one-to-one basis at least once a week for at least 20 minutes.
Numerator – the number of people in the denominator who saw their consultant on a one-to-one basis at least once a week for at least 20 minutes.
Denominator – the number of people admitted as inpatients to mental health services.
Data source: Local data collection.
c) Proportion of people staying in hospital for mental health care who saw a specialist mental health pharmacist.
Numerator – the number of people in the denominator who saw a specialist mental health pharmacist.
Denominator – the number of people admitted as inpatients to mental health services.
Data source: Local data collection.
Outcome
a) Evidence from experience surveys and feedback that people staying in hospital for mental health care see a mental healthcare professional known to the person using services on a one-to-one basis every day for at least 1 hour.
Data source: Local data collection.
b) Evidence from experience surveys and feedback that people staying in hospital for mental health care see their consultant on a one-to-one basis at least once a week for at least 20 minutes.
Data source: Local data collection.
c) Evidence from experience surveys and feedback that people staying in hospital for mental health care know they can meet a specialist mental health pharmacist.
Data source: Local data collection.

What the quality statement means for different audiences

Service providers (such as mental health trusts) ensure that systems are in place for people staying in hospital for mental health care to have daily one-to-one contact with known mental healthcare professionals and regularly see other members of the multidisciplinary mental healthcare team.
Health and social care professionals (such as psychiatrists, mental health nurses and pharmacists) ensure that people staying in hospital for mental health care have daily one-to-one contact with known mental healthcare professionals and regularly see other members of the multidisciplinary mental healthcare team.
Commissioners (such as clinical commissioning groups and NHS England) ensure they commission services that provide people staying in hospital for mental health care with daily one-to-one contact with known mental healthcare professionals and the opportunity to see other members of the multidisciplinary mental healthcare team.
People staying in hospital for mental health care see a mental healthcare professional who they know every day, and regularly see other members of their multidisciplinary mental healthcare team.

Source guidance

Service user experience in adult mental health services (2011) NICE guideline CG136, recommendation 1.6.6

Inpatient meaningful activities

This quality statement is taken from the service user experience in adult mental health services quality standard. The quality standard defines clinical best practice for service user experience in adult mental health services and should be read in full.

Quality statement

People in hospital for mental health care can access meaningful and culturally appropriate activities 7 days a week, not restricted to 9am to 5pm.

Rationale

Staying in hospital for mental health care can be a difficult and worrying experience for some people. Giving people the opportunity to do meaningful activities can help provide a structure to their day and reduce stress, frustration and boredom. It can also help to increase their social interactions, relieve anxiety and improve wellbeing. Being engaged in meaningful activities can help to foster an atmosphere of hope and optimism, which can enhance recovery. Activities can help maximise therapeutic benefits and prevent a ward from being seen as a place of containment.

Quality measures

Structure
Evidence of local arrangements to ensure that people staying in hospital have access to meaningful and culturally appropriate activities 7 days a week, not restricted to 9am to 5pm.
Data source: Local data collection.
Outcome
Evidence from experience surveys and feedback that people staying in hospital felt they could access meaningful and culturally appropriate activities 7 days a week, not restricted to 9am to 5pm.
Data source: Local data collection.

What the quality statement means for different audiences

Service providers (such as mental health trusts) ensure that systems are in place for people staying in hospital for mental health care to access meaningful and culturally appropriate activities 7 days a week, not restricted to 9am to 5pm.
Health and social care professionals (such as psychiatrists and mental health nurses) ensure that people staying in hospital for mental health care have access to meaningful and culturally appropriate activities 7 days a week, not restricted to 9am to 5pm.
Commissioners (such as clinical commissioning groups and NHS England) ensure that they commission services providing people in hospital for mental health care with meaningful and culturally appropriate activities 7 days a week, not restricted to 9am to 5pm.
People staying in hospital for mental health care can join in with a range of activities, including creative and leisure activities and exercise, 7 days a week, both during the day and in the evening.

Source guidance

Service user experience in adult mental health services (2011) NICE guideline CG136, recommendation 1.6.9

Definitions

Meaningful and culturally appropriate activities
Meaningful and culturally appropriate activities should include creative and leisure activities, exercise, self-care and community access activities (where appropriate). Activities should be facilitated by appropriately trained health or social care professionals.
[NICE’s guideline on service user experience in adult mental health, recommendation 1.6.9]

Effective interventions library

Effective interventions library

Successful effective interventions library details

Implementation

Information for the public

NICE has written information for the public on each of the following topics.

Pathway information

Person-centred care

People have the right to be involved in discussions and make informed decisions about their care, as described in your care.
Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations, and has information about prescribing medicines (including off label use), professional guidelines, standards and laws (including on consent and mental capacity), and safeguarding.

Your responsibility

Guidelines

The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian.
Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Technology appraisals

The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, health professionals are expected to take these recommendations fully into account, alongside the individual needs, preferences and values of their patients. The application of the recommendations in this interactive flowchart is at the discretion of health professionals and their individual patients and do not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.
Commissioners and/or providers have a responsibility to provide the funding required to enable the recommendations to be applied when individual health professionals and their patients wish to use it, in accordance with the NHS Constitution. They should do so in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Medical technologies guidance, diagnostics guidance and interventional procedures guidance

The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take these recommendations fully into account. However, the interactive flowchart does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.
Commissioners and/or providers have a responsibility to implement the recommendations, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this interactive flowchart should be interpreted in a way that would be inconsistent with compliance with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Supporting information

Glossary

the Equality Act 2010 replaces all previous anti-discrimination legislation and includes a public sector equality duty requiring public bodies to have due regard to the need to eliminate discrimination and to advance equality of opportunity and foster good relations between people who share certain protected characteristics and those who do not. The protected characteristics are age, disability, gender reassignment, pregnancy and maternity, race, religion or belief, sex and sexual orientation. The Act provides an important legal framework which should improve the experience of all mental health service users, particularly those from black and minority ethnic communities

Paths in this pathway

Pathway created: March 2012 Last updated: September 2019

© NICE 2019. All rights reserved. Subject to Notice of rights.

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