Chapter guide and links
1. Introduction and Policy Context
This chapter provides an overview of the adult mental health needs assessment (AMHNA) and national, regional and local context.
Chapter outline
- Definition of public mental health and importance
- Rationale for AMHNA
- Aims and objectives of AMHNA
- Scope
- Methodology
- Data Sources
- National and Regional Policy Context
- Local context in Havering
Full Chapter Link
Download the chapter here: Introduction and Policy
2. Prevalence of Mental Health Conditions in Havering
This chapter provides an estimation of the current and future mental health needs in Havering.
Chapter outline
- Havering population and demographics
- Prevalence of mental health conditions in Havering
- Long-term projections (2030, 2035)
Key Findings
- There are an estimated 36,268 adults in Havering with a Common Mental Health Condition (CMD).
- It is estimated that 2,150 adults in Havering have a Severe Mental Illness (SMI). This is broadly in line with the current registered SMI population.
- It is estimated that one in six adults meet the criteria to have a mental disorder.
- Women are more likely to have a CMD than men.
- The prevalence of most CMDs and SMIs decreases with age.
Recommendations
- Ensure adequate support to meet increasing demand for Talking Therapies and Mental Health and Wellness Teams.
- Public Health to review estimates of prevalence when 2023/24 Adult Psychiatric Morbidity Survey results are available.
Full Chapter Link
Download the chapter here: Prevalence of Mental Health Conditions in Havering
3. Service Provision and Service Demand
This chapter provides an overview of the use of mental health services by Havering residents and identifies groups which who are over- and under-represented in referrals to services.
Chapter outline
- North East London context
- Information and data on current mental health services
- GP practices
- Talking Therapies
- Community Mental Health Services
- Acute and Urgent Care Services
- Inpatient Services
- Personality Disorder Services
- Adult Social Care Services
- Safeguarding
- Digital Services
- Community and Voluntary Sector Organisations
Key findings:
Demand and Capacity
- There is significant rising demand for, and expectations of, mental health services in Havering, especially for more specialist services where there is higher complexity of need.
- Referrals to Talking Therapies, Mental Health and Wellness Teams and Older Adult Mental Health Team have all increased.
- Referrals to the Early Intervention in Psychosis and IMPART personality disorder services have been stable.
- Mental Health and Wellness Teams have increasing caseloads.
- There is rising demand in the acute and crisis pathway – with increased referrals for Psychiatric Liaison and Home Treatment Teams.
- The number of Havering residents admitted to acute mental health wards increased by 15% between 2019/20 and 2023/24.
- There is large expenditure on out-of-area placements due to lack of inpatient capacity at North East London Foundation Trust (NELFT) and East London Foundation Trust (ELFT), particularly for female admissions.
- The number of people with mental health problems receiving support from Adult Social Care has been relatively stable.
Demographics and Inequities
- Rates of referral are consistently highest for people aged 18-25 to all NELFT services (except older adult services).
- Services consistently receive a greater number of referrals for females than males, except Early Intervention in Psychosis (EIP).
- Male patients (ages 18-64) are admitted at higher rates to acute mental health wards than female patients, whereas females have a higher rate of admission to the over 65 wards.
- Overall numbers are low which limits analysis, but there has been a rise in rates of referral for people from racially minoritised groups to some services.
- Rates of referral to mental health services are generally lower for people from Asian ethnic groups than other ethnic groups.
- Low numbers of Havering residents are admitted to psychiatric intensive care units but Black males and non-White women are over-represented in admissions.
Physical Health
- Havering consistently has the lowest performance across North East London for completion of physical health checks for people with Severe Mental Illness (SMI).
Recommendations
Service Provision
- System to continue efforts improving acute patient flow to relieve pressure on acute pathway.
- Talking Therapies and Havering Primary Care Networks (PCNs) or integrated neighbourhood teams to explore embedding Psychological Wellbeing Practitioners across Havering Primary Care.
- Talking Therapies to continue expanding group therapy, providing individuals with immediate access to peer and professional support, reducing reliance on one-to-one services.
Workforce and Digital
- Strengthen and improve data capture and recording for mental health related hospital attendances and admission.
Inequalities and Vulnerable Groups
- Improve equitable access, experience and outcomes in mental health care for all ethnic groups in Havering, working with NELFT’s Patient and Carer Race Quality Framework (PCREF) team. System to engage with results of findings.
- Work to improve the uptake of Talking Therapies by men.
Physical Health for Individuals with Severe Mental Illness
- North East London Integrated Care Board (NEL ICB) and commissioners to conduct outreach to low-performing practices (those below 40% as highest priority) to understand if low performance is due to data, capacity, engagement, or other challenges.
- Consider learning from the practices of neighbouring boroughs (e.g., offering to complete incomplete health checks, setting up two-week clinics to increase uptake) and adapting to Havering’s circumstances by commissioners, PCNs and the GPs.
- PCNs to explore uptake and delivery of related interventions, including specialist smoking cessation service.
Full Chapter Link
Download the chapter here: Service Provision and Service Demand
4. Service User and Stakeholder Insights
This chapter draws on findings from stakeholder insights from engagement through AMHNA Working Group meetings, focus groups with service users and staff, and friends and family feedback data.
Chapter outline
- Summary of AMHNA Stakeholder Findings
- Key findings from focus groups with:
- Community mental health service users
- Community mental health staff
- Talking Therapies focus groups (Black males and carers)
- Talking Therapies Friends and Family Data and Patient Feedback
Key Findings
- Mental health needs in Havering are increasing in both volume and complexity; staff report feeling underprepared to manage complex cases amid growing caseloads and limited specialist resources.
- Many residents face intersecting challenges such as mental illness, substance misuse, homelessness and financial hardship. A lack of multidisciplinary working means that residents with multiple challenges can face barriers accessing appropriate support.
- Individuals whose needs exceed primary care capacity but don’t meet secondary care thresholds are sometimes left unsupported, contributing to poor outcomes and clinician burnout within primary care.
- There is low public awareness of alternatives to A&E during a mental health crisis. Community-based crisis services (e.g. crisis cafés) and preventative interventions are urgently needed.
- High caseloads, low staff retention and competition from the private sector continue to strain the workforce. Recruitment of mental health specialists remains particularly challenging in outer boroughs like Havering.
- Individuals with Attention Deficit Hyperactivity Disorder (ADHD) or autism spectrum disorder (ASD) face long waits, missed appointments, and a lack of sensory or communication accommodations, limiting equitable access to care.
- Mental health and housing are often treated in silos, missing opportunities for holistic support. Stronger pathways and joint working between these sectors are needed.
- Long waiting times, rising eligibility thresholds, stigma, and limited awareness of services (especially among high-risk groups) lead to disengagement of residents to mental health support.
- Service users report feeling dismissed or misunderstood by professionals. However, peer support workers are seen as a positive force, fostering trust and connection.
- Service users feel that peer support and group activities are vital for wellbeing.
- Inpatient care can be associated with fear, poor support and rushed discharges, deterring individuals from seeking help in future crises.
- Stakeholders support a shift toward integrated, person-centred services with shared care pathways, early intervention and meaningful involvement of service users in service design.
- Substance misuse continues to be a barrier to care, with patients often excluded or referred multiple times without their mental health needs being addressed holistically.
Recommendations
Increasing demand and rising complexity
- Conduct an ADHD needs assessment or a service review to determine the capacity and service model needed to resource services.
- NELFT and NEL ICB to review local policies and practices in relation to providing intensive and assertive community care to better help those in crisis.
- The London Borough of Havering and NELFT to provide staff training in trauma-informed care and culturally competent care for relevant front-line services.
Service Provision
- NELFT to investigate piloting a Complex Case Pathway to bridge the gap between primary and secondary care.
- NELFT to monitor and take appropriate actions to improve patient-reported outcome measures (PROMs).
- Services to adopt patient-centred discharge approach to prevent premature and/or unsafe discharge and prolonged length of stay.
Service Coordination and Integration
- Primary Care and NELFT to identify and address gaps in care pathway and communication (e.g., Mental Health and Wellness teams and Talking Therapies teams to send confirmation to GPs when referrals are accepted).
- NELFT and the London Borough of Havering teams to explore opportunities to strengthen cross-sector multidisciplinary teams (MDT) for mental health-related issues in Havering to avoid duplication and improve collaboration (e.g., neighbourhood MDT model).
- NELFT and voluntary sector organisations to promote awareness and information sharing among staff and service users, such as via the Havering Live Well Network and Carers Forum.
- The London Borough of Havering Communities Team to promote Live Well Network and Service Directory across the system.
- NELFT to investigate protected social workers in Mental Health and Wellness Teams to alleviate pressure for Mental Health and Wellness teams clinicians.
Service Accessibility and Waiting Times
- Implement a Waiting Well initiative (e.g., a clear user-friendly guide for parents/carers/clients outlining the stages from referral-to-assessment process. Automated text message updates to confirm referral status and reduce unnecessary follow-up calls. A resource list provided at initial assessment, ensuring individuals are aware of services available while they wait, including support for carers.)
- Services to investigate implementing patient-initiated follow-up model in relevant services following discharge.
Awareness of Mental Health Services
- Create digital and offline materials to raise residents’ and providers’ awareness of preventative and community-based mental health support services and promote across the system.
- Maintain or improve outreach in community locations (e.g., hub spaces, substance misuse provider site, temporary accommodation).
- Ensure availability of inclusive and accessible mental health information in different languages and easy-to-read formats.
Workforce and Digital
- Prioritise staff wellbeing, workplace development plans and manageable caseloads to reduce burnout and improve retention of mental health professionals.
- Strengthen efforts to recruit from diverse backgrounds, ensuring the workforce understands the cultural nuances of the communities it serves and is equipped to meet a wide range of needs.
Inequalities and Vulnerable Groups
- Talking Therapies and the London Borough of Havering Supported Housing to work to develop an offer for psychological support for housing-vulnerable residents, including care leavers.
Co-occurring Needs
- Change Grow Live (CGL) and NELFT to continue collaboration for co-occurring mental health and substance misuse issues, including funding a joint worker post and strengthening training and collaboration with voluntary sector providers, GPs and other services.
- CGL and Primary and Secondary Mental Health (Talking Therapies and Mental Health and Wellness Teams) to cross-train staff in substance misuse management and mental health, respectively.
- The London Borough of Havering Safeguarding to promote training to frontline staff from across the system, including training on destigmatising substance misuse.
- NELFT, Housing, commissioners and voluntary sector organisations to work together to improve coordination for complex needs accommodation cases, including continuing joint meetings for case discussions.
- Supported Housing to investigate how housing provision for individuals with SMI can be expanded.
Full Chapter Link
Download the chapter here: Service User and Stakeholder Insights
5. Mental Health Support across Frontline Workforce
Frontline council staff are a vital access point for residents seeking mental health support. This chapter explores the role of frontline Havering Council staff and external partner organisations in supporting mental health among residents. It presents insights from a targeted survey of council staff and outlines the current landscape of frontline mental health support across Havering.
Chapter outline
- The role of frontline staff
- Survey of Havering Council frontline staff and findings
- Frontline staff from external organisations
Key Findings
- Frontline staff are a key gateway to mental health support, often engaging residents in distress despite mental health not being their primary role.
- Mental-health related staff sickness is rising, costing Havering Council £5 million in the latest year—up from £2.9 million—with 27% citing mental health issues.
- Survey findings include:
- Most staff (70%) support having a mental health role, but over half feel unprepared or lack confidence to do so effectively.
- Only 46% understand referral procedures, with many facing challenges like unclear thresholds, poor communication, and delays from mental health services.
- Training needs are significant: Only 15% feel very confident in identifying mental health issues, and interest in Mental Health First Aid training is low (22%).
- Staff want clearer referral tools and better communication with mental health services to improve coordination and outcomes.
- Multiple council services (e.g. Housing, Adult Social Care, Libraries) are informally involved in mental health support, highlighting a wide but fragmented system.
- External agencies (e.g. Police, Ambulance, London Fire Brigade, Department for Work and Pensions, CGL) regularly deal with mental health-related incidents but have varied and often limited training.
- Overall, there is a strong need for system-wide training, better referral pathways, and inter-agency collaboration to strengthen mental health support in Havering.
Recommendations
- Upskill existing staff, training in person-centred approaches and mental health first aid to give better patient experience and improve retention.
Full Chapter Link
Download the chapter here: Mental Health Support across Frontline Workforce
6. Moving from Child and Adolescent to Adult Mental Health Services
This section focuses on the cohort of young people who progress from Child and Adolescent Mental Health Services (CAMHS) to Adult Mental Health Services and is not intended as an overview of young adult mental health. While this is a narrow slice of the broader mental health landscape, it is a crucial gap raised by the Havering Community Mental Health Board as impacting long-term outcomes for young adults in Havering with complex mental health needs.
Chapter outline
- Rising Mental Health Challenges in Young People
- The Gap when moving out of CAMHS
- Havering 18-25 Pathway
- Focus group findings with those supported by the Pathway
- Key Findings
Key Findings
- National and local data suggest increased prevalence of mental ill health in young people, leading to increased demand for mental health services.
- The majority of CAMHS leavers are discharged to their GP or referred to other community services, while a small proportion of CAMHS users move into adult mental health services or the 18-25 Pathway.
- Young people reported feeling they only can receive help after reaching extreme distress, such as self-harm or suicide attempts.
- Young people report internal and external stigma about mental health issues – including from school and NHS staff.
- Poor communication as young people move out of CAMHS leads to confusion and frustration, including while people are on waiting lists
- Lack of interim support while waiting for assessment and treatment for some services.
- Relationships with mental health staff were mixed, but young people were positive about the impact of the 18-25 Pathway.
Recommendations
- Analyse referrals and admissions among this cohort, segmented by diagnosis and demographics including ethnicity, sex and deprivation; and work with Community Mental Health Board to manage the demand.
- Commissioners to support continuation of 18-25 Pathway, also considering lowering entry age criteria to 16 and reviewing eligibility criteria to be fit for purpose.
- NELFT to evaluate 18-25 Pathway’s access, outcomes and demographics, including by deprivation.
- 18-25 Pathway to explore options for increased group workshops and peer support groups.
- Allocate STR (Support, Time, Recovery) resources to improve engagement with young adults, especially those with complex needs.
- NELFT to ensure that young people are fully involved and informed in discharge and transition planning (as per NICE guidelines).
- Ensure staff are trained on LGBTQIA+-related mental health, with a focus on young people.