Improvements need to be made in mental health service delivery if it is to keep pace with changes in treatment. Michael Clark and Martin Knapp review the evidence
Community mental health teams
Personal Social Services Research Unit researchers in Manchester have looked at progress in joint working within community mental health teams for older people, taking national standards as the benchmark (Wilberforce et al 2010). They collected data from almost 90% of all such teams in England. Although they found lots of progress against standards of joint working, some difficulties were also evident.
For example, most teams could not access local authority service user records, and the research also found that health staff within the teams were unable to commission social care services. In other words, some of the long-standing challenges of integrated working remain.
As budgets shrink, so decision-makers are increasingly interested in value for money. Sharac et al (2011) conducted one of the few economic evaluations in child care services. They looked at adoptive parents of children aged three to eight who participated in home-based, manualised, parenting programmes delivered by trained family social workers. They compared this programme with services as usual, looking at two groups of children and families over a six-month period. They found "satisfactory parenting" to be greater in the intervention group, but no differences between the groups on any of the child measures. The intervention was also more expensive than usual services. The researchers concluded that the intervention might be cost-effective in enhancing satisfaction of parenting but not in reducing child behavioural problems.
Mental Capacity Act
The introduction of the Mental Capacity Act 2005 in England and Wales in 2007 has had profound implications. Samsi and colleagues (2010) examined the knowledge and experience of - and expectations for - the Act with a sample of staff working for Age Concern across London. They found varied levels of knowledge and a general lack of confidence in providing advice to people, but also hopes that the Act would benefit older people, including those with dementia. With the third sector having the potential to play a significant role in supporting people to make decisions, the authors conclude that we need to be very clear on the provision of information, advice and/or advocacy from colleagues in these organisations, and ensure they are supported to undertake these roles.
Payment by results
Adult mental health services in England are in the process of preparing for payment by results, based on a care cluster model grouping the needs of individual service users. A recent paper examines these developments with an eye on the potential to support social inclusion and recovery-based practice. Although the care cluster model is not obviously supportive of these, Clark (2011) argues there is scope in the ongoing development of care pathways and outcomes indicators to further such progressive practice. The word of warning, though, is that these will need to be actively pursued and nurtured, and require evidence to ensure the best possible outcomes.
● Clark M (2011). Mental health care clusters and payment by results: considerations for social inclusion and recovery. Mental Health and Social Inclusion, 12(2):71-77
● Samsi K, Manthorpe J & Rapaport P (2010). As People Get to Know It More: Experiences and Expectations of the Mental Capacity Act 2005 amongst Local Information, Advice and Advocacy Services. Social Policy & Society, 10(1):41-54
● Sharac J et al (2011), Enhancing adoptive parenting: a cost-effectiveness analysis. Child and Adolescent Mental Health, 16:110-115.
● Wilberforce M et al (2010), Towards integrated community mental health teams for older people in England: progress and new insights. International Journal of Geriatric Psychiatry, 26:221-228.
School for social care research
The School for Social Care Research, which was set up in 2009, has commissioned new studies of adult social care practice in relation to people with mental health needs. Findings will emerge over the next two years to support improvements in practice. Full details of currently commissioned projects are available on the SSCR website.
DIGEST OF THE DIGEST
The government published its mental health strategy in February 2011, with many of its recommendations built on research evidence. Policy and practice continue to evolve at a rapid pace. But the evidence base on service organisation and prevention remains under-developed compared with the volume of clinical evidence on treatment. Among the studies published in the last year, we highlight a few of particular interest.
Michael Clark is research programme manager at the School for Social Care Research, London School of Economics. Martin Knapp is professor of social policy and director of SSCR, London School of Economics
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This article is published in the 3 November 2011 edition of Community Care under the headline "Organising mental health services"