M ental I llness C oncerns A ll	The three core services in mental illness - psychiatry, social work, and psychiatrist, have moved apart, and retreated into their own separate habits - the same background - yet again. (see Inquiry Review Lingham; Sinclair) p19 Reorganisation was occurring at all levels. Regional, Authority, Trust, and LA Social Services. Social Services were focussing on severe and enduring mentally ill and post-detention after care support, but 'the lack of any effective joint working mechanisms prevented joint developments'. The Panel considers that when things become difficult 'each service will retreat into what it knows best'. 'Many managers were reapplying for their jobs a second and a third time'. Key relationships for collaborative working were underdeveloped. 'At times, the Panel is doubtful if some staff even knew who their current employer was'. Management changes have removed psychiatry from a lead position, and no one has taken the place. Family doctor involvement has quit the field. General Practice family doctors had acquired 'fundholding' and were using community mental health nurses to hold minor mental health. This ' may have caused the Day Unit to lose focus and impacted on the medical oversight of patients on case loads'. Retraction of the services provided by the mental hospital was not replaced by effective community working. ' Management appeared to worry about buildings and obtaining capital funds .. resulting in lost opportunities for visionary thinking about community based models of mental health service' ... the consultants appeared to be poorly involved in the thinking and planning of new services ... ... Up to retraction the family doctors held the services provided in good regard, with good relationships with the consultants. Out-patient appointments waiting were not too long; domiciliary consultation readily available ; no problem with securing a 'bed' for admission.... Initiative concerning the Care Programme Approach was at a central administrative level ...' that resulted in a lack of ownership of the process by the consultants,amongst others'. Difficulties in recruitment meant a regular use of locum consultants, less likely to be committed. Community mental health nurses were transferred from a hierarchical and supervised hospital system to an environment where this was missing, and they worked largely autonomously. When you break up arrangements that were working, everybody becomes vulnerable. Including patients. Back to Inquiry Galbraith; 'T'	E-mail reaction is welcome mica@didgy.freeserve.co.uk

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