The co-ordination of mental healthcare for users should be outsourced from social workers and NHS colleagues to the third sector to improve the independence and creativity of support.
That was a key conclusion from a report today on reforming mental health from the Centre for Social Justice, the think-tank set up by work and pensions secretary Iain Duncan Smith.
Currently, patients who receive specialist care under the Care Programme Approach have their care managed and brokered by “care co-ordinators”, typically social workers or NHS professionals working for mental health trusts.
However, the report said this created a conflict of interest on the grounds that trusts provide services directly, and backed giving this role to voluntary sector organisations that did not themselves provide services.
It said third sector organisations often had a more holistic appreciation of service users’ wider social, as well as clinical, needs, and may be better able to source creative support for people, compared with trust co-ordinators.
“The voluntary sector ‘army’ that would be required would be composed of many people who are already embedded in service provider organisations, but who would have to be willing to leave those bodies to establish or join truly independent entities,” the report said.
The report admitted that there were doubts among NHS healthcare workers that the voluntary sector would be capable of fulfilling the care co-ordinator role because of the required levels of skill, sensitivity, experience and awareness of services available.
The Centre for Social Justice said this challenge could be overcome though, as “these skills can also be found outside the NHS”. The report did acknowledge the need for “an extended period of transition” in implementing such a change to build capacity in the voluntary sector.
However, it concluded: “Such a move is essential if people are to receive not only specialist treatment, but also all the other support and care they need to reduce their dependency and help them fulfil their potential.”
Steve Shrubb, director of the NHS Confederation’s Mental Health Network, said there was scope for greater third sector involvement in mental health services.
“My network is broad church, so I need no persuading that there’s no one organisation that can solve all the problems,” he told Community Care. “You need different organisations working in different ways and we need to focus on co-operation and partnership as much as on altering the marketplace.”
The report also recommended an increased use of personal budgets within mental health services to ensure that funding “seamlessly follows the patient”.
It also highlighted concern about community treatment orders (CTOs), introduced under the Mental Health Act 2007, where patients are required to comply with certain conditions while living in the community. The report said the process around CTOs was unclear to the point that a number of patients did not even realise they were subject to an order. Some patients were also being discharged from hospitals on CTOs without consultation with community teams, who would need to monitor compliance with the orders.
The centre backed previous calls from mental health leaders for a review of the Mental Health Act 2007 after a “sensible waiting period”.
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