Welfare Reform on the Web (February 2000): Mental Health - UK

AS YOU DON'T LIKE IT

R. Ford

Health Service Journal, vol.109, Nov. 4th, 1999, p.26-27

The publication of the national service framework for mental health provides a good opportunity to review acute psychiatric services, which are unpopular with patients and understaffed. The framework recommends a balance of hospital beds, community provision and home care. Alternative models include provision of acute treatment in day hospitals or in clients' homes by community teams, and use of 'step-down' units, which have 24-hour nurse staffing but not 24-hour medical staffing. These can provide care after a stay on an acute ward, or acute care for cases which do not warrant a more restrictive environment.

CHILDREN IN MIND: CHILD AND ADOLESCENT MENTAL HEALTH SERVICES

Audit Commission

Abingdon: Audit Commission Publications, 1999

Reports that spending on mental health services for children and adolescents varies seven-fold across England and Wales. Findings show that 10% of trusts cannot offer appointments for non-urgent cases within six months, only half of HAs have agreements for emergency and 24-hour cover, and over one third of trusts say they cannot respond effectively to young people presenting in a crisis. Audit also highlights poor links between CAMHS and other agencies, and the fact that the scope of services varies widely across the country.

COMING DOWN TO EARTH

M. Muijen

Health Service Journal, Nov. 4th 1999, p.20-21

In a critical appraisal of the new mental health national service framework, points out that no costing has been given for implementation, nor extra resources identified. The announcement that primary care trusts may in future provide mental healthcare may have unintended consequences in the shape of wrangles about prioritisation and decimation of some services if funding is switched.

CREATING ACCEPTING COMMUNITIES: REPORT OF THE MIND INQUIRY INTO SOCIAL EXCLUSION AND MENTAL HEALTH PROBLEMS

London: Mind Publications, 1999

Highlights the discrimination faced in all aspects of life by people with mental health problems. Once diagnosed as mentally ill, people lose their jobs, are refused insurance and denied access to banks and further education. Calls for legislation to protect people from discrimination through mental health problems and an initiative to promote employment for mental health service users.

EFFECTIVE CARE CO-ORDINATION IN MENTAL HEALTH SERVICES

Department of Health

London: 1999

Guidance introduces fundamental changes to the care programme approach (CPA) governing effective mental health services. Key changes will see:

• an integration of health authority and social services care co-ordination approach into a single system;
• the introduction of two levels of CPA (standard and enhanced);
• crisis planning for those in receipt of enhanced CPA; a consistent audit of information for mental health patients on the CPA;
• the abolition of supervision registers.

FIRST NATIONAL GP SURVEY OF MENTAL HEALTH IN PRIMARY CARE

London: MACA, 1999

Data were gathered through a questionnaire distributed to 1966 GPs in England, of which 325 were returned. Results show that GPs spend on average 30% of their time on mental health problems, but their training is limited. Concern about the time required to deal with mental health problems in the contest of an already heavy workload was widespread. Health authorities and PCGs should take a proactive role in developing mental health services by addressing the training needs of GPs, experimenting with alternatives to GP consultation, educating patients about the determinants of mental health, encouraging specialisation among GPs, and creating support networks.

FLEXIBLE FRIENDS

J. Newton

Health Service Journal, vol.109, Sept. 23rd 1999, p.24-25

A scheme that trains students to become part-time community support workers to people with mental health problems has proved popular with clients. However, a third of carers had felt unsafe on at least one occasion and the service requires a high level of supervision. Professionals considered the service particularly useful for clients who felt isolated, and those at risk of self-neglect.

LEARNING DISABILITY SERVICES (AND BEYOND): WILL HAVING AN EVIDENCE BASE MAKE A DIFFERENCE?

R. Greig

Managing Community Care, vol.7, Oct. 1999, p.3-6

Recently published research on the costs and quality of village, residential communities and supported housing for people with learning disabilities has raised fundamental questions beyond the central research issue. Results show that:

• needs assessment and care management systems fail to get to the roots of people's real preferences;
• the quality of life and services is uniformly poor;
• a national performance management framework is required to ensure uniform standards of provision;
• high quality care management is central to effective person-centred planning.

NATIONAL SERVICE FRAMEWORK FOR MENTAL HEALTH: MODERN STANDARDS AND SERVICE MODELS

Department of Health

London: 1999

Focuses on the mental health needs of working age adults up to 65. Sets standards in five areas: mental health promotion; primary care and access to services; effective services for people with severe mental illness; support individuals who care for people with mental health problems; and action necessary to meet the governments target to reduce suicides.

NATIONAL SERVICE FRAMEWORK FOR MENTAL HEALTH

M. White

Community Care, no.1293, 1999, p.4-5

Tough new standards announced as part of a government move to end the 'postcode lottery' of mental health services are doomed to failure unless more money is forthcoming. However, the government intends to measure progress as early as April 2000, and tough action will be taken against failing health agencies and social services departments, using powers afforded under Best Value and through the Commission for Health Improvement.

NEED FOR FRAMEWORK CONFIRMED

R. Winchester

Community Care, no.1294, 1999, p.10-11

Argues that GP's current heavy mental health caseload, unexpectedly high use of ECT and allegations of racism in the admissions system reveal serious flaws in mental health services and confirm the need for the new standards framework.

A NEGLECTED POWER

B. Hatfield, S. Evans and J. Shaw

Community Care, no.1289, 1999, p.24-25

Mental health professionals in England and Wales make only limited use of the guardianship provisions of the Mental Health Act 1983. Guardianship would give practitioners powers involving statutory supervision of mentally ill people in the community. In the US most states have provisions for a similar form of statutory supervision, 'outpatient commitment'. US studies suggest that outpatient commitment can both reduce hospitalisation and improve treatment outcomes.

OPENING THE DOORS TO SHORT-TERM BREAKS: HOW TO ACCESS AND INFLUENCE PROVISION OF SHORT-TERM BREAKS IN YOUR AREA

Mencap

London: [1999]

Both people with learning difficulties and their carers can benefit from short breaks. This guide, aimed primarily at carers of people with learning difficulties, is intended to inform carers of their entitlements under the community care legislation, and to raise awareness of their right to have their needs assessed by social services.

A REVIEW OF CHILD MENTAL HEALTH SERVICES: BIRMINGHAM'S IMPLEMENTATION OF A NEEDS-BASED COMMISSIONING STRATEGY

K. Padki and J. Bywaters

British Journal of Health Care Management, vol.5, 1999, p.357-358

Fragmentation and haphazard development are common features of mental health services for children and adolescents. Paper discusses the role of Birmingham Health Authority in developing a strategic framework for a comprehensive child and adolescent mental health service.

STANDARD ISSUE

L. Donnelly

Health Service Journal, vol.109, 14th Oct. 1999, p.11-12

The new national framework for mental health sets out care standards without specifying in detail how services should be organised. Article reports a mixed response from professional organisations in the field.