Mental health policy reforms and case complexity in CMHTs in England: replication study

Huxley, Peter; Evans, Stephen; Munroe, Maria; Cestari, Leticia

doi:10.1192/pb.bp.107.015792

Cited by 4 publications

(3 citation statements)

References 13 publications

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“…These multi-disciplinary teams may consist of community psychiatric nurses, occupational therapists, psychiatrists, psychologists, psychotherapists, social workers, housing workers, welfare rights workers and Support, Time and Recovery (STR) workers who aim to provide companionship and friendship and support with daily living. CMHTs generally support patients with time-limited disorders who are then referred back to their general practitioner (family doctor) when the condition has improved after treatment, though an increasing number provide care for people with chronic and severe mental health problems [ 21 ].…”

Section: The Care Programme Approach In Englandmentioning

confidence: 99%

Integrating care for people with mental illness: the Care Programme Approach in England and its implications for long-term conditions management

Goodwin¹,

Lawton‐Smith²

2010

Int J Integr Care

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IntroductionThis policy paper considers what the long-term conditions policies in England and other countries could learn from the experience of the Care Programme Approach (CPA). The CPA was introduced in England in April 1991 as the statutory framework for people requiring support in the community for more severe and enduring mental health problems. The CPA approach is an example of a long-standing ‘care co-ordination’ model that seeks to develop individualised care plans and then attempt to integrate care for patients from a range of providers.Policy descriptionThe CPA experience is highly relevant to both the English and international debates on the future of long-term conditions management where the agenda has focused on developing co-ordinated care planning and delivery between health and social care; to prioritise upstream interventions that promote health and wellbeing; and to provide for a more personalised service.ConclusionThis review of the CPA experience suggests that there is the potential for better care integration for those patients with multiple or complex needs where a strategy of personalised care planning and pro-active care co-ordination is provided. However, such models will not reach their full potential unless a number of preconditions are met including: clear eligibility criteria; standardised measures of service quality; a mix of governance and incentives to hold providers accountable for such quality; and genuine patient involvement in their own care plans.ImplicationsInvestment and professional support to the role of the care co-ordinator is particularly crucial. Care co-ordinators require the requisite skills and competencies to act as a care professional to the patient as well as to have the power to exert authority among other care professionals to ensure multidisciplinary care plans are implemented successfully. Attention to inter-professional practice, culture, leadership and organisational development can also help crowd-in behaviours that promote integrated care.

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Section: The Care Programme Approach In Englandmentioning

confidence: 99%

Integrating care for people with mental illness: the Care Programme Approach in England and its implications for long-term conditions management

Goodwin¹,

Lawton‐Smith²

2010

Int J Integr Care

View full text Add to dashboard Cite

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“…The data-collection proforma was based on a modified version of the Matching Resources to Care (MARC-2) instrument, which encompasses the main items characterising severe mental illness specified in the academic and policy literature 11 , 12 . The majority of data (over 40 items), including the Health of the Nation Outcome Scale (HoNOS) 13 and other items utilised within the Mental Health Clustering Tool, 14 were extracted from the Trust's electronic record system by National Health Service (NHS) information technology staff and, where data permitted (just one or two items were missing), multiple imputation was used to fill missing HoNOS values.…”

Section: Methodsmentioning

confidence: 99%

“…Focusing on the multidisciplinary groups' recommendations, four case types (33, 35, 36 and 37) were overwhelmingly perceived to be most appropriately treated in hospital, and the majority of groups also recommended in-patient care for a further three (7, 39 and 40). In contrast, if enhanced community services were available, five case types were unanimously perceived to be more appropriately supported in the community (11,12,32, 47 and 48), and the vast majority of groups favoured community care for a further two (15 and 16). Views about the remaining three (3, 13 and 31) were more mixed, albeit most groups favoured community care ( Table 3).…”

Section: Alternative Care Optionsmentioning

confidence: 99%

Reconfiguring in-patient services for adults with mental health problems: changing the balance of care

et al. 2018

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BackgroundResearch suggests that a significant minority of hospital in-patients could be more appropriately supported in the community if enhanced services were available. However, little is known about these individuals or the services they require.AimsTo identify which individuals require what services, at what cost.MethodA ‘balance of care’ (BoC) study was undertaken in northern England. Drawing on routine electronic data about 315 admissions categorised into patient groups, frontline practitioners identified patients whose needs could be met in alternative settings and specified the services they required, using a modified nominal group approach. Costing employed a public-sector approach.ResultsCommunity care was deemed appropriate for approximately a quarter of admissions including people with mild-moderate depression, an eating disorder or personality disorder, and some people with schizophrenia. Proposed community alternatives drew heavily on carer support services, community mental health teams and consultants, and there was widespread consensus on the need to increase out-of-hours community services. The costs of the proposed community care were relatively modest compared with hospital admission. On average social care costs increased by approximately £60 per week, but total costs fell by £1626 per week.ConclusionsThe findings raise strategic issues for both national policymakers and local service planners. Patients who could be managed at home can be characterised by diagnosis. Although potential financial savings were identified, the reported cost differences do not directly equate to cost savings. It is not clear whether in-patient beds could be reduced. However, existing beds could be more efficiently used.Declaration of interestNone.

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Audit as discovery: context and complexity in secondary-to-primary care mental health service users

Firth¹,

Powling²,

Witter³

2012

Journal of Social Work Practice

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Mental health policy reforms and case complexity in CMHTs in England: replication study

Cited by 4 publications

References 13 publications

Integrating care for people with mental illness: the Care Programme Approach in England and its implications for long-term conditions management

Integrating care for people with mental illness: the Care Programme Approach in England and its implications for long-term conditions management

Reconfiguring in-patient services for adults with mental health problems: changing the balance of care

Audit as discovery: context and complexity in secondary-to-primary care mental health service users

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