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M
ental
I llnessC oncernsA ll
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? The Inquiry appends the 1991circular originating the Care Programme Approach. It carried the appending coda .... " Health authorities are expected to meet any health service costs arising from the introduction of more systematic procedured form within existing resources. Introducing the care programme approach places no new requirement to provide services either to health or social services authorities.
..but social services will have available specially targetted resources through the new specific grant to be used in ways agreed with the relevant health Authorities. " This Inquiry report recognises longstanding underfunding. It is difficult for the poor to get out of the mess they are in from their own overstretched resources. Changes cannot be accepted as possible. The T.A.P.S programme which emptied two North London mental hospitals started out with one whole years bonus money, and at the end of ten years still had not substituted an adequate admission service nor substituted an 'activity' programme which the hospitals had provided. Here the three core services - nurse, social work, psychiatrist seem to have gone their separate ways. They had developed, and fallen back into, their own independent management systems and hierarchies, without taking into practice that mentally ill patients require an approach which leans heavily on face to face settling between services, and relies on report and observation from a community source, from access to a supporting companionship which allows the patient to endure.
Professional contact with that cocoon was absent here. What is also missing is a clear psychiatric decision making process that wrapped together patient care, giving the clinical lead and maintaining that until supporting forces were in place. That authority seems to have lapsed. He needed to be eased out of his current companionship and accompanied into another sort. Always we remember Lingham/ Sinclair
- the weekly attendance at out-patients of community nurse, social worker, psychiatrist - which allowed a proper appreciation of each other to develop, a system of review and renewal which arose naturally out of the traditional care alliance. The response of the Authority has been a substantial catching up of funding with additional psychiatric posts. There is to be pooling of mental health service monies between NHS and LA Authorities in this delivering Trust. Whether this will lead to sufficent working together will await the system in practice. This website has insisted that the regular meeting together of all three cores - nurse, social worker, psychiatrist - at sufficient seniority - is necessary to provide the mutual supervision of service delivery.
The Authority is to be praised for setting up a dated reappraisal of what progress there has been in working practice and an independent oversight.
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