No evidence was found to support the hypothesis that the establishment of the registers had improved CMHN targeting of patients with SEMI. However, findings were inconclusive because shortages of CMHNs and the disruption associated with widespread service reorganization meant the registers were never fully implemented in practices during the study period.
Government policy to reduce social exclusion focuses on increasing employment opportunities and incentives, especially for disadvantaged groups. This paper discusses the ndings of an evaluation of a project in the North West of England for people with learning dif culties, which sought to create opportunities for paid and/or integrated employment. The ndings suggest that this goal can be undermined by many factors such as the isolation of social care services from employers and the disinclination of service organisations to include users, carers and staff in the development of new service approaches. Social welfare policies also mitigate against this aim, by failing to enable providers to translate the rhetoric of social inclusion into a reality. We discuss some of the obstacles preventing people with learning dif culties from inclusion into mainstream employment, by considering their impact upon the achievements of the North West project.
As the focus of mental health care has shifted from the hospital to the community, so the importance of effectively targeting resources on those with the greatest need has become paramount. One approach to identifying and targeting people deemed to have severe and enduring mental health problems is the establishment of mental health case registers at primary care level. This paper raises a number of conceptual issues associated with these registers and, on the basis of the available literature, offers suggestions to guide those who are contemplating their introduction.
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