The balance between giving a patient individual attention , and giving proper regard to the supporting background , which sometimes requires concern for confidentiality set against against the need for information , is sometimes difficult to get right , yet it is often crucial that the difficulty is resolved , in continuing care practice .
The system helping B. did not have this built-in facility .
Day centre work , out-patient attendance , and social services mental health were all conducted separately with no accustomed linkages .
Nobody had charge of the care of B. He saw different junior doctors who changed frequently .The mother was shut out except when she pushed her way in to the professional support service .
The Griffiths and Seebohm reforms in the National Health Service and Local Authority Social Services management structures led to hierarchical changes and an inward withdrawal into linear supervision . Customary 'lateral' exchanges between the three core professions in mental illness - psychiatry , social work , and community mental health nurse faltered . Natural arrangements were lost in reorganisations .
A later Inquiry highlights this . [Lingham; Sinclair]
That Inquiry Report describes the situation before Social Services Department management changed .
....... " The consultant , the social worker for the catchment area and the community mental health nurse , all met at the out-patients , and at mid-morning break , brought each other up-to-date , and settled outstanding matters . The consultant and his junior staff brought with them any in-patient affairs "......
But after re-organisation the Social Services developed its own system of mental health community teams. Although in the same building, the community nurse in the Health mental health team had no formal nor much informal contact with her . The nurse was attached to a family doctor surgery and lost her regular familiarity with the Consultant , who had not changed his routine to add on community work. She attended in-patient ward rounds , but did not always see the consultant .
Information known to one of them could not be got across in time. There was no 'up and running' regular meeting where all became familiar with each other; and with the limitations , habits, and abilities of each other at their work .
( Inquiry 13. Lingham:Sinclair )
The dissolution of good previous working teams, teams that had built-up relationships in regular work-face sharing and meeting, is the final theme in this examination of the mental health services.
...what time had brought effectively together no management should lightly have put asunder ...
E-mail reaction is welcome
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