Developing community mental health services: an evaluation of Glasgow’s mental health resource centres

Abstract

Greater Glasgow Health Board's strategy for the development of community mental health services includes the establishment, over a 7-year period, of multi-disciplinary community mental health resource centres throughout Glasgow. An evaluation of the first phase of the development was carried out in three resource centres. This focused on three key themes: the establishment of multi-disciplinary teams, targeting of those with the most severe illnesses and the participation of users in the care process. The evaluation exercise comprised five substantive elements: analysis of the clinical database; interviews with staff within each of those centres, interviews with representatives of key external agencies associated with each centre; a survey of general practitioners; and a survey of the views of clients, their carers, their key workers, and their general practitioners (GPs). Clients were generally very satisfied with the services and felt that the resource centres met all their mental health needs. Although the majority of current centre cases had severe mental illnesses and those with the more severe conditions had the highest contact rates there was evidence that in the absence of a clear framework for referral the centres were also providing services for those with less severe illnesses. Despite a wish by centre staff to move towards modes of working less dominated by health professionals and more inclusive of other resources and especially of clients themselves, these goals remained to be achieved: there was a lack of clarity in the definition of the appropriate target groups for the centres; access to crisis support was regarded as problematic; the concept of multi-disciplinary team working had yet to be fully realized with evidence suggesting that some psychiatrists working in the resource centres had not embraced many aspects of the new approach to service delivery including a focus on the severely ill; and progress towards the ideal of active client involvement had been slow.

Collaboration and local networks for rural and remote primary mental healthcare in South Australia

“…The teams indicated that this caused tension about whether they should service these clients because of their own limited resources and because of a lack of referral synergy with other service providers in the system. Studies in the UK have found a similar tendency: when community mental health teams were aligned to work under a primary mental healthcare approach, then the team caseloads became skewed to servicing those with less severe illness (Hannigan 1999, Martin et al . 1999, Murphy et al .…”

Perspectives of day and accommodation services for people with enduring mental illness

“…Where staff actively facilitated users to develop strategies for self-management, creating networks of support specific to each user, the day service appeared to be more successful. In contrast, a more general study by Martin et al (1999) illustrated that passive roles alienated users and staff. This study used multiple methods to examine community mental health services provided in Glasgow and concluded that, whilst users were satisfied with services in general, a lack of coherent joint working between staff groups prevented user empowerment, especially in relation to power and control over decisions.…”

“…In particular, it is imperative to ensure users have means of negotiating their own care packages via the Care Programme Approach and have means of influencing the configuration and provision of services (Bond 1999). Not only do they have views but they are also keen to be involved in the change process and are aware of how they could be facilitated to do so reflecting the views of the users in Martin et al's (1999) study.…”

“…All participants recognised that staff skills in supporting users were central to the success of services and that there was a need for improved staff training. Focusing this around encouraging user participation could benefit users and staff (Martin et al 1999).…”

Initial Assessment and Eligibility for Secondary Care Mental Health Services: Not a Simple Equation

“…More recently, the Royal College of Psychiatrists (2005 p6) referred to CMHTs as the 'backbone' of community mental health services, noting that augmentation rather than replacement was their likely future. Nevertheless, three main concerns have traditionally hindered their development: the threat of genericism (Huxley, 1995), the interdisciplinary versus multidisciplinary divide (Peck & Norman, 1999) and professional self-interest, in particular the reluctance of some consultant psychiatrists to adapt to team working (Martin et al, 1999). The competency-based role ascription recommended in New Ways of Working for Everyone (NWW) (DH, 2007) adds a new element to how CMHTs can best use their internal resources.…”