Commitment And Growth: Advancing Mental Health Nursing Now And For The .
Health Education EnglandCommitment and Growth:advancing mental health nursing now and for the futureBaroness Watkins of Tavistock Review of Mental Health Nursing in Englandwww.hee.nhs.ukWe work with partners to plan, recruit, educate and train the health workforce.
Commitment and Growth:advancing mental health nursing now and for the futureThe workforce review subgroup on mental health nursing in England established three interconnected task and finishGroups (T&F): mental health nursing and serious mental illness; children and young people’s (CYP) mental health; andimproving population and public health outcomes. All three T&F reviewed their specific topic areas identifying key issuesfaced by the profession of mental health nursing, while making system-wide recommendations to overcome them.Theme 1: Establish, reclaim and belong- the purpose of contemporary mentalhealth nursing Recommendation 1: Mental health nursingshould be evidence based and recognised thatevidence based interventions change in the light ofnew findings. Therefore, CPD is essential to ensurethe workforce can learn and develop their practiceto provide contemporary care and therapeuticinterpersonal skills for the populations they serve. Recommendation 2: Mental health nurses mustenhance the therapeutic relationship, valuingexperimental knowledge, while acknowledgingand overcoming the power differential betweenstaff and service users. Recommendation 3: Mental health nurses mustplace a renewed focus on identifying and promotingthe core skills of mental health nurses, across thelifespan, within all practice settings and in directresponse to the needs of our local populations.Theme 2: unite, engage and overcome addressing inequalities through diversityand inclusion Recommendation 4: Mental health nurses mustprioritise their focus on addressing health inequalitiesfor the population that they serve, improving access toservices for people from all backgrounds by developingculturally competent practice. Recommendation 5: All mental health nursing rolesmust be representative of local populations, while valuingthe strength of ethnic diversity at all career levels.Theme 3: Implement, evaluate and discover mental health nurses as leaders in research Recommendation 6: Mental health nurses asclinical academics and implementation scientistsmust be developed in every NHS mental health careprovider organisation in England, underpinned bynationally standardised capabilities and a careersdevelopment framework.www.hee.nhs.ukTheme 4: Nurture, growand develop - advancingmental health nursingfor the future Recommendation 7: A renewedfocus must be placed to ensuremental health nurses aresupported and developed whentransitioning from student tonewly registered nurse. Recommendation 8: Mentalhealth nursing must becomemore of an attractive andaccessible profession, with clearcareer development pathwaysand opportunities at all levels.Commitment and Growth: advancing mental health nursing now and for the future2
It has been a privilege to chair this review, working with service users and senior mental health nurses to examine relevantliterature and data to inform recommendations for the future development of the profession.Health Education England is to transition into a new organisation alongsideNHS England and NHS Improvement. This should enable a thorough approachto identify the investment needed to ensure that mental health nursing thrivesand is sufficiently robust to provide high quality care to the populations itserves. This report is designed to inform that process with recommendationsclearly set out for consideration.Culturally competent, evidence based practice will benefit the users of mentalhealth services and mental health nurses should remain a key componentof multidisciplinary teams providing care, support and treatment. The reportconcluded that co-production with service users is a hallmark of contemporarypractice and should be promoted to provide optimal mental health services.I thank everyone who has given their time and expertise to the productionof this report and trust that it will inform NHS England and Improvement,Health Education England and integrated health care systems in planning andinvesting in mental health nursing. It is vital that there are sufficient numbers ofwell-educated mental health nurses to meet the needs of the populations weserve today and in the future.The government has introduced living allowances for those studying tobecome mental health nurses, which have been widely welcomed and haveundoubtedly contributed to the increase in UCAS acceptances (Table 2).However, more needs to be done to retain staff and reduce mental healthnurse vacancies. This will require investment in continuing professionaleducation and career development opportunities (Recommendation 6).Investment in retention of qualified mental health nurses is imperative.Employers may, for example, consider contributing to paying student universityfee loans after a period of service of between 3 and 5 years.Mary WatkinsBaroness Watkins of TavistockFurther opportunities for entry into mental health nursing should be developed,including apprenticeship routes which have been shown to encourage a widerdiversity of applicants, as well as traditional undergraduate programmes. It isvital that the strength of diversity in the workforce is encouraged, particularlyat senior levels.www.hee.nhs.ukCommitment and Growth: advancing mental health nursing now and for the future3
Mental health nursing is a phenomenal career that has theexpertise, knowledge and skills to make transformationalimpacts on the mental health of our citizens and communities.For decades, mental health nursing has been a critical part of our nationalhealth and social care system, improving access and outcomes for mentalhealth services across the country. It also recognises the work that mentalhealth professionals have delivered in service change innovation and researchto make further improvements in the lives of many.I would like to thank Baroness Watkins for her leadership and focus in supportof this review into mental health nursing.It brought together a wide range of service users and staff in a thoroughreview of the nature of mental health nursing and areas for improvement anddevelopment that can be taken forward by the profession and other partners.I want to thank all those who have given their time in the development of thisand step change that this makes in relation to mental health nursing in England.Mark RadfordHEE Chief Nurse Officerwww.hee.nhs.ukCommitment and Growth: advancing mental health nursing now and for the future4
IntroductionEngland has long been viewed as an exemplar ofbest practice when it comes to mental health care,particularly in relation to pre-registration nursingeducation in mental health.To advance the development of mental health nursing, theworkforce review subgroup on mental health nursing in Englandhas recently established three interconnected task and finishgroups (T&F groups): mental health nursing and serious mentalillness; children and young people’s (CYP) mental health; andimproving population and public health outcomes. All three T&FGroups reviewed their specific topic areas, identifying key issuesfaced by the profession of mental health nursing, while makingsystem-wide recommendations to overcome them. This reportbrings together these recommendations and describes the stepsrequired to put them into practice.The views and experiences of service users and their families inrelation to the value and importance they attribute to mentalhealth nurses have been central components in the planningand development of this report. Service users and their familieshave highlighted that mental health nurses possess empathy,communication skills and the ability to build strong therapeuticrelationships. Two of many statements received from service usersabout mental health nurses and nursing was:She treats me as a person, who hasfeelings, and a poorly brain and needssupport building a life I can be proud of.But she also sees my illness, the cause of that illness,and the care she provides encompasses all of thesethings. I’m treated and related to as a whole.”The mental health nurses were reallyfriendly and easy to talk to. Due to COVID,I couldn’t see my family, so my relationshipwith them was vital so I didn’t feel lonely. My leadmental health nurse was really good at representingme in Ward Round, which made it less intimidating.”The report begins with an overview of the main problems currently affecting the mentalhealth nursing profession. It then introduces the T&F groups and the main steps used toguide the internal reviews of the main issues in each area. The recommendations developedby each T&F group are discussed in relation to four themes and each theme includes a ‘howand where’ section, where the recommendations are operationalised in the form of actionpoints to guide future policy and practice.www.hee.nhs.ukCommitment and Growth: advancing mental health nursing now and for the future5
The problemThe vacancy rates of mental health nurses are at high levels, with increasingnumbers of nurses leaving the workforce. If changes are not madeimmediately, there is a high risk that this profession will be lost. Vacancy ratesfor nurses in mental health trusts vary between 12% in the North East andYorkshire, and 20% in East of England. Mental health trusts account for 28%,or just over 11,300, of all vacancies in nursing. Leaver rates are also increasing– having dropped to below 6% during the initial stages of the pandemic,leaver rates are now at 6.9% - levels last seen in 2017-18. This means thatthere is a risk that vacant nursing posts will not be filled by nurses but insteadby non-nursing new roles.This report refers to nurses recorded as working in the branch of mental healthnursing, as defined by nurses with either N*D or N*E occupation codes. Thisis a narrower definition than nurses working in the mental health and learningdisabilities workforce which includes nursing in branches other than mentalhealth nursing.The healthcare workforce has reduced significantly in the last decade, withlevels similar to the start of the 2010’s, as shown in the table below. Therefore,the recruitment and retention of mental health nurses must remain a prioritythroughout the implementation of the NHS Long Term Plan1 and beyond.Chart 2: Leaver Rates in Mental Health Nursing,January 2020 to December 2021Chart 1: Mental Health Workforce FTE, September 2009 to December 2021Leaver Rate, Mental Health Nursing, January 2020 to December 2021Mental Health Nursing, FTE, September 2009 to December %5.0%4.0%358223.0%2.0%Source: NHS Digital Workforce Statistics, 0%Mar-1033000320008.0%Source: HEE analysis of Electronic Staff Record datawww.hee.nhs.ukCommitment and Growth: advancing mental health nursing now and for the future6
Table 1: Nursing vacancies in Mental Health trusts and all trusts, December 2021RegionNorth East and YorkshireNorth WestMidlandsEast of EnglandLondonSouth EastSouth WestNationalNumber of nursingNumber of nursingvacancies, Mentalvacancies, all trusts,Health trusts,December 2021December ,5641,8855,8978652,65911,34139,652% Vacancy Rate,% Vacancy Rate, AllMENTAL HEALTHTrusts, Decembertrusts, 0.3%18.2%13.0%21.7%11.3%16.0%7.9%16.8%10.3%Source: NHS Vacancy Statistics April 2015-December 2021 Experimental sMore positively, there has been an increase across all regions of England in the number of people commencing their pre-registrationmental health nurse education, with numbers two thirds higher in the 2020 UCAS cycle compared to 2015. This increase creates astrong position for the future, provided numbers remain at current levels.www.hee.nhs.ukCommitment and Growth: advancing mental health nursing now and for the future7
Table 2: UCAS acceptances for Mental Health Nursing courses in England, 2011 to 2020North East and YorkshireNorth WestMidlandsEast of EnglandLondonSouth EastSouth Source: HEE analysis of UCAS dataHowever, not all students will complete their course and become registered mental health nurses. Historically, attrition rates fornurses on mental health courses have been at about 14%.Most recent cohorts to have mostly completed their course (2018-19 Undergraduates, 2019-20 Postgraduates), discontinuationrates2 were at 12% and 11% respectively – suggesting a possible drop in attrition.www.hee.nhs.ukCommitment and Growth: advancing mental health nursing now and for the future8
Table 3: Student numbers and progress, mental health nursingUndergraduate tgraduate 89Net 5013957747234546Starters669608988584Net Transfers4-67421Discontinued7859400Interrupts Active Students18811621029025251929296644803960Interrupts Active Students275157305499739596Source: HEE October 2021 Student Data CollectionIn September 2021, there were 72,045 NMC registrants in the field of mental health. Assuming a headcount of 43,240 in the NHSin September 2021, this means that about 3 in every 5 mental health nursing registrants are employed within the NHS, with theremainder in other locations or not employed3.www.hee.nhs.ukCommitment and Growth: advancing mental health nursing now and for the future9
Task and Finish GroupsThe workforce review subgroup on mental health nursing in Englandestablished three interconnected Task and Finish Groups (T&F). T&F Groupsconsisted of mental health nurses, clinical and policy experts, as well as peoplewho have lived experience of mental illness and use of services (as patients,families and carers). Placing a specific focus on core areas of contemporarypractice. The three areas were: mental health nursing and serious mentalillness; children and young people’s (CYP) mental health; and improvingpopulation and public health outcomes.The final 8 recommendations of each T&F were groupedinto 4 themes across all core areas of contemporarymental health nursing practice.1. Establish, reclaim and belong- the purpose ofcontemporary mental health nursing2. Unite, engage and overcome - addressinginequalities through diversity and inclusionCo-production4 was the applied approach to planning, assimilating andproducing all T&F recommendations. This was achieved through a variety ofmethods, workshops were held with over 100 mental health nurses, onlinequestionnaires and focus groups were held with over 200 mental health nursesand people with lived experience. Work was undertaken with the common roomto also gain feedback from children and young people with lived experience.3. Implement, evaluate and discover - mental healthnurses as leaders in research4. Nurture, grow and develop - advancing mentalhealth nursing for the future.All three T&F Groups reviewed their specific topic areas, identifying key issuesfaced by the profession of mental health nursing, while making systemwide recommendations to overcome them. Recommendations, informed byempirical evidence through a scoping literature review, and developed viawider stakeholder engagement.www.hee.nhs.ukCommitment and Growth: advancing mental health nursing now and for the future10
RecommendationsTheme 1: Establish, reclaim and belong - the purpose of contemporary mental health nursingRecommendation 1Mental health nursing should be evidence based. Mental healthnurses recognise that evidence based interventions change in thelight of new research findings. Therefore, continuing professionaldevelopment (CPD) is essential to ensure that the workforce canlearn and develop their practice to provide contemporary care andtherapeutic interpersonal skills for the populations they serve.CPD is essential for the mental health workforce to develop and grow as aprofession. However, it can often be challenging for mental health nursesto get time away from the workplace to access such learning. When weundertook the listening sessions with mental health nurses for this review,we heard from a number of colleagues that they struggle to find coursesthat are mental health nurse focussed and specific to their needs.Mental health nurses should have both the time to carry out CPD andeasy access to high quality evidence based training relevant to theirdevelopment needs and clinical skills, wherever they are based5.The CPD utilised should follow these 5 core principles:1. be each person’s responsibility and be made possible and supportedby their employer2. benefit the service users3. improve the quality of service delivery4. be balanced and relevant to each person’s area of practice or employment5. be recorded and show the effect on each person’s area of practice6.www.hee.nhs.ukCommitment and Growth: advancing mental health nursing now and for the future11
Recommendation 2Recommendation 3Mental health nurses must enhance the therapeutic relationship,valuing experiential knowledge, while acknowledging andovercoming the power differentials between staff and service users.Mental health nurses must place a renewed focus on identifyingand promoting the core skills of mental health nurses, across thelifespan, within all practice settings and in direct response to theneeds of our local populations.The 2006 review of mental health nursing called for a professionunderpinned by the values of person-centred care, collaboration andpersonal recovery7. By the same core values, contemporary policy andpractice has moved towards the concept of co-production8. Althoughwe found several examples of interventions, there is a general paucity ofempirical evidence evaluating co-production in mental health nursing.The issue of a coherent and standardised identity has been a topic ofdebate in mental health nursing since the days of ‘asylum attendants’19.Professional diversity and flexibility have allowed the nursing role to adaptand grow in direct response to constant socio-political changes. Today,mental health nurses practice in a multitude of settings, across a varietyof populations and at all stages of the lifespan.The literature highlights different approaches to co-production, includingparticipatory action research9,10; Expert by Experience involvement innursing education 11; and a world café (a process designed to facilitatedynamic structured conversations) as a learning experience for differentstudent groups12.As a diverse profession, it can be easy to lose the unique contributionsmental health nurses make to the healthcare system and the people whoare served; patients, service users and carers. Throughout this review ofmental health nursing, stakeholders, both nurses and non-nurses, havereported that they are witnessing the erosion of the ‘nurse’, merging intoa more generic and underdefined ‘mental health practitioner’ or ‘care coordinator’ role.Interacting with experts can assist in challenging stigmatising attitudesand can support the development of “social literacy” or “culturalcompetence”13,14. The most common barriers to co-production are cited asa lack of respect and regard for the value of experiential knowledge15; andpower differentials among participants16,17,18.Nursing is regularly voted as the most trusted profession20. Therefore, effortsshould be made to protect the title of ‘nurse’. As outlined by the NMC:“It is essential that we have the right protected titles and associatedenforcement powers to be able to take effective action to protect thepublic and maintain confidence in the professions.21 We would welcomea further discussion with DHSC to ensure that our protected titles andenforcement powers are fit for purpose under the new legislation”The benefits of co-production are multiple: greater integrity in terms ofthe end product, as it has been derived from the ideas and experiences ofthe group16,17; participants feel heard and valued16; and patient experiencenarratives may help to better plan and allocate health and social care resourcesaccording to their needs16.www.hee.nhs.ukCommitment and Growth: advancing mental health nursing now and for the future12
How and where - establish, reclaim and belongClinicalpracticeDevelop culturalcompetence, fosteringthe therapeuticrelationship and coproduction throughcare planning, must bethe central tenets of allmental health nursingpractices and policies.Co-production mustbe clearly incorporatedwithin mental healthnursing capabilitiesframeworks; at all careerlevels (pre and post-reg)and across all strategicand operational rolesand policies.Nursing strategy andgovernance processesmust enable andpromote culturalcompetence, therapeuticrelationships and coproduction through careplanning.Mental health nursesmust place a greater focuson prevention, holisticand person-centred care,always considering theinterplay between physicalhealth, mental healthand social wellbeing. Aswe know that peopleliving with a mentalhealth condition oftenhave significantly poorerhealth outcomes andlife chances comparedto those of other certaingroups in society.Research andevaluationAll research that hasan impact on serviceusers and/or carers,must be co-produced atthe point of planning,implementing andpublishing. Thisshould be reflected inrelevant strategies andorganisational policies.The development andevaluation of tools andmodels that measureand/or assess thetherapeutic relationship,co-production and careplanning, must be aresearch priority formental health nursing.Funding must be madeavailable to supportthe development andundertaking of nurseled research that isundertaken through coproduction.Policies and proceduresmust be in place toensure research isundertaken jointlywith service users and/or carers, particularlywhen the anticipatedoutcomes are to impacton care delivery andservice design.www.hee.nhs.ukThe title ‘nurse’ mustbe maintained in allclinical positions wheremental health nursespractice. Services mustavoid creating genericpractitioner roles thatfail to clearly distinguishbetween regulated andnon-regulated workers,or indirectly undervaluethe unique contributionsof mental health nurses.Commitment and Growth: advancing mental health nursing now and for the future13
Educationand trainingTraining and educationon therapeuticrelationships and coproduction throughcare planning should beincorporated into theformative function ofclinical supervision.Awareness onrecognising andunderstanding personaland professional biases,as well as human rightsand equality issues inthe context of restrictivepractices needs tobe developed on acontinuous basis.All sectors employingmental health nursesshould embed existingpublic health resourcessuch as the All OurHealth eLearningplatform into theirworkforce training offer.Mental health nursesmust be educatedto understand theprofession’s history anddevelopment over time,improving their sociopolitical knowledge andcultural competence.Organisationand serviceleadershipSystem leaders must betrained and supportedto become culturallycompetent; identifyingand tackling all formsof bias (includinginstitutional racism) thatimpact on the deliveryof services, as wellas the outcomes andexperiences of serviceusers and carers.Any service whichhas nurses workingwithin it must havea registered nurse aspart of the leadershipteam. This individualwill have the authorityand the responsibility toidentify, establish andmaintain the nursingworkforce required tomeet the needs of localpopulations22.Mental health nursesmust be enabled tolead the design anddelivery of research thatinfluences the practicesof the profession andpromotes co-production.Leaders must provideadvice, support and,where necessary,interventions which willallow nurses to takeaction to improve theirown physical and mentalhealth.www.hee.nhs.ukThe standards, deliveryand evaluation of mentalhealth nurse training/education should beco-produced betweenproviders and serviceusers. Ensure thatmental health nurseshave protected time andresources to undertakethis CPD.Commitment and Growth: advancing mental health nursing now and for the future14
NationalbodiesNHS England mustensure that the voice ofmental health nursing isintegral to all educationand developmentprogrammes that impactthe profession and thedelivery of care.Health EducationEngland must developand expand theirnational educationand training strategiesto incorporate sociopolitical knowledge,cultural competenceand a global healthcareawareness of all mentalhealth nurses.Monitoring ofsuch training andimplementation shouldbe included in CQCinspection guidanceunder regulations 18(2)(a)23 and 10(2)(c)24.IntegratedCare SystemsThere is a need todevelop operationalprocesses that enablemental health nursesto review, develop andadapt the structureand delivery of services(i.e. practice and timepriorities), in directresponse to the needs oflocal populations.Dilution of the nursingrole is becoming evidentin many areas of serviceprovision. The ‘Nurse’title needs to be in everynurse designation toensure the profession isvalued and developed.Work in partnershipwith Health EducationEngland and highereducation institutionsto develop and deliverevidence based learning,aligned to the needs oftheir local workforce andpopulations.www.hee.nhs.ukActively promote andsupport mental healthnurses in evaluating andembedding researchrecommendations thatinfluence and promoteco-production andpersonal recovery withinmental health services.System wide action isrequired to accelerate andsupport mental healthnurses to strengthen theirpractice and leadershipin addressing thebiopsychosocial healthof local populations.Commissioners of mentalhealth services shouldbuild upon outcomesmeasures which focus onphysical health issues asdetailed in the ‘Improvingthe physical health ofpeople with mentalhealth problems: Actionsfor mental health nurses’publication.Commitment and Growth: advancing mental health nursing now and for the future15
Theme 2: Unite, engage and overcome - addressing inequalities through diversity and inclusionRecommendation 4For example, the final report of the Independent Review of the MentalHealth Act 1983 highlighted that “LGBTQ patients also reported beingstigmatised and not having their needs addressed”26. The discriminationexperienced by asylum seekers and refugees as well as Gypsy, Roma andTraveller communities is highlighted by the RCN, who further state:Mental health nurses must prioritise their focus on addressing healthinequalities for the population that they serve, improving access toservices for people from all backgrounds by developing culturallycompetent practices.Evidence suggests that a wide range of factors can affect accessibility,quality, and therapeutic relationships in mental health care23: for example,people from Black and ethnic minority backgrounds may be less likely torecognise and accept mental health problems and may not receive culturallysensitive care when they attempt to access it24, 25. Although this review placesa renewed focus on the issues of race inequalities in mental health care andthe under-representation of ethnic minorities across mental health nursing,we cannot forget about the multiple issues of intersectionality within ourlocal populations.“There is little recognition of the mental health needs of Eastern Europeancommunities alongside perinatal mental health issues. The proposed reforms saylittle about promoting the mental health of men.”27The mental health nursing workforce should prioritise their focus onaddressing health inequalities, building cultural competence for thepopulations that they serve. Greater action is required to ensure that there isequitable access and uptake of key public health interventions and physicalhealth services for people with serious mental illness, across the lifespan.www.hee.nhs.ukCommitment and Growth: advancing mental health nursing now and for the future16
All three T&F groups highlighted the specificissues of equality and diversity across themental health nursing workforce and withinservices for people with serious mental illness.The 2006 review of mental health nursingcalled for the profession to be culturally andethnically representative of local populations28.Where many services have improved thediversity of their nursing workforce, thereremain clear disparities within the mostsenior clinical and non-clinical nursing roles.ESR Current Breakdown (June 2021) by Ethnicity Group and AFC BandBand 5Band 6Band 7Band 8aBand 8bBand 8cBand 8dBand 9Non AfC100%80%% BreakdownAll mental health nursing roles must berepresentative of local populations, whilevaluing the strength of ethnic diversity atall career levels.HEE Workforce Profile - Diversity Inclusion - BETA60%40%20%0%ESR Trend (March 2014 to June 2021) by Ethnicity Group80%% Breakdown by DateRecommendation 579%73%60%40%19%20%0%14%4%20152016Dimension Parameter YAFC BandRegionAllTrust NameAllProfessionsMental
advancing mental health nursing now and for the future Baroness Watkins of Tavistock Review of Mental Health Nursing in England www.hee.nhs.uk We work with partners to . throughout the implementation of the NHS Long Term Plan1 and beyond. Chart 1: Mental Health Workforce FTE, September 2009 to December 2021 32000 Sep-09 Mar-10 Sep-10 Mar-11 .
Advancing Education Efiectiveness: Interconnecting School Mental Health and School-Wide PBIS iii Volume 2: An Implementation Guide Acknowledgments Thank you to all contributing authors from Advancing Education Effectiveness: Interconnecting School Mental Health and School-Wide Positive Behavior Support. The second volume would not
3.2 european Policy 12 3.4 Happiness and wellbeing debates 14 4.0 Concepts and definitions: what is mental health? 15 4.1 Dual continuum model of mental health 16 4.2 Measuring mental health 17 5.0 Benefits of mental health promotion 19 5.1 Benefits of preventing mental illness 19 5.2 Benefits of promoting positive mental health 22
Mental capacity and the Mental Capacity Act 2005 - A literature review 1.0 SUMMARY This literature review was carried out to collate academic literature relating to mental capacity issues and to the implementation of the Mental Capacity Act 2005. Mental capacity is the ability to make one's own decisions. The Mental Capacity Act (MCA),
Mental Health, Mental Health Europe NGO and the UK Royal College of Psychiatrists7. "No health without mental health" has also been adopted by the Irish organisation Mental Health Ireland, Supporting Positive Mental Health. Burden of Mental Disorders Mental disorders have been found to be common, with over a third of people worldwide
Civil Commitment: Historical Roots . The vast majority of mental health services today are provided on a voluntary basis. Every state, however, provides for the civil commitment of those who meet the requisite legal standard. These standards and the procedures that are followed to impose commitment vary from state to state.
Mental h. ealth problems: A mental health problem can also imp. act an individual’s cognitive, emotional or social abilities, but may not meet the criteria for a diagnosable mental illness. Mental health problems are said to occur as a result of life stressors, and are usually less severe and of shorter duration than mental illnesses.
3.1 Prevalence of mental ill health 9 3.2 Mental health service need 9 3.3 Mental health service provision gap 10 3.4 Housing system and homelessness 10 3.5 Entries into homelessness 11 3.6 Mental health and housing system capacity 12. 4 Links between housing and mental health 13 5 Housing for people with lived experience of mental ill health 16
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