APPENDIX 7
Memorandum by the National Development
Team (MH 24)
PROVISION OF
NHS MENTAL HEALTH
SERVICES
The National Development Team was established by
the Secretary of State for Health in 1976 to provide a lead to
services for people with a learning disability. Twenty four years
of consultancy work with health and social care providers have
brought us into frequent contact with NHS mental health services.
Our observations include the following.
Firstly, care routinely consists of one or more
standard items from a fixed menu of options, rather than being
designed to meet the unique needs of the individual. This results
in a poor fit between personal need and the services provided,
which wastes scarce resources and increases risk. A further consequence
of this menu-based approach to care is the tribalism of service
providers. For example, our recent survey of the mental health/learning
disability interface at 30 NHS trusts found shared care and effective
collaboration to be extremely rare. Similar difficulties occur
at all the boundaries of the mental health service (addiction,
adolescent, elders, forensic, psychotherapy and rehabilitation).
A variety of changes are required to shift mental health services
from "menu-based" thinking towards "person-centred"
approaches.
Secondly, people with mental illness hold ordinary
ambitions—to a decent home, a job and the opportunity to
contribute to community life. Meanwhile, mental health services
spend almost no time at all in building links with housing providers,
employers or informal community members. Instead of creating artificial
alternatives such as sheltered workshops in place of real jobs,
the mental health service needs to develop effective alliances
with partners in the community. Projects do exist which support
mentally ill people in real jobs and at college, in sports centres
and the museum, as volunteers and at the community centre. However,
these projects are marginal, poorly funded and insecure. Moving
them into the mainstream would provide hope and a future for people
who at present have little identity beyond their mental health
status.
In summary, mental health services would be
more effective, safe and efficient if care packages were tailored
to the individual and support was provided for people to have
a positive life in the community.
February 2000
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