Warning over 'third way' for mental health

The government says community care has failed many patients

The government's mental health policy - dubbed the "third way" - may create unrealistic expectations, health managers have warned.

The Institute of Health Services Management (IHSM) says government statements that the policy of closing big hospitals and treating people in the community has failed may create false expectations among mental health workers and users.

"In practice there needs to be an understanding that mental illness is still largely managed and manageable in the community," it says in a paper published on Thursday.

It adds that government strategy appears to contradict itself.

On one hand, it is encouraging patients' independence, it says, and on the other it seems to be moving more towards an institutional approach to care.

"Managers will find themselves grappling with competing principles," it warns.

Funding

The IHSM is also worried that the strategy may not be backed by long-term funding - a concern shared by some other mental health organisations.

The government has pledged £700m for its new mental health policy over the next three years.

It includes a promise to increase outreach teams and mental health beds.

The government is also revising mental health legislation and is expected to promote the compulsory use of medication by community care patients.

When he launched the strategy, Health Secretary Frank Dobson said: "As a totality the system of care in the community has failed because it failed in the most difficult circumstances.

"You cannot claim success for an arrangement which fails in a crisis."

The government was responding to concern following media reports about community care patients who have attacked and, in some cases, killed members of the public.

Missed opportunities

The IHSM says it wants the new mental health strategy to succeed, but inadequate resourcing in the past and poor implementation has led to "disillusionment" among staff.

It is also concerned that opportunities for partnerships between the new primary care set-up and mental health services have been missed.

With regard to other partnerships, it warns that managers should ensure they are not an end in themselves, but actually improve services.

Results should be measured not only in terms of clinical improvements to health, it says.

And imaginative ways of reducing stress and isolation experienced by staff need to be looked at.

The IHSM is holding a national conference on new ways of working in mental health in May.