NHS Continuing Healthcare Funding for Mental Health Needs: Is It Possible?

Yes. NHS Continuing Healthcare can apply to people whose primary care needs arise from a mental health condition. However, NHS Continuing Healthcare for mental health needs is less straightforward than for physical health conditions, and there are specific frameworks that apply.

When can mental health needs qualify for NHS Continuing Healthcare?

NHS Continuing Healthcare is available to any adult whose primary need for care is health-related, regardless of whether that health need is physical or mental. A person with a severe and enduring mental health condition can qualify for NHS Continuing Healthcare if the nature, intensity, complexity, and unpredictability of their needs meet the threshold.

In practice, this tends to apply to people with:

• Severe and treatment-resistant mental illness (such as schizophrenia or bipolar disorder with significant and persistent impact on functioning)

• Complex needs that require ongoing specialist clinical input and cannot be managed safely through standard community mental health services

• Behaviours that present a significant risk to themselves or others and require intensive management

• Mental health conditions combined with physical health needs that together create a level of complexity requiring clinical oversight

What about Section 117 aftercare?

Section 117 of the Mental Health Act 1983 creates a separate legal duty for the NHS and local authorities to provide aftercare for people who have been detained under certain sections of the Act and then discharged from hospital.

Section 117 aftercare is free at the point of use and cannot be means-tested. It covers health and social care services designed to meet the needs arising from the person's mental disorder and to reduce the risk of readmission.

Importantly, Section 117 and NHS Continuing Healthcare are separate frameworks. A person receiving Section 117 aftercare is not automatically assessed for NHS Continuing Healthcare, and vice versa. However, a person's eligibility for one should not prevent them from being assessed under the other.

How is mental health NHS Continuing Healthcare assessed differently?

There is a separate Decision Support Tool for mental health that can be used for people whose primary needs are mental health-related. This tool uses a different set of care domains that are more appropriate to the kinds of care needs that arise from mental health conditions.

In practice, the mental health NHS Continuing Healthcare pathway is used less frequently than it should be. Families and professionals are often less aware of it, and mental health ICB teams may not routinely refer people for assessment.

What should families do?

If a family member has severe, complex mental health needs that require significant and ongoing clinical input, it is worth asking whether an NHS Continuing Healthcare assessment has been considered. A nurse advocate can advise on whether the circumstances are likely to meet the threshold and can help navigate both the NHS Continuing Healthcare and Section 117 frameworks.