The NHS is divided into three systems of service delivery.
1. the Primary Service = the GP based service -
These days they work to contracts agreed between them and your local NHS Primary Care Trust [ PCT ].
The PCT receives funding allocated to it from Central government through the Department of Health.
The PCT then decides what the local NHS Needs to commission for good service , and then contracts to commission it from a provider Trust: here for psychiatry - the local Mental Health Trust - the Trust Teams you will meet [ and contend with ] , that then delivers a service to provide, in a Care Plan, for those Needs to be met and delivered to the person you are caring for and about.
Remember - if not in the decision of your Primary Care Trust as to what is mental health NEEDs - then not funded = not commissioned = not delivered.
Crucially what is the experience , the priorities in the mind of the mental health advisor in your local Primary Care Trust
{ for example, my local PCT advisor said there are more numbers of people with the less serious mentally ill than those with schizophrenia ... backed up by ... and a lot of those are depressed - that comes into the category of serious mental illness - if we - and our customers the GP's say, choose to say so.
One weakness in the GP Contract agreement is the OUT-of-Hours system which is no longer offered by your local GP , but contacted out to agencies.
Another is the lack of experience and confidence of many family doctors in the care of the serious and and enduring mental illnesses. That is important because they are the gatekeepers to the specialist Service ... and they are bothered more by the 'worried well' whom they NEED to pass on to the counsellor service - funded a mental health service.
2. The Secondary Specialist layer of service - hospital based. Here it is your local Mental Health Trust
If you are internet and table literate with linking you can
try this service mapping website to find out the services provided for your Mental Health Trust geographical area ... compare them to other areas [ e.g. supported housing has wide variation: Dorset lots, ]
Or for your local Mental Health Trust
{ go to LIT - provider Trust area , under service group, tick 'all services' then, at bottom, click RUN REPORT
and ; or in a particular service type ... try 'continuing care' ...type ... Rehabilitation and Recovery services - the after-care service ]
In mental health delivered by th local Mental Health Trust through it's much reduced hospital admission facility, and it's community service provision.
Gp's will largely go to the Community mental health team in any difficulty or puzzlement. There the potential patient [ and carer usually - problems with confidentiality and privacy may start here ] is seen by a Team member at a convenient time and place for Assessment
and whether the Team as a whole will take on further care and treatment
The first contact team member is not necessarily a psychiatric doctor; perhaps more usually a nurse team member [ of varying experience - ask about that and what grade; but can be a social worker
[
One local description of Crisis/Home Treatment Teams
There was a wide range of team staffing levels (includes part-time) from 11.7
– 37.5,
with patient episodes varying from 284 – 900. Given DoH on staffing (15
per 150,000 population with 300 patient episodes) only 50% of teams had
sufficient staffing. This was lower than the reported results in the National
Survey (88%).
Wessex Crisis Teams' Composition when compared to the National Survey had
similar input from Nurses (100% vs 98%),
higher input from Support Workers (100%
vs 70%),
Approved Mental Health Professionals (83% vs 49%),
OTs (50% vs 30%) and
Psychologists (50% vs 8%).
When comparing medical staff input 100% of teams had medical input.
The
proportion composition found was 8.6% which is higher than the 5.2% previously reported
Of these 100% of teams had consultants of which:-
83%
(five teams) had dedicated consultants with other medical staff
and 50% (three
teams) had dedicated non consultant staff.]
When the secondary service or the Courts are concerned about safety and danger, and/ or believes a long term solution is required, the patient under a Mental Health Act Order may be transferred to the tertiary NHS Service
3. Tertiary - a Regional Medium Secure Unit, or a Secure Mental Hospital [ Ashworth in Liverpool, Rampton in th Nottingam area, Broadmoor near London. ]
The Primary Care Trusts seem to favour the general health service before the psychiatric services.
In stringent times money may go from mental health to make up for overspend on general service ....follow the A-Z publication Sainsbury mental health charity Report Sainsbury: Publications A-Z ...go to U nder Pressure; and ... S pending 2008 ....Still at it Most government cash set aside to help carers has not reached the frontline.
Data from two charities, the Princess Royal Trust for Carers and Crossroads Care, has revealed .
80% of the funding pledged by the Government last year has not been allocated or has been spent elsewhere.
The Government gives money to PCTs but often does not ring-fence it, meaning PCTs sometimes spend it on other things.
Care services minister Phil Hope has suggested MPs should help ensure PCTs are spending the money as intended. [ How ? ]