Medicines in community mental health services

This research looks at what good care looks like for people who take mental health medicines in the community.

We commissioned Ipsos to carry out this research. They wrote the full report and the summary below.

Why it matters

Most people take mental health medicines while in the community and not in hospitals. It is important that people taking these medicines take them properly.

Health services have a role in helping people with this. This includes:

• making sure people have the right medicines
• helping people with any side effects
• helping people understand why and how to take their medicines.

However, some people have said that it is hard to get help from community mental health services. They also worry about the quality of care in the community. We want to support improvement in these areas, so people have better experiences.

This research looks at the help people get when they take mental health medicines while living in the community. We ask:

• What help is already there?
• What is working well?
• What is not working?
• How can we help local services do better?

The approach used

We collected information in 2 ways:

1. An online survey

A total of 314 people completed an online survey. Those who took part all help people in the community with their mental health medicines. This included:

• general practitioners (GPs)
• pharmacists
• hospital staff (doctors and nurses) working in health and care
• some people working in charities or in the NHS.

The survey ran from 14th February to 17th March 2025.

2. Interviews 

We interviewed 13 people who work in health and care roles. These interviews helped explain more about the answers from the survey. The interviews were conducted in March 2025.

Findings

Overall views

What is working well to help people take their mental health medicines:

• Seeing a healthcare worker often to talk about their medicines.
• Having good relationships with health and care staff. Also, seeing the same person again and again helps people feel safe to talk about their medicines.
• Different staff working together to give care. This is also called multi-disciplinary working.
• Giving support in different ways. For example, meeting people at home, outside (such as if they are homeless), or texting them reminders.
• Having specialist mental health pharmacists as part of the care team.

It was hard to provide good care because:

• There is not enough time or staff. People talked about there not being enough healthcare workers. They also talked about staff being very busy. It can be hard for people to get help, and waiting lists are long (33% of people said this).
• Poor communication. This means health and care staff or services don’t always share information well. This includes between the different health and care staff or services (mentioned by 27%). One reason is computer systems don’t work together. Over a quarter (27%) also say it can be hard to keep patients interested or involved in their care. Over a quarter (26%) say shared care arrangements are a problem.

Medicines adherence (taking medicine the right way) and engagement (staying involved in care)

The biggest worry for people taking these medicines are the side effects. These can include feeling tired, gaining weight or having trouble sleeping. These side effects can make it hard to work, go to school or do everyday things. The survey found that 4 in 5 (80%) say this was the biggest worry people have.

People also worry about the perceived stigma about mental illness (30% said people were worried about stigma). This can lead to people finding it hard to talk about side effects with their doctor or nurse.

Side effects are also the main reason people stop taking their medicine. Other main reasons include:

• Not understanding the medicine. For example, people stop medicines because they don’t think it works, or they think they don’t need it (73% say this). People also stop taking their medicine because they don’t know how to take it properly (45%).
• Confusing medicines schedules. Almost half (48%) say that forgetting to take their medicines is the reason they stopped. The survey found that 1 in 4 (25%) also say that complex treatment plans make it hard to keep taking it.

Another big problem is that health services do not always have enough time or staff to give people the help they need.

Helping people who take mental health medicines

People talked about what good care looks like. There were 2 main themes:

• Medicines reviews are important. These are check-ups to talk about medicines. They usually happen once a year, but people think it would be better to have them more often. People saw these as a useful way to support patients.
• Having experts helps, mainly from community mental health pharmacists and pharmacy technicians. But not every area has this kind of support.

Other things that help make care better:

• Good communication, and the right information about people’s care, shared between services.
• Helping families and carers understand mental health problems and medicines.
• Different health and care staff working together to talk about someone’s care.
• Seeing the same staff member each time. This helps staff get to know their patients well. It also helps patients feel safe and listened to.
• Changing care to fit the patients. For example, meeting patients at home.

People also shared new ideas for working better. This included:

• The use of artificial intelligence (AI) to spot people who might be at higher risk.
• Using 2-way texting services to make talking easier.

Communication and partnership working (talking and working together)

Good care happens when health and care staff talk and work together well. Some good examples of this are:

• GPs and hospitals using the same computer systems to help them share patient information easily.
• Having online meetings between different health and care staff and services. This means they can make decisions quickly.
• Different staff and services working together with someone’s care. This helps give people all the care they need in one place.

Communication problems are common. These included:

• Services sending information that is hard to understand or missing information.
• People not knowing who is in charge of each part of a person’s care.

Shared care agreements are written plans between services like hospitals and GPs. They explain what GPs should do to help manage a person’s medicines in the community. The survey found 2 in 5 people (38%) think shared care agreements work well, but 42% feel that they do not work well.

• Good things about shared care agreements include, helping services talk to each other more clearly.
• Problems with shared care agreements: some GPs don't feel confident managing patients who take mental health medicines. Hospitals don’t always give GPs clear support or information. This can lead to confusion and frustration for patients and health and care staff. Hospital staff said GPs can be unsure about looking after stable patients.

People want to improve how teams work together. They said we need:

• Computer systems that let GPs and hospitals share information with each other.
• Better joined-up working.
• Staff who focus on helping people manage their medicines.
• For shared care: clearer guidance, standardised protocols (one clear way of doing things everywhere), and better support for GPs.

Health inequalities

Some groups of people find it harder to get the mental health care they need. The survey showed that the groups who face the most challenges include:

• people who don't speak English as their first language (53%)
• people who are homeless (52%)
• autistic or neurodivergent people (48%)
• people with a learning disability (46%)
• people who have multiple long-term health problems (46%).

These groups face different issues, including:

• Communication problems. For example, someone who doesn't speak English may not understand how to take their medicines.
• Practical problems. For example, someone who is homeless might not have a safe place to keep their medicines.

People taking part in the research talked about different ways to support these groups. Examples included:

• Translation services, translation apps, and hiring staff who speak different languages to help people who don’t speak English.
• Providing culturally competent services. This means giving care that respects different backgrounds, cultures and beliefs.
• Giving injections in temporary housing or shelters for people who are homeless.
• Training staff so they know how to support people with different needs.

But 44% did not know how their service was helping these groups.

Support and training

People would like:

• smaller workloads (64%)
• better sharing of information between services (60%)
• a better mix of staff to help people with their medicines (53%).

Two in 5 (40%) said training would help health and care staff. People said that GPs and pharmacists who are not specialists need more training. This could be on topics such as side effects (how medicines can make people unwell), and how different medicines interact (when multiple medicines affect each other).

Some said training on ‘motivational interviewing’ (a way of talking that helps people feel ready to make positive changes) would be helpful. Also, training on ‘trauma-informed’ care (understanding how past experiences can affect someone’s mental health and how they respond to care) was seen as helpful.

Conclusion

People shared what they think makes good care. They said it’s important to have:

• regular check-ups for patients (called reviews) about their medicines
• good relationships with health and care staff
• better teamwork
• care that fits around people (called flexible support)
• help from specialist pharmacists who know a lot of about mental health medicines.

But there are some problems that make this hard to do. These include:

• not enough staff
• poor communication
• not enough time, money, or tools (limited resources).

The research has shown some ways to make things better:

• Helping people understand their medicines and mental health problems. This can help people to keep taking their medicines. Specialist mental health pharmacists can support patients directly. They can also help other health and care staff do a better job.
• People would like to see more teamwork and joined-up care. People want better communication between different services. They also want to use more technology – like shared records and online meetings.
• Shared care agreements are not always working well. People said GPs sometimes don’t feel ready or have enough time to manage these patients. They also want better communication between GPs (primary care) and hospitals (secondary care).

We can help make care better. People said CQC should:

• focus on sharing examples of what works well
• report on key trends (the main things that are happening or changing)
• work with other national organisations, such as the National Institute for Clinical Excellence (NICE), to give clearer guidance
• ensure that regulatory activities promote good medicines optimisation in community settings (making sure people get the right medicines, at the right time, and use them in the best way to help them feel better and stay healthy).

Read the full report

Download the full report: