Soc Psychiatry Psychiatr Epidemiol. 2003;38( 1):44-8.
BACKGROUND: Mental health policy in England is undergoing radical change involving
the integration of services aimed at improving outcomes for patients. At the same
time, there is limited evidence about how conventional services are performing. The
present paper reports data on the services provided and short-term outcomes achieved
in eight community services in England. METHOD: A survey of caseloads of nurses and
social workers was undertaken using a single-page assessment tool (MARC1) (n = 3024).
After 5 months a random sample of psychotic cases was followed up (n = 393). RESULTS:
A tendency was observed for health and social care practitioners to use the services
available from within their own organisation. Over time, in the most severe cases,
there was a substantial increase in provision of the services of the other organisation.
Outcomes in terms of changes in HoNOS, GAS and MARC1 scores were similar for both
professional groups, and both reported similar amounts of met and unmet need (and
in the same categories) at follow-up. CONCLUSION: The most likely explanation for
the change in service provision is the separate operation of different professional
groups acting as gatekeepers for their own resources.