This content is written and produced by Leeds and York Partnership NHS Foundation Trust (LYPFT).

Community Mental Health – the need for change

Transforming community mental health services is a priority set out in the
government’s NHS Mental Health Implementation Plan 2019 / 20 – 2023 / 24 and in
the West Yorkshire and Leeds Integrated Care boards’ mental health strategies*.

Key deliverables in the NHS Long Term Plan by 2023 / 2024 are:

Core community model

  • a multi-agency community-based offer, redesigning community mental health teams around primary care networks (PCNs) through establishing integrated community mental health hubs.

Transforming care for specific groups

Improving access and treatment for older adults and adults:

  • with complex emotional needs associated with a diagnosis of personality disorder
  • in need of mental health rehabilitation
  • with eating disorders / disordered eating.

Physical health

  • increasing the number of people with serious mental illness (SMI) receiving a comprehensive physical health check.

Employment support

  • supporting more people to participate in the Individual Placement and Support Programme, which supports people with complex and ongoing mental health needs into paid employment.

Early intervention in psychosis

  • maintaining the 60 per cent Early Intervention in Psychosis access standard and ensuring 95 per cent of services achieve level 2 NICE concordance.

Therefore, we need mental health care and support that responds to all of people’s
needs (psychological, physical and social) so people can live fulfilling lives with
access to the right care and support when and where they need it.

Transformation programme

Delivering effective mental health support, care and treatment to meet a wide range of mental health needs in the community can only be achieved if all parts of the health and social care system, including voluntary, community and social enterprise (VCSE) organisations work together.

Challenges in how services are organised and delivered currently make it difficult for people who need services and staff to access the right care and support in a simple way when they need it.

Transforming Community Mental Health Services means bringing all the services and agencies that support people with varying mental health needs much closer together to ensure that people get the right care, without having to navigate multiple service boundaries and without repeatedly telling their story.

The Leeds model

Leeds is a city rich in services provided by lots of different health, social and
voluntary sector organisations that support people experiencing difficulties with their
mental health.

We aim to bring these services closer together and add new roles, with a new model
of joined-up primary and community mental health that responds to local people’s
needs and removes barriers to access, so that people can access care, treatment
and support as early as possible and live as well as possible in their communities.

We will do this by:

  • providing holistic person-centered care
  • having a more joined-up approach with services working together, removing thresholds and barriers to access
  • involving service users and carers as equal partners in their care
  • building in involvement and co-production at all levels of service design delivery
  • delivering needs-led and personalised trauma-informed care.

The new joined-up model will operate in what we are calling ‘Integrated Community
Mental Health Hubs’, which are close to people’s communities and aligned to local
care partnerships (LCPs)

The Leeds Community Mental Health Transformation Programme is using the
expertise and experience of hundreds of people who have had contact or worked
with mental health services and care to identify what and where the problems are
and how we can fix them.

This programme is using this information to design a model combining the services
and support people need to be able to live fulfilling lives in their communities. Click
on the following link to read about how this work started.

Local care partnerships (LCPs) are made up of a range of people working together, regardless of their employing organisation, to deliver joined-up collaborative care that meets an identified population’s needs. There are 15 individual LCPs in Leeds, each tailored to meet local need and the features of that particular community. Membership includes statutory organisations, third sector (community groups), elected members and local people.

Together, we are building our vision for a model that will provide a range of core services and support as well as those designed to meet individual community needs.  We will start to test this model in our three early implementer LPCs during 2023.


Re-designing community mental health and care services that meet current and future local needs involves massive investment in time and money. The government is funding the nation-wide programme with an additional £2.3 billion a year by 2023 / 2024. Leeds’ investment funding increases over the course of the three-year transformation programme and is expected to be £3.9 million per year from 2024.