Editorial

Citation

Samele, C. (2011), "Editorial", Mental Health Review Journal, Vol. 16 No. 2. https://doi.org/10.1108/mhrj.2011.55816baa.002

Editorial

Article Type: Editorial From: Mental Health Review Journal, Volume 16, Issue 2

The Health and Social Care Bill (2011-2012), following on from the National Health Service (NHS) White Paper – “Equity and excellence: liberating the NHS” (Department of Health (DH), 2010), proposes radical reforms to the NHS. These reforms are far reaching; the most major being the transfer of healthcare commissioning to general practitioners (GPs), with the de-layering of Primary Care Trusts and the Strategic Health Authorities. Local government will also have a greater role in running health services in England; a significant change indeed, potentially creating a large vacuum in leadership oversight at the local healthcare level.

GP consortia, when created, will take on the bulk of the healthcare commissioning responsibility, far beyond previous attempts at GP Fundholding and Practice-based Commissioning. To make this a reality GPs need to have real control over budgets; sufficient commitment to this agenda and to think that it will work. The big question is – are GPs equipped to take on this role, particularly for commissioning mental health services?

To help ensure GPs and other commissioners are well informed various publications have been produced to help with delivering best outcomes. In March of this year, for example, the Joint Commissioning Panel for Mental Health published “Practical mental health commissioning, volume one” (Bennett et al., 2011). This guidance document pushes forward the priority areas listed in the mental health strategy (DH, 2011) such as preventing mental illness, promoting mental and physical health, improving access to talking therapies and employment, enabling recovery and personalisation.

An interesting part of the Practical Mental Health Commissioning is the section on realigning investment. It is envisage that investment will be shifted from acute, specialist and other secondary services to preventive and early intervention services as a way of reducing future demand for secondary services. Despite this specialist mental health services will remain important, although ensuring they run efficiently and cost effectively through minimising the numbers of admissions and reducing length of stay are key.

Following on the theme of improving and enhancing both hospital and community-based mental health services, this issue presents a series of evaluations to demonstrate good practice with positive effects. Bowers and Aldouri, in their pilot study, aimed to reduce bed occupancy rates using an inpatient programme of Rapid Assessment, Treatment and Discharge, found an increase in short treatment episodes and a reduction in admissions greater than seven days. Bowers and Aldouri, in their conclusion, rightly remind us that the patient experience is ultimately what counts, more so than the actual cost of the admission.

Ryan et al. look at alternatives to inpatient care where they evaluated a four-bedded crisis house in Liverpool. Working solely with the local Crisis Resolution Home Treatment (CRHT) team, this community-based crisis house revealed reductions in symptoms, disability and other risks associated with mental illness for those with significant mental health needs on entry into the service. What is encouraging is the level of collaboration between professionals and integrated practice that develop and evolve to meet local demand and address the multiplicity of client needs.

Another example of integrated practice is described by Nepe et al.’s enhanced community mental health service in New Zealand. Working jointly with a large number of government and non-statutory services, including employment, education and other local services, Community Link operates a “super” one-stop shop. Results of a preliminary evaluation were favourable in terms of the acceptability and value of co-located mental health services that are integrated with other important and essential services.

By contrast to the usual outcomes analyses of Crisis Resolution and Home Treatment services Freeman et al. explore the experiences of staff – the stresses, their coping techniques and what they found enjoyable. The positives included the close working with clients and the building up of relationships. The stressors were all too evident from tensions relating to inappropriate referrals to gaps in supervision and staff training. Individual and team coping skills were maximised to deal with the many stressors of working in a CRHT team. Staff, however, remained motivated knowing their work makes a difference to their clients.

Chiara Samele