Draft mental health report says there is still much to be achieved

The draft report is critical of many elements of the mental health services, writes Martin Wall.

The draft report is critical of many elements of the mental health services, writes Martin Wall.

There have been major developments in the provision of services for patients with mental illness since the last official national policy was produced 20 years ago.

A number of the old psychiatric hospitals have closed as patients increasingly receive treatment in general hospitals or in the community.

However a final draft of a new policy report, drawn up for the Government by an expert group, is highly critical of many elements of current mental health services and indicates that there is still a lot to be done.

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The draft report maintains that the implementation of the 1984 blueprint has been incomplete and patchy around the country.

It warns that despite developments in community services, many of the features associated with the 19th- and 20th-century model of institutional psychiatry still remain.

"While services are notionally based on sectors [ in the community], the hospital still remains the dominant site from which services are delivered," the draft report states.

"In-patient units still dominate in the mind-set of care delivery. The catchments of the former mental hospitals are still extant in many areas despite quite dramatic social and demographic changes."

It maintains that the resources available in the current catchments are reflective of the resources provided historically to the hospitals that served them.

"The situation has been reached where there are now gross disparities of resources across different catchments of the country," it says.

The draft is also strongly critical of the current management structure in many catchments which is made up of a clinical director, a director of nursing and a hospital administrator.

It says that this system had obvious applications to a hospital-based system but that it has been less effective in the development and management of dispersed community-based and increasingly multi-disciplinary services.

"Interest and competency in the planning, management and evaluation of services has varied greatly in these small management teams resulting in quite substantial catchment variations in the degree of competency in service management."

It adds that there has been little imperative for existing catchments to match each other in the quality of care provided and that patient choice of service use has been unduly curtailed.

The draft report will be considered by the expert group later this month and the final document is then expected to be submitted to the Department of Health.