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Welfare Reform on the Web (February 2008): Mental health services - UK

Beggars in the market

M. Elphick

National Health Executive, vol.1, Nov./Dec. 2007, p. 28-29

Funding for mental health trusts is at risk because they are still working under the 'block funding' contract system which has been replaced by payment by results in the rest of the NHS. Payment by results enables acute trusts to precisely enumerate their need for funds. Mental health services, which have no comparable way to argue their case, have become a soft target for budget cuts. Mental health trusts are also facing competition from independent providers and from acute and primary care trusts creaming off easily costed services. The resulting fragmentation of services will adversely affect people with complex mental health needs.

Better services for people with an autistic spectrum disorder

E. Chaplin

Advances in Mental Health and Learning Disabilities, vol. 1, Dec. 2007, p. 27-28

This commentary seeks to summarise the nature and intent of current government policies for services for people with an autistic spectrum disorder, based on the Department of Health's review Better services for people with an autistic spectrum disorder published in 2006.

Challenges for mental health commissioning

I. McPherson

National Health Executive, vol.1, Nov./Dec. 2007, p. 30-31

The author outlines the major challenges facing those commissioning mental health services in England:

  • Lack of prioritisation of mental health within primary care trusts and local authorities
  • The powerful position of specialist mental health service providers vis--vis commissioners
  • Lack of a proper career structure for those commissioning mental health services

He goes on to point out the emerging opportunities and support available to help commissioners in their demanding task.

Constructing and reconstructing 'best interests': an interpretive examination of substitute decision-making under the Mental Capacity Act 2005

M.C. Dunn and others

Journal of Social Welfare and Family Law, vol. 29, 2007, p. 117-133

The Mental Capacity Act 2005 authorises substitute decision-making in England and Wales in relation to 'acts in connection with care and treatment' for a person lacking capacity to make an autonomous decision, if it is both necessary and in his or her 'best interests' to do so. The Act codifies 'best interests' within its statutory framework to enable it to provide a general, decontextualised model of substitute decision-making. The authors argue that this codification of 'best interests' may produce tensions between the abstract conceptualisation of substitute decision-making, built around a rigid set of compulsory requirements, and its everyday application in health and social care settings.

Helping people through mental health crisis: the role of crisis resolution and home treatment services

National Audit Office

London: TSO, 2007 (House of Commons papers session 2007-2008; HC5)

In recent years Crisis Resolution Home Treatment (CRHT) services have been developed to provide acute care for mental health service users living in the community and experiencing a severe crisis requiring emergency treatment. However, this report finds that services are being limited by a lack of input from specialist health and social care professionals, variations in staffing levels across the country and too few admissions to hospital being assessed by CRHT teams. The report highlights that the Department of Health met its target of establishing 335 teams in England by 2005. The Department's guidelines specify that teams should be multi-disciplinary with input from a variety of health and social care professionals. Yet almost a third of teams received no dedicated consultant psychiatrist input at all and fewer than half reported having dedicated input from approved social workers. The NAO concludes that there is still more to do. To maximize the impact of CRHT and improve value for money the Department and the NHS need to ensure that CRHT teams are properly resourced, fully functional and integrated with local mental health services. The Department needs to take the lead in improving national data on services, and encouraging better use of feedback and data at the local level. Local NHS organizations need to improve links between CRHT teams and other mental health services, and Mental Health Trusts should enforce written policies and procedures requiring every inpatient admission to be preceded by a CRHT assessment.

Mental health

E. Dent (editor)

Health Service Journal, Jan. 24th 2008, p. 27-37

This special report on reform of the mental health services covers: 1) the introduction of Community Treatment Orders as an alternative to compulsory detention in hospital; 2) new investment in age appropriate inpatient provision for children and teenagers, so that they do not end up being treated on adult wards; and 3) the introduction of the new roles of responsible clinician (replacing responsible medical officer) and approved mental health professional (replacing approved social worker). The role of responsible clinician will be open to nurses, occupational therapists and psychologists as well as psychiatrists.

Mental health services for adults with autism spectrum disorders

A. Ward and A. Russell

Advances in Mental Health and Learning Disabilities, vol. 1, Dec. 2007, p. 23-25

Autism spectrum disorders (ASD) are lifelong developmental disorders that are characterised by abnormalities in social interaction and by a restricted, stereotyped or repetitive pattern of interests or behaviours. The majority of people with an ASD have intellectual ability within the average range, but often fail to secure employment in adulthood and suffer from high rates of psychiatric disorders. This paper aims to describe the current situation regarding clinical services and what is required from these services to address co-morbid mental health needs in adults with an ASD.

Mental health service users' experiences of returning to paid employment

M. Boyce and others

Disability and Society, vol. 23, 2008, p. 77-88

The Labour government which came to power in 1997 has worked to get unemployed people, including those with mental health problems, off benefits and into paid employment. This paper explores the experiences of 20 clients of employment support agencies who had succeeded in returning to work. A number of barriers to getting back to work were identified, but receiving employment support could enable people to overcome them. All participants identified positive impacts that working had had on their lives, including those who were dissatisfied with their job in some way. The quality of employment support provided was important, including advice and counselling during job search, enabling informed choice about disclosure, and support in work.

Patient choice in mental health services: building blocks or stumbling blocks?

S. Lawton-Smith

National Health Executive, vol.1, Nov./Dec. 2007, p.32-33

The government has made patient choice central to its health reforms in response to what it believes are increased patient expectations about their care and treatment. This article reports progress in implementing the choice agenda in mental health services.

Patients denied admission as PCTs argue over who will pay

C. Santry

Health Service Journal, Jan 31st 2008, p. 5

The Mental Health Act Commission has found practitioners are being told to delay sectioning people with severe mental health needs until primary care trusts (PCTs) ascertain who should pay for their treatment. In order to control costs, primary care trusts are not detaining people who have travelled from other areas until the home PCT has agreed to pay.

What, when, where

A. Alonzi

Professional Social Work, Jan. 2008, p. 20-21

This article sets out the provisions of the Mental Capacity Act 2005 and its accompanying guidance, and explains what the new law means for social work practitioners trying support vulnerable people when they are unable to make informed choices for themselves.

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