The development of Community Mental Health Centres in the U.K.

Abstract

This paper describes a survey of British Community Mental Health Centres (CMHCs). CMHCs are by far the most visible manifestation of the implementation of community mental health care policies of the 1980s. While these centres have demonstrated achievements in terms of accessibility, co-ordination and responsiveness to clients, they have also been bedevilled by ambiguity. The vast majority of CMHCs aim to serve the needs of all forms of mental illness within their catchment area, yet in practice, they have frequently failed to meet the needs of people with long term severe disorders and concentrate instead on providing assessment and counseling services for neurotic and transient situational disorders. It appears that this is a function of an early failure of multidisciplinary teams to delineate boundaries and priorities. If the British CMHC movement sharpens its focus and combines this with a determination to address the complexities involved in both rationing and enhancing choice, it could begin to improve upon rather than simply repeat the history of similar developments in America.

Clients' perceptions of outcome following contact with a community mental health team

“…By contrast, psychotic sym ptom s or disorders were stated as the reason for referral in only 3% of cases, with 14% eventually diagnosed as having a psychotic disorder. This is in line with the reported experience of other CMHTs, where the main call on the service by referring agencies is for assistance with the less severe form s of m ental health problem (Sayce et al, 1991). However, as the diagnostic breakdown of the CMHT' s on-going caseload demonstrates, nearly half have a psychotic disorder, so the team is targeting its resources on the m ore severely ill.…”

“…For m ost CMHTs, being `com prehensive' usually m eans providing a limited range of services to a broad range of people (Peck, 1995), and assistance is often not provided with problems in the areas of housing, finances, etc. In one survey of Com m unity Mental Health Centres, only 8% gave any help with employm ent, finance or accomm odation issues (Sayce et al, 1991). To Downloaded by [University of Otago] at 15:01 20 July 2015 what extent does this approach to comprehensive service provision meet the needs of those referred for help?…”

“…There has been substantial growth in the num ber of m ulti-disciplinary com m unity m ental health teams (CMHTs) in the United Kingdom over the last 15 years (Patmore & W eaver, 1991;Sayce et al, 1991). Early Com m unity Mental Health Centres operated as auxiliaries to the m ainstream psychiatric services, but with the closure of the old m ental hospitals, they have increasingly becom e integral com ponents of these m ainstream services, often being the local base and first point of referral for the sector served.…”

Running an effective community mental health team

“…Community care also reduces the number of days patients stay in hospital, but not the number of admissions (Marshall et al, 1995). However, community mental health teams (CMHTs) have been criticised for their ambiguous and overambitious aims, and their tendency to neglect people with the most challenging health-and socialcare needs (Patmore & Weaver, 1991;Sayce et al, 1991). All mental health workers are not necessarily eager, or skilled, to work effectively in teams.…”

Complexity and Change in the United Kingdom's System of Mental Health Care

“…Initially termed community mental health centres (CMHCs) in the style of their United States predecessors, CMHT numbers doubled every two years throughout the late 1980s (Sayce et al, 1991). By the early 1990s over 500 were in existence in England (Onyett et al, 1994).…”