Tuesday 11 May 2010

What about the CMHTs?

There is much discussion in the mental health community about mental health promotion (informing the public about how to maintain their own - and look out for others’ – mental health) but, important though such matters are, they are not the priority issue and they impact relatively little on the front-line of secondary mental health services delivered in hospital and in the community which require at least 80% of the resources available for mental health services.

There is a less public but important debate among people concerned for secondary services in Wales about how to structure services delivered in the community. This debate can be illustrated by reference to the Welsh Assembly Government’s project to identify required practice and standards for services delivered to those who first experience psychosis. Hafal’s Sue Barnes and Keith Jones have been centrally involved in this important discussion, representing the patients’ and families' perspective and winning ready acceptance by colleagues involved in the project of the importance of an holistic approach to care planning. More contentious has been the strong inclination of many involved in the project to propose separate, specialist teams to deliver these services, based on studies of existing services and the compelling logic that if you want something done then having a team specifically dedicated and accountable for the required action will be most effective. But Hafal’s members and clients have always supported the concept of a single, but expanded and well-resourced Community Mental Health Team taking on and delivering new standards: the advantage of this approach would be efficiency and flexibility for the service and (more importantly) a consistent, familiar service for patients at the early stages, in the longer-term, in crisis, etc, rather than getting referred between different teams. All credit to those handling this project (Les Rudd from NLIAH in particular) that the different options for delivery of these vital new standards have been acknowledged. There is not much on this yet in the public domain but I understand that the guidance will be going out for consultation soon: keep an eye on the Mental Health Wales news.

I suspect that underlying this debate there is an unspoken belief by some conscientious managers seeking real change that CMHTs may not really be up to the job, won’t change, and so can’t take on and deliver new standards even if they were given the resources. Let’s be frank, this will be true of some CMHTs, even though there are many dedicated staff working over and above the call of duty to deliver the rather thankless and forgotten duties of CMHTs. Little wonder given the history of restricted resources and the recruitment of many keen and able CMHT staff into those specialist teams! Our Members are certainly well aware that morale is low among many CMHTs not least because their staff feel left out of the "sexier" new services which are more likely to attract resources. The Assembly Government is also looking at the role of the Teams but I am not sure that the key challenge of constructing an integrated community mental health service is being addressed nor the pressing need to respect and, yes, expect much more of the CMHT function.

I can’t conclude this point without reference to a yet more fundamental matter. All such community (and indeed in-patient) services need to be subordinate to the individual care plans of clients who should have maximum control over choosing – or indeed commissioning – a bespoke package of holistic treatment and care designed for them personally: see here what users want.