Community Care Process Model

The Community Care Process Model is an outline of the standards of best practice patients can expect to receive at each stage of their journey whilst under the care of a community mental health team. It reflects the NHS long-term plan to develop “new and integrated models of primary and community mental health care which will support adults and older adults with severe mental illnesses.” It supports the community transformation work being carried out across the Trust.

The model was developed so a patient’s experience and recovery journey is structured, purposeful, collaborative, safe and compassionate, considering complex needs and harm minimisation. It helps people who access our services navigate the system by being transparent about our processes.

We know there is variation in the quality of care and outcomes for people who use our services including length of stay and waiting times in the community. We want the people who access our services to experience the same standards of care, no matter which borough they live in or which service they are under.

What has been done so far?

Work began on the Community Care Process Model in 2019 with several engagement events with staff, service users and carers. Building on the Royal College of Psychiatrists’ Community Standards and existing Trust operational policies, attendees of the engagement events co-produced an outline of the care that should be offered to patients from referral through to discharge for a community team. Further sessions were run with service users to develop prompts for staff to support patient-centred conversations at each stage of the process. In light of adult community transformation framework, further iterations have recently been made to the Community Care Process Model. In addition, diagnosis specific clinical care pathways are being developed providing guidance on best-evidenced screening, assessment, and interventions.   

What do the models look like? 

Short Term Support - Community Care Process Model.[pdf]     Long Term Support - Community Care Process Model.[pdf]