Nigel Turner's HyperGUIDE to the Mental Health Act

Developing Partnerships in Mental Health

Background

Developing Partnerships in Mental Health is the title of a government "Green Paper" - or consultation document - issued in February 1997. In recent years, the need for all the agencies which contribute to mental healthcare to work closely together, has been emphasised in all aspects of mental health policy. While effective joint working has been created in some areas, it is not clear that the existing organisational arrangements will ever provide the "seamless" service which is being sought.

There are many different agencies which can contribute to the support of someone who is experiencing mental ill-health, including health services, social services, General Practitioners - local doctors, housing organisations, voluntary and self-help groups, and larger independent sector service providers in the not-for-profit and private sector.

Mental Health services should be viewed within the five long-term objectives the Government has set out for all health services generally:

• a well-informed public;
• a seamless service, working across geographical and organisational boundaries;
• decisions about care and treatment based on evidence and knowledge of what is successful;
• highly trained and skilled staff; and
• a service which responds to different and changing needs.

The Green Paper sets out to establish ways in which the existing arrangements can be made more effective, but also suggests that options for more radical change must be considered.

Developing and Implementing Existing Arrangements

Mental Health policy has been developing at an increasing pace since the move away from large, long-term institutional care which began in the 1950s. The Green Paper notes some of the more recent initiatives, such as:

• The Spectrum of Care, the principle that many people's needs will be best met by locally-based community and primary services, but that a broad range of options is needed, including adequate residential care and hospital facilities, through to secure hospitals at one end of the spectrum
• The Care Programme Approach, which aims to ensure that people who have had contact with specialist psychiatric services have adequate aftercare and support, with an identified key worker co-ordinating this
• Supervision Registers, which record that certain individuals require especially close follow-up when deemed to be a potential risk to themselves or others
• Special funding initiatives, such as the Mental Health Challenge Fund and the Mental Illness Specific Grant, which have aimed to target resources more effectively and promote innovation
• Collecting Evidence on the effectiveness of clinical interventions, particularly through the Health of the Nation Outcome Scales

These policy initiatives tend to flounder where agencies do not work well together and there is poor communication and co-ordination. While frameworks exists for effective joint working, there is great variation around the country in the way this is carried out. Examples of good practice need to be notes more publicly, with lessons learned being made available for the benefit of others who have not made such good progress.

Key elements of successful joint working are:

• a clear, shared vision of service development
• effective leadership and personal commitment from managers and practitioners
• formal mechanisms for bringing people together and sharing information
• mutual understanding of each other's culture, roles, values and constraints.

The existing arrangements might be more effective if the policy initiatives listed above were more consistently applied, and if:

• health authorities and local authorities developed joint mental health plans
• NHS Trusts had a greater role in delivering social care.

Options for Change

Despite the many policy initiatives over recent years, and the scope for their further development, it may be that more radical changes to organisational structures and responsibilities, involving a change in the law, are required. Implementing new structures would involve a significant period of disruption and bring a danger of spending more time and money on new administrative arrangements, leaving less for front-line service provision. Therefore any structural change should only take place if there is a high level of confidence that what is being introduced is better than the existing arrangements.

The Green Paper puts forward four options which should be considered (but it does not favour any one option):

1 - The Mental Health and Social Care Authority

A new type of statutory authority would be created, accountable to the Secretary of State for Health. These authorities would be responsible for planning, commissioning and purchasing mental health care and social care for adults with severe mental illness.

2 - Single Authority Responsibility

Either health authorities or local authorities would be given the single, lead responsibility for planning, commissioning and purchasing mental health care and social care. Health authorities are seen as the most likely choice for taking this on.

3 - A Joint Health and Social Care Body

Health authorities and local authorities would create a joint body to plan, commission and organise the contractual framework for delivering mental health and social care services. This would mean a pooling of resources, although the joint body would remain accountable to each "parent" body for the funds contributed to the pool. Such pooling of resources is extremely difficult under existing law.

4 - Agreed Delegation

Health authorities and local authorities would be able to delegate specific functions or responsibilities to each other, as an optional arrangement which might be more extensive in some local areas than others.

Further Information and Comments

Copies of the Green Paper itself are available from The Stationery Office.

Comments on the issues raised by the Green Paper can be made (by 9 May 1997) to: