Changes to mental health care proposed

BMJ 1997; 314 doi: (Published 08 February 1997) Cite this as: BMJ 1997;314:393
  1. John Warden, parliamentary correspondent
  1. BMJ

    Britain this week began a search for better ways to treat mental illness in the community with the publication of a green paper, Developing Partnerships in Mental Health. Recent homicides committed by people with mental illness have both raised public concern and exposed shortcomings in the present system of care in the community.

    The government, while not abandoning the concept of care in the community, has now put forward four options to be considered by a new administration after the coming general election. Comments on the document are sought by 9 May, which will be after a new government is elected.

    The four options, which would remove the division between health and social care for adults with severe mental illness, are:

    • The formation of a new mental health and social care authority, accountable directly to the health secretary and using ring fenced government funds. It would be neither a health nor a local authority but would need to work in association with both. The new type of authority would cover populations of between one and four million people

    • The designation of either health authorities or local authorities as a single agency for mental health and social care. Health authorities are the most likely choice as they spend more on mental health care

    • The establishment of a joint body by health and local authorities to provide services. It could cover the area of more than one present authority

    • The delegation of particular functions or responsibilities by health and local authorities to each other. For example, a health authority may decide to delegate the purchasing of mental health services to a local authority, accompanied by the necessary funds.

    The government says that it is open minded about which, if any, option should be adopted. Retaining the present framework, with minor changes, remains an option, although existing structures may present barriers to progress.

    The aim is to deliver mental health and social services that are seamless and effective. But before embarking on structural change, the government says that it would need to be convinced that the effort and cost required were justified.

    Health minister Stephen Dorrell said: “Some health authorities and local authorities are already working successfully together. But there continue to be too many cases where cooperation between health and social services is not sufficiently close to deliver high quality mental health care.” He added: “Successful joint working is often crucial to deliver high quality mental health care.”

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