Mental health support remains challenging to navigate despite increased awareness and resources available today. Unfortunately, many people still struggle to find appropriate help when facing emotional or psychological difficulties. The complex network of services, referral pathways, and treatment options often creates confusion during times when clarity is most needed.
This comprehensive guide cuts through the complexity of the mental health system as it stands in 2025. We examine the different levels of care available locally, how to access these services effectively, and what to expect throughout your journey. Furthermore, we outline your rights as a patient and the choices available to ensure you receive appropriate support.
Whether you’re seeking help for yourself or assisting a loved one, understanding how mental health services work locally gives you the best chance of receiving timely, effective care. This guide provides the practical information needed to navigate the system confidently.
Understanding the Mental Health System in 2025
The NHS mental health system operates on a structured three-tier framework that determines how patients access different levels of support. Understanding this structure helps you navigate the system effectively and get the right care for your specific needs.
Primary, secondary, and tertiary care explained
The mental health system starts with primary care, which serves as the entry point for most patients seeking help. This level handles mild to moderate mental health concerns through several key services:
- Your GP, who can provide initial assessment and treatment
- Local link workers accessible through your GP
- Talking therapy services through your local Improving Access to Psychological Therapies (IAPT) program [1]
When your needs exceed what primary care can offer, you move to secondary care. This level encompasses both community and hospital-based services for more complex conditions. Secondary care includes community mental health teams (MHTs) staffed by specialists such as psychiatrists and psychologists. Additionally, it covers inpatient treatment for those who require hospital stays, either voluntarily or under the Mental Health Act [1].
At the highest level, tertiary care provides highly specialized treatment for complex or rare mental health conditions. Examples include:
- Assertive outreach teams for intensive community support
- Specialist national services like those at the Maudsley Hospital in London
- Secure units for patients who present risks that general mental health services cannot safely manage [1] [2]
The allocation of resources across these tiers reveals significant disparities. While high-income countries spend up to £51.62 per person on mental health services, low-income countries spend as little as £0.03 per person [3]. In England, mental health funding comprises just 2% of total health budgets—a figure that has remained unchanged since 2017 [3].
What is integrated care and how it affects you
Integrated care represents a fundamental shift in how mental health services work together. Essentially, it aims to remove traditional divisions between:
- Hospitals and GPs
- Physical and mental health services
- NHS and local authority services [1]
These historical divisions have often resulted in fragmented care experiences for patients. Consequently, many people receive disjointed support that fails to address their complete needs.
The introduction of Integrated Care Systems (ICSs) marks a significant advancement in this area. These systems create partnerships between the NHS, local authorities, voluntary organizations, and social enterprises [1]. By 2025, these collaborations have grown substantially, with most areas making progress toward community-based models of care [3].
For you as a patient, integrated care offers several tangible benefits:
- More coordinated support – Your physical health, mental health, and social needs are considered together rather than separately
- Smoother transitions between different services
- Person-centered approach that puts your specific needs at the center of care planning
Despite progress in integrated approaches, challenges remain. Nearly half of mental health hospital admissions still occur involuntarily, and over 20% of admissions last longer than a year [3]. Furthermore, fewer than 10% of countries have fully transitioned to community-based care models [3].
As the NHS implements its 2025/26 priorities, there’s increasing emphasis on reducing unnecessary hospital stays and improving access to crisis alternatives [4]. These changes aim to create a more responsive system that better meets patients’ needs across all levels of care.
Types of Mental Health Support Available Locally
Local mental health services are delivered through specialized teams that offer targeted support for different needs and situations. Each team has distinct functions yet works collaboratively to provide comprehensive care.
Community mental health teams (CMHTs)
Community mental health teams form the backbone of local mental health support, working with people who have complex or serious mental health problems. These multidisciplinary teams typically include psychiatrists, community psychiatric nurses, social workers, psychologists, and support workers who collaborate to provide holistic care [5]. CMHTs offer both short and long-term treatment, with appointments taking place in clinics, health centers, or through home visits depending on your local NHS Trust’s arrangements [5].
Moreover, CMHTs serve adults aged 18-65, with specialized teams available for younger people (Child and Adolescent Mental Health Services) and older adults [5]. The NHS Long Term Plan has allocated an additional £1 billion in funding per year by 2023/24 to transform community mental health care, aiming to help at least 370,000 adults annually [6].
Crisis teams and emergency support
Crisis teams (sometimes called crisis resolution and home treatment teams) provide urgent mental health support outside of hospital settings. They intervene when you’re experiencing severe difficulties such as psychosis, serious self-harm, or suicidal thoughts [7].
The team usually includes psychiatrists, mental health nurses, social workers, and support staff who can:
- Visit you at home or elsewhere in the community
- Assess your needs and provide support to help you stay at home
- Administer medication and offer practical assistance with issues like housing [7]
Importantly, if you need immediate help, you should call 111 and select the mental health option, or in life-threatening situations, call 999 or go to A&E [8]. Your crisis team contact information should be included in your care plan if you’re currently under the care of mental health services [7].
Early intervention services
Early intervention in psychosis teams (EIT) work specifically with people experiencing their first episode of psychosis. The evidence shows that reducing the duration of untreated psychosis significantly improves outcomes for symptoms, overall functioning, and quality of life [9].
These multidisciplinary teams include nursing staff, social workers, occupational therapists, and psychology professionals who provide various supports, including care coordination and psychological interventions [9]. As of 2018-19, 83% of referrals in the South of England were seen within two weeks [10], with the NHS aiming for at least 56% of people aged 14-65 experiencing first-episode psychosis to start treatment within two weeks [10].
Assertive outreach and complex care teams
Assertive outreach teams (sometimes called complex care teams) provide intensive support for adults with severe mental illness who have complex needs. They typically work with people who have difficulty engaging with traditional services, multiple hospitalizations, or complex issues like violent behavior or serious self-harm [4].
These teams use a “no wrong door” approach to identify people who might not present via standard routes [11]. They provide holistic, trauma-informed care with smaller caseloads to allow more frequent contact—up to seven days per week if needed [12]. The model maintains continuity of care during poor engagement or inpatient admissions [11].
Support for dual diagnosis
Dual diagnosis refers to having both a mental health disorder and a substance use disorder simultaneously [1]. This combination can create a challenging cycle as untreated mental health issues can worsen substance use problems and vice versa [1].
In 2023, approximately 20.4 million U.S. adults had a dual diagnosis [1]. The most effective treatment approach combines care for both conditions simultaneously through the same healthcare providers [1]. Some areas have specialized dual diagnosis teams working within community mental health services, although in many places, you may need support from both mental health and substance misuse services [4].
How to Access Mental Health Services
Navigating the pathways to mental health support requires understanding various access routes available in your area. Different services have unique referral processes, and knowing these options ensures you receive timely care.
GP referrals and when they are needed
Your GP often serves as the primary gateway to mental health services. GP referrals are necessary for accessing specialist mental health clinics, community mental health teams, and many hospital-based services. When you consult your GP about mental health concerns, they will listen to your needs, provide initial advice, and refer you to appropriate services. Upon referral, your GP should discuss different types of mental health support available through both NHS and community resources, involving you in decisions about which service best suits your needs.
NICE guidelines recommend mental health services should offer appointments within three weeks of GP referral, with new NHS standards aiming for appointments within four weeks for community-based services [2]. In England, you have the legal right to choose which service provider and clinical team you’re referred to for your first appointment [13].
Self-referral options and eligibility
For many services, you can bypass GP involvement through self-referral. Notably, NHS talking therapies (previously called IAPT) are accessible directly online without a GP referral [14]. You don’t need a diagnosed mental health condition to use this option [15].
Self-referral is also available for:
- Drug and alcohol support services
- Some local community mental health programs
- Certain psychological therapy services
To be eligible for most self-referral services, you typically need to be registered with a GP in the relevant area, regardless of whether you live there [16]. Some services have age requirements, frequently supporting those 16 or 18 and older [17].
Access through schools, employers, and local councils
Schools now offer improved mental health support through Mental Health Support Teams (MHSTs). Presently, over 600 MHSTs operate across England, serving 52% of pupils and learners in over 10,000 education settings [18]. This coverage is expanding, with approximately 700 MHSTs expected by Spring 2026 [18].
Many employers provide free counseling through occupational health services [13]. Similarly, colleges and universities typically offer free counseling to students [14].
Local councils play a crucial role through statutory responsibilities to support people experiencing mental health problems. They commission services including public health initiatives, social care, and substance misuse support [19].
What to do if your referral is rejected
Rejected referrals have increased, with appointment slot issues rising 85% between February 2020 and March 2022 [20]. If your referral is rejected:
- Ask your GP to explain why and discuss alternative options
- Request referral to a different service provider
- Consider self-referral pathways where available
- Remember your rights—you can ask to change hospital if waiting longer than maximum waiting times (18 weeks) [21]
- Seek advocacy support if you believe your rejection was inappropriate
Be aware that some referrals are rejected on minor technicalities without clinical review [20]. If you feel your healthcare rights haven’t been respected, you can make a formal complaint [21].
What to Expect After Referral
After being referred to mental health services, understanding what happens next prepares you for the journey ahead. The post-referral process involves several important steps that determine how your care will proceed.
Your first appointment and mental health assessment
Your first appointment typically includes a comprehensive mental health assessment—a conversation with professionals to determine appropriate support. This is not a test but an opportunity to discuss your needs. Your appointment letter should arrive within three weeks of referral and include details about location, timing, and who you’ll meet [2].
During the assessment, you’ll discuss:
- Mental health symptoms and experiences
- Feelings, thoughts and behaviors
- Physical health and wellbeing
- Housing and financial circumstances
- Social relationships and support systems
- Past experiences and what helps you best [22]
You can bring a friend, relative, or advocate for support. The professional conducting your assessment will explain the process beforehand, including confidentiality boundaries and how your information will be used [23].
Care planning and the Care Program Approach (CPA)
Following assessment, you’ll receive a care plan outlining your treatment. For complex needs, you might be placed under the Care Program Approach (CPA)—a framework ensuring coordinated support [4]. The CPA is designed for those with severe mental illness, risk factors, or complex needs [24].
Your care plan typically covers medication, therapy options, physical health needs, practical support, and crisis planning. You should receive a copy within one week of your planning meeting [25].
Role of care coordinators and support staff
A care coordinator becomes your main contact person—typically a nurse, social worker, or occupational therapist [26]. They’re responsible for:
- Organizing and monitoring your treatment
- Coordinating between different services
- Regularly reviewing your care plan
- Ensuring your needs are met [27]
This professional acts as your central point of contact, particularly valuable if you’re working with multiple services simultaneously [28].
How long you might wait for services
Unfortunately, waiting times remain a significant challenge. Currently, 1.8 million people are on waiting lists for NHS mental health treatment [3]. There are now 12 times more people waiting 18 weeks for mental health treatment than for physical health services [3].
The impact of these waits is substantial—83% of people report their mental health deteriorated while waiting, with one-third of these individuals attempting suicide [3]. Additionally, one in five people had to give up work during their wait for treatment [3].
Though new NHS standards aim to reduce these waiting times, with appointments offered within four weeks for community-based services [2], accessing timely support often requires persistence.
Your Rights and Choices in Mental Health Care
Beyond understanding how to access services, knowing your rights empowers you to advocate for quality care. The mental health system offers specific protections and choices you should be aware of.
Choosing your provider and care team
In most cases, you possess the legal right to choose which mental health service provider you see in England. This right applies to your first appointment, enabling you to select both the service provider and clinical team [13]. Nevertheless, this right doesn’t apply in certain situations—including emergencies, if you’re already receiving care for the condition, or if you’re detained under the Mental Health Act [13].
Confidentiality and information sharing
Your personal health information remains confidential unless you consent to sharing it. Professionals can only share your information without permission in specific circumstances: if there’s serious risk of harm to you or others, risk of serious crime, or you lack mental capacity [29]. Importantly, NHS and social care professionals can share information with colleagues directly involved in your care under “implied consent” [29].
Support for carers, friends, and family
Caring for someone with mental health issues brings unique challenges. As a carer, you can access specific support including counseling [30], respite care [30], and financial assistance such as Carer’s Allowance [30]. Many areas have dedicated carers’ support groups—both online forums and face-to-face meetings [30].
Making complaints and getting advocacy help
Advocates provide independent support to help you navigate the system, understand your rights, and have your voice heard. They can attend appointments with you, help prepare for meetings, and assist with complaints [31]. For NHS complaints, every service must have a complaints procedure [6]. Initially, speak directly with staff involved [5]; alternatively, contact PALS in hospitals for informal resolution [5].
Conclusion
Navigating the mental health system requires knowledge, patience, and persistence. Throughout this guide, we’ve explored the three-tier framework of care, the benefits of integrated approaches, and the specialized teams available to support different needs. Additionally, we’ve outlined various pathways to access these services, what happens after referral, and your rights within the system.
The mental health landscape continues to evolve, albeit with significant challenges still present. Waiting times remain problematic, with many people experiencing deteriorating conditions while awaiting treatment. Nevertheless, understanding your options gives you the best chance of receiving appropriate care when needed.
Remember that self-referral pathways exist for many services, providing alternatives when traditional routes prove difficult. Your rights to choose providers, maintain confidentiality, and access advocacy support further strengthen your position within the system.
Mental health support extends beyond clinical settings. Schools, employers, and local councils now play crucial roles in providing resources. Family members and carers also deserve support—dedicated services exist specifically to help those supporting loved ones through mental health difficulties.
Armed with this knowledge, you can approach the mental health system more confidently. The journey toward better mental health rarely follows a straight line, yet knowing how to navigate the available resources significantly improves your chances of finding effective help. Most importantly, despite system imperfections, support exists—taking that first step toward seeking help remains the most powerful decision you can make.
