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Understanding the mental health system

Last updated Thursday, 27th Nov 2014

If you have a concern about your mental health, you may benefit from help and support from a mental health professional. The way that mental health services are organised and delivered can seem confusing as it differs across Kent and Medway and changes from time to time.

Health care and social care

Help and support services for people with mental health needs who are not in hospital are broadly divided into health care and social care. Health care describes the care that you need to treat a diagnosed health condition. It is the responsibility of the NHS to provide you with health care. This is provided free.

Social care describes the help and support you need to live an independent life within your community. Social services can charge you for the support it provides following an assessment of your ability to pay. This is called a means test.

In parts of the country, health and social care services work together to provide support which should be tailored to meet both your health and social care needs.  Funding for services is managed by health (clinical commisioning group) and social services Kent County Council and Medway Council. They work together to ensure the provision of mental health services. For example, community mental health teams, which provide support to people with mental health needs in the community, are made up of NHS employees and social services staff.

Primary care

This is the care provided by people such as your doctor, dentist, pharmacist or optician when you have an initial problem with your health. Clinincal Commisioning Groups (CCGs) are responsible for ensuring that these and other health services are provided in local communities. They are also responsible for getting health and social care systems to work together for the benefit of patients.

In Kent there are three CCGs.

  • South Kent Coast Clinical Commisioning Group
  • Medway Clinincal Commisionng Group
  • West Kent Clinincal Commisioning Group

Secondary care

If your mental health needs cannot be supported by primary care services, you may be referred for more specialist support. This is often known as secondary care. Secondary care can include community mental health teams, hospital care or support from other mental health service providers. In Kent and Medway, secondary care is provided by the NHS mental health trust - Kent and Medway NHS and Social Care Partnership trust (KMPT), Kent and Medway social services teams and other mental health services from the voluntary or private sector.


If you seek support with your mental health, you will probably be assessed at different times by different people. This is to help work out how best to help you. Assessments should be undertaken with your involvement and focus on you as a person.

GP assessment 

Unless you are in severe crisis, your family doctor or general practitioner (GP) is typically the first person to see for an assessment of your mental health. Your GP will ask you questions about how you have been feeling and what you have been experiencing. Using this information, he or she may offer guidance, medication and/or refer you for more specialist support. For example, you may be referred to a counselling service or to the community mental health team which would undertake a further assessment of your needs.

Community care assessment 

If you need a service to help you manage your mental health, you are entitled to a community care assessment. A community care assessment is the process whereby a trained health or social care professional meets with you to find out more about your needs and decides whether or not you are eligible for a service and if so, which service(s) you should have. An assessment does not automatically lead to the provision of a service.

Emergency assessment  

If there is a great deal of concern about your mental health to the extent that there is a worry that you may harm yourself or others, you may be given an emergency assessment. This can be done under mental health legislation with, or without, your consent. Following this assessment, you may be provided with emergency treatment.

Changes to the way people are supported with their mental health

The way that people are supported with their mental health is changing. 

At present, people are offered a package of support or care, following an assessment of their needs. The support package may include referral to mental health services that health and social services have purchased in advance. This sometimes means people do not receive the support they feel they really need to help them achieve improved mental wellbeing. Sometimes people feel that they have to fit in with the services that are available, rather than being supported in a way which fits in with them and their needs.


The new way of working is called personalisation. Personalisation is about giving people much more choice and control over their lives. It applies to everyone with a whole range of needs, including people with mental health needs and those people who may not be entitled to publicly funded care or support.

Personalisation reinforces the idea that the person with mental health needs is best placed to know what they need and how those needs can be best met. It means that people can be responsible for themselves and can make their own decisions about what they require. In this way services should respond to the person and their needs instead of the person having to fit with the service.

Self-directed support

The term ‘self-directed support’ is used to describe what happens when people are in control of the support they need to live their life as they choose.

Rough guide to personalisation

The Social Care Institute for Excellence has produced a rough guide to personalisation which gives more information about personalisation and an easy read summary. It also has a video that explains what personaliation is about, where people with experience of personalised services explain the impact that personalisation has had on their lives.

In Control

In Control is an organisation helping people get real choice and control. It is supporting local authorities to deliver self-directed support. Its website contains information about personalisation and self-directed support.

Personal budgets

In future, people with mental health needs who are eligible for social services support will be told how much money is available to spend on their support needs. This is called a personal budget. This is sometimes referred to as an individual budget (although this term is more commonly used to describe a budget which includes funding from other sources such as health).

Direct payments

Direct payments are local council payments for people who have been assessed as needing help from social services, and who would like to arrange and pay for their own care and support services instead of receiving them directly from the local council. Everyone will be offered this option after a social services assessment, and for those people who choose direct payments it will give them greater choice and control over the support they receive.

Who can receive a direct payment?

The following groups of people could receive direct payments from Kent County Council and Medway Council:

Carers can receive direct payments if they provide or intend to provide a substantial amount of care for someone aged 18 or over where the council is satisfied that the person being cared for is eligible to receive community care services. Carers may receive direct payments in respect of services for themselves, but not for services in respect of the person who is cared for.

The regulations made under the Health and Social Care Act specify that direct payments may not be offered to certain people whose liberty to arrange their care is restricted by certain mental health or criminal justice legislation. Information on these groups of people can be provided by your case manager or care co-ordinator on request.

If you live in Kent (excluding the Medway area)

If you live in the Kent County Council area (which does not include Medway), you may be interested in using the Kent Card. Kent Card is a secure and convenient way of receiving your direct payments. It is an easy way to pay for your support as the Kent Card is a Chip and PIN VISA card which does not need a bank account.

If you live in Medway

People who have care and social support needs are able to receive money directly so that they can arrange, organise and pay for their own help. People who have been assessed as needing support can phone Medway Council on 01634 334466 and ask for the Self Directed Support Team to find out more.


A broker is a person who supports a person to arrange, organise and pay for their own help and support using their personal or individual budget.  A broker is sometimes known as a support broker or a social care broker. The service a broker provides is called brokerage.  A broker’s role is to support you to:

  • explore what is possible
  • find out what is available
  • plan how you are going to manage and spend the money provided.

The broker is accountable to the person they are supporting. They do not answer to a particular provider or organisation.

The National Brokerage Network (NBN) has been set up to act as an information exchange and an authoritative voice for the development of brokerage throughout the UK. Its website has more information about brokers and brokerage services.

Signpost UK

Signpost UK aims to provide people with information, support and guidance to help them plan what they want to do and make choices about the support they need. 

We are working with Kent and Medway health and social services and the Department of Health. We are exploring how we can ensure people with mental health needs are offered support from independent brokers who have agreed to work within the Signpost UK Quality Charter.

To find out more about this initiative and how you can get involved in its development, please contact us.


In addition to the services and information above, Medway also offers:

Children and Adolescent Mental Health Services (CAMHS)

CAMHS offer specialist mental health services to children and young people (up to age 18) and their families. CAMHS helps children and young people when they find it hard to cope with their feelings or thoughts, or find it hard to manage their behaviour.

To find out more information about this service through the Medway Childrens Trust click here


    Help and Support A-Z links