scholarly journals Working for psychiatric patients?

1989 ◽  
Vol 13 (8) ◽  
pp. 407-408 ◽  
Author(s):  
Edward Peck
Keyword(s):  
Health Care ◽  
Community Care ◽  
Psychiatric Patients ◽  
White Paper ◽  
Psychiatric Services ◽  
Fundamental Change ◽  
Government Response ◽  
Department Of Health ◽  
The Government ◽  
Surgical Conditions

Working for Patients and the subsequent Working Papers mention psychiatric services explicitly only twice. The proposals have been formulated for patients requiring tests and treatment for elective surgical conditions. They are the conditions which are believed to be predictable and therefore the most receptive to contractual specification and pricing. The health care contract is to be central to the new NHS. It is the device by which the Department of Health hopes to produce a fundamental change in attitude by both doctors and managers. Kenneth Clarke seems much more concerned with this attitudinal shift than with the detail of what the NHS might resemble a decade from now. This omission of overt consideration of psychiatric services does not allow us to ignore the White Paper. I intend to focus on the potential implications of the proposed themes for psychiatric services, particularly in the context of what they might indicate about the Government response to Community Care: Agenda for Action.

scholarly journals Health Services Development Resource Assumptions and Planning Guidelines 1990/1991

1990 ◽  
Vol 14 (5) ◽  
pp. 316-316
Author(s):  
M. M. Tannahill
Keyword(s):  
Public Health ◽  
Health Care ◽  
Community Care ◽  
White Paper ◽  
Health Care Needs ◽  
Health Issues ◽  
Care Needs ◽  
Department Of Health ◽  
Health Authorities ◽  
Development Resource

In August 1989 the NHS Management Executive of the Department of Health issued Health Authorities with Circular HC(89)24 which lays down planning guidelines and resource assumptions for 1990/91. In five terse pages, the document sets the scene for the Government's priority health issues over the next two years. Several of these issues are of interest and importance to psychiatrists, as they are concerned with the implementation of the White Paper Caring for People: Community Care in the Next Decade and Beyond. Health Authorities are asked to “identify the health care needs of their populations” and to set targets, based on reports of their Directors of Public Health, to improve the overall health of their population.

scholarly journals Caring for People: a critical review of British Government policy for the community care of the mentally ill

1990 ◽  
Vol 14 (11) ◽  
pp. 641-645 ◽  
Author(s):  
Frank Holloway
Keyword(s):  
Government Policy ◽  
Mentally Ill ◽  
Community Care ◽  
The Elderly ◽  
White Paper ◽  
Care For The Elderly ◽  
Department Of Health ◽  
Specific Responsibility ◽  
The Government ◽  
The One

The development of ‘community care’ for the elderly, mentally ill, mentally handicapped and physically disabled has been Government policy in Britain since the 1950s. Problems with implementation of this policy led the Audit Commission (1986) to conclude that “the one option that is not tenable is to do nothing about present financial, organisational and staffing arrangements”. Sir Roy Griffiths was commissioned to review “the way funds are used to support community care policy …”. Radical solutions were proposed and subsequently incorporated in the Government White Paper Caring for People (Department of Health, 1989a). However, two very significant measures were not accepted: the ‘ring-fencing’ of community care monies and the creation of a ministerial post within the Department of Health with specific responsibility for community care.

scholarly journals Readmissions of long-stay psychiatric patients to the acute services from hostels in the community

1993 ◽  
Vol 17 (9) ◽  
pp. 524-525 ◽  
Author(s):  
Rosie Shepperd
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Disorders ◽  
Psychiatric Patients ◽  
Psychiatric Services ◽  
Social Aspects ◽  
Community Mental Health Care ◽  
Alternative Vision ◽  
The Social ◽  
The 19Th Century

The asylum movement was developed in the 19th century to provide care and cure for people with mental disorders. In the 20th century the old vision of asylum was abandoned, but no new alternative vision of community mental health care has taken its place. A divide between acute psychiatric services and provision for the social aspects of care has been described by Murphy (1991).

scholarly journals Community in-patient units and halfway hospitals

2000 ◽  
Vol 6 (2) ◽  
pp. 120-127 ◽  
Author(s):  
Anthony Boardman ◽  
Richard Hodgson
Keyword(s):  
Public Policy ◽  
Patient Care ◽  
Community Care ◽  
Patient Admission ◽  
Psychiatric Services ◽  
Pragmatic Approach ◽  
Psychiatric Admission ◽  
Department Of Health ◽  
Post War ◽  
A Current

There is a current gap in the nomenclature of psychiatric in-patient services. There are few descriptions of types of in-patient care and over recent years the literature has abounded with debates concerning alternatives. However, it may be argued that these debates have been based on the creation of the ‘straw man’ of the psychiatric admission, which is only fit for knocking down. Although a post-war consensus has emerged concerning the need to abandon the Victorian asylums, this has often been misrepresented as the need to avoid in-patient admission. The poorly articulated and emotional concept of community care and its lack of clear and consistent definition in public policy and key legislation have contributed to this (Bulmer, 1987). Recent changes in our view of community care have led to a refining of the concept and a shift from its comforting appellations (Titmus, 1968) to a pragmatic approach that matches it to empirical experiences and new resources. This approach sees psychiatric services for adults as being based locally and provided by a spectrum of services – in-patient, residential and ambulatory (Department of Health, 1996) – based on best available evidence. This article has been written with these issues in mind. We will address the current problems of in-patient care and the current literature on alternatives and supplements to traditional in-patient units.

Evaluating risks

2000 ◽  
Vol 6 (6) ◽  
pp. 399-406 ◽  
Author(s):  
Navneet Kapur
Keyword(s):  
Service Provision ◽  
Psychiatric Patients ◽  
Home Office ◽  
Care Programme ◽  
Department Of Health ◽  
Secretary Of State ◽  
National Service Framework ◽  
The Government ◽  
Risky Business ◽  
Service Framework

Mistakes are inevitable in any branch of medicine, but psychiatry is a particularly risky business (Holloway, 1997). When psychiatrists get it wrong there may serious consequences for their patients, the clinical team and the wider public. The Government introduced a series of initiatives in the 1990s: the Care Programme Approach (1990), the supervision register (Department of Health & Home Office, 1994) and supervised discharge (Secretary of State for Health, 1997). One of the main purposes of this legislation was to minimise the risk psychiatric patients pose to the community. Future service provision will be shaped by clinical governance and the National Service Framework for Mental Health (Secretary of State for Health, 1997), and evaluation and management of risk will become increasingly important.

scholarly journals The Department of Health perspective on handling uncertainties in health sciences

2011 ◽  
Vol 369 (1956) ◽  
pp. 4853-4863 ◽  
Author(s):  
Glenn Wells ◽  
Sandra Williams ◽  
Sally C. Davies
Keyword(s):  
Clinical Practice ◽  
High Standard ◽  
Standard Of Care ◽  
Evidence Base ◽  
Decision Makers ◽  
Government Response ◽  
Department Of Health ◽  
Wide Range ◽  
Policy Making Process ◽  
The Government

Recognizing and working with uncertainty in handling risk are part of both clinical practice and the policy-making process. The Department of Health recognizes the inherent challenges that uncertainty brings and employs a wide range of research mechanisms, drawing on a diverse set of disciplines, to provide an evidence base to inform both policy creation and implementation, and clinical practice. This paper describes a variety of situations and the Government response to them, each time highlighting the use of science to reduce unknowns and to support decision-making. It highlights the need for a strong research infrastructure to support the Department's requirements, and those of the NHS, both in real time to respond to emergencies and to establish a high standard of care. However, although science provides a powerful tool to reduce uncertainty, it will not always produce definitive answers and often provides the start point for a dialogue between decision makers and researchers.

scholarly journals Continuing Care for Mentally Stable Psychiatric Patients in Primary Care: Patients' Preferences and Views

2012 ◽  
Vol 2012 ◽  
pp. 1-5 ◽  
Author(s):  
Vincent I. O. Agyapong
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Health Care ◽  
Mental Health Care ◽  
Psychiatric Care ◽  
Psychiatric Patients ◽  
Psychiatric Service ◽  
Health Centre ◽  
Psychiatric Services ◽  
Community Mental Health Centre

Objective. To investigate the preferences of psychiatric patients regarding attendance for their continuing mental health care once stable from a primary care setting as opposed to a specialized psychiatric service setting. Methods. 150 consecutive psychiatric patients attending outpatient review in a community mental health centre in Dublin were approached and asked to complete a semistructured questionnaire designed to assess the objectives of the study. Results. 145 patients completed the questionnaire giving a response rate of 97%. Ninety-eight patients (68%) preferred attending a specialized psychiatry service even when stabilised on their treatment. The common reason given by patients in this category was fear of substandard quality of psychiatric care from their general practitioners (GPs) (67 patients, 68.4%). Twenty-nine patients (20%) preferred to attend their GP for continuing mental health care. The reasons given by these patients included confidence in GPs, providing same level of care as psychiatrist for mental illness (18 patients or 62%), and the advantage of managing both mental and physical health by GPs (13 patients, 45%). Conclusion. Most patients who attend specialised psychiatric services preferred to continue attending specialized psychiatric services even if they become mentally stable than primary care, with most reasons revolving around fears of inadequate psychiatric care from GPs.

What general practitioner fundholders want to buy from a psychiatric service

1997 ◽  
Vol 3 (4) ◽  
pp. 225-232 ◽  
Author(s):  
Christine Wright
Keyword(s):  
Health Care ◽  
General Practitioner ◽  
Health Services ◽  
Health Authority ◽  
Psychiatric Service ◽  
White Paper ◽  
Policy Changes ◽  
The West ◽  
West Midlands ◽  
The Government

The Government White Paper ‘Working for Patients' (1989) incorporated the idea of general practitioners (GPs) managing funds in order to purchase health services for the patients under their care. The aim was for decisions about purchasing and providing health care to be taken as close to the patient as possible, by their own GP. It has meant that two forms of purchasing have grown side by side – health authority and GP fundholding. Subsequent policy changes have made fundholding accessible to more practices, and have extended the fundholders' areas of purchasing. More than 50% of the population in England are now covered by fundholding GPs. The proportion of GPs who are fundholders varies enormously geographically, with high levels in the West Midlands, Trent, South Thames, Oxford and Anglia regions, where the collective purchasing function of GP fundholders is now very considerable.

scholarly journals Community treatment orders – a bridge too far?

1999 ◽  
Vol 23 (11) ◽  
pp. 644-646 ◽  
Author(s):  
Joanna Moncrieff ◽  
Marceleno Smyth
Keyword(s):  
Mentally Ill ◽  
Community Care ◽  
Community Treatment ◽  
Department Of Health ◽  
Mental Health Legislation ◽  
The Media ◽  
The Government ◽  
Health Legislation ◽  
Treatment Order ◽  
Community Treatment Order

Compulsory treatment in the community is high on the agenda in the current review of mental health legislation and the government has already announced its intention to introduce a ‘community treatment order’ (CTO; Department of Health, 1998). Concern about the implications of community care has been gathering momentum over the last decade, spurred on by tragedies such as those involving Ben Silcock and Christopher Clunis in the early 1990s. The notion that community care has failed has taken deep root with the media and the government (Department of Health, 1998). This is despite the lack of any evidence to suggest that mental illness is less effectively treated (Johnstone et al, 1991; Anderson et al, 1993) or that violence attributable to the mentally ill is rising (Taylor & Gunn, 1999). It also indicates a tendency to ignore the fact that patients prefer to live in the community (Tyrer, 1998). Psychiatrists, who are increasingly implicated in this purported failure of care, feel besieged. In such a climate, the promise of more power is understandably attractive. However, we feel that psychiatrists should resist pressure for this sort of ‘quick fix’ and reflect upon some of the dilemmas involved.

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