The forgotten foundations: in core mental health services, no one can hear you scream

The Five Year Forward View for Mental Health (FYFVMH) was a welcome development in the emerging ‘Parity of Esteem’ agenda, but focused mainly on a select few specialist services; much more limited attention was given to ‘core’ general adult and older age mental health services, such as community mental health teams, crisis teams and in-patient units. This relative policy vacuum, when combined with prolonged financial pressures and limited informatics, has left core services vulnerable and struggling to meet growing demands, with little sense of hope, in contrast to some of the newer, ‘shiny’ specialist services growing around them. Policy makers need to recognise the growing crisis and take action, ensuring that any sequel to the FYFVMH redresses this imbalance by clearly prioritising core services as the vital foundations of the larger whole-system. The potential benefits are huge and wide-ranging, but the harms of a second missed opportunity are perhaps even greater. DECLARATION OF INTEREST: A.M. works in a National Health Service general adult community mental health team and is an elected member of the Royal College of Psychiatrists General Adult Faculty Executive Committee.