Academic journal article Care Management Journals

Variations in Care Management Arrangements for People with Mental Health Problems in England

Academic journal article Care Management Journals

Variations in Care Management Arrangements for People with Mental Health Problems in England

Article excerpt

Since 1989, government policy in the United Kingdom has advocated that social services providers develop care management systems in order to deliver coordinated and individually tailored packages of care to all user groups. This cross-sectional postal survey describes national variations in care management arrangements for people with mental health problems in England on 14 key indicators developed from previous research. One hundred and one social services providers (response rate: 77%) completed two questionnaires: The first related to care management arrangements for all user groups, and the second related specifically to arrangements for people with mental health problems. Significant national variation was found. Furthermore, there was little evidence of integration between health and social care, of care management being delivered through specialist multidisciplinary mental health teams, and of selective arrangements targeted at those most in need. The results are discussed in the context of apparently widespread disparity between existing care management arrangements and government policy guidance.

Keywords: community care; social services; care coordination; integration

The development of effective community care for adults with mental health problems has been a long-standing goal, particularly after the acceleration of "dehospitalization" in the United States and United Kingdom in the 1950s. In the latter, policy initiatives were related to the closure of long-stay asylums for people with mental health problems (Department of Health and Social security, 1981; "A Hospital Plan for England and Wales," 1962), together with the development of community-based services for this user group. In particular, emphasis was placed on the development of specialist multidisciplinary teams, known as community mental health teams (CMHTs), spanning health and social care and predominantly comprising social workers and nurses ("Better Services for the Mentally 111," 1975; "Caring for People," 1989; Department of Health and Social security, 1981, 1983). Recent guidance has introduced a number of initiatives designed to improve the range of statutory and voluntary services available in the community for people with mental health problems, together with mechanisms to improve their coordination across the health and social care interface. Their aims have been to develop services to avoid unnecessary admissions to hospitals, to strengthen arrangements promoting timely and safe discharges from hospitals, and to improve the coordination of community services in order to prevent people with long-term mental health problems from "falling through the net" of multiagency support (Department of Health, 1994a, 1994b, 1995a, 1996b, 1999a, 1999b, 1999c; "Modernising Social Services," 1998; Smith, Kingdon, & Peck, 1996). However, despite initiatives to promote greater integration of health and social care (Department of Health, 1999b; "The NHS Plan," 2000), social care continues to be provided predominantly by local government and includes social workers, day care, and domiciliary care. Health care is provided by the National Health Service (NHS), with community services provided by nurses, doctors, and other allied professions. The Care Programme Approach (CPA) was introduced to provide a framework for effective mental health care prior to the introduction of care management (Department of Health, 199Oa) and has subsequently been integrated with care management to provide a single care coordination approach for adults with mental health problems (Department of Health, 1999a). It is within this context that care management (or case management, as it is sometimes known) has developed for people with mental health problems in England.

At their inception, the objectives of care management were the effective use of available resources; the promotion of independence by restoring or maintaining people in the community; the prevention and minimization of the effects of illness or disability; the provision of equal opportunities; the promotion of individual choice and self-determination; and the promotion of partnership between users, carers, and service providers (Department of Health, 199Ob). …

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