John Carpenter

Twelve Years On: service use and costs for people with mental health problems who left psychiatric hospital

Background: Few studies have estimated the full costs of moving people from long-stay psychiatric hospitals to community residence. Fewer still have examined the long-term implications of this important component of mental health policy. Aims: To assess the full service and cost implications of community care for people who moved from long-stay psychiatric hospitals 12 years ago. To explore the associations between costs and peoples characteristics, needs and outcomes. Method: Data were collected from 128 people in seven English localities that were part of the 1983 Care in the Community Initiative. For a sub-sample of 75 people, changes in resource use between 1 and 12 years after leaving hospital were assessed. Results: Most people live in staffed accommodation supported by a range of community-based services. Mean community care costs (£555 per week) are lower than long-stay hospital residence or community costs 1 year later. Conclusions: High support homes, in-patient beds, and day care services are costly but important care components. The low utilization rate of general practitioners is concerning given residents increasing age. There was no evidence to suggest the reduction in costs was a response to reductions in user needs. Declaration of interest: The Department of Health funded the research.

Twelve Years On: The Long‐term Outcomes and Costs of Deinstitutionalisation and Community Care for People with Learning Disabilities

This paper reports on the key findings of a study into the outcomes and costs of community care for a large cohort of people with learning disabilities, supported in 12 study sites across England, who left various long‐stay hospital 12 years ago as part of a centrally monitored and evaluated government policy initiative on deinstitutionalisation. It represents the last follow‐up of a raft of linked longitudinal evaluations, conducted at four time points over a twelve‐year period. The paper identifies the findings from the last follow‐up and interprets and presents them as summary observations and trends in relation to the findings in learning disability, briefly reviewing them in relation to wider evidence on deinstitutionalisation and community care in England.

From the asylum to the community : A longitudinal study of staff involved in the transition from Tone Vale Hospital to community-based services

A longitudinal study of the effects on staff (N =108) of the transition from a Victorian asylum to dispersed community-based services is reported. The majority of staff supported the policy of community care in general and following the closure, two-thirds thought it better for staff, although only half considered it was better for people with mental health problems. Four months after the closure there was little change in perceived job responsibilities, but after a year working in the new services very significant changes were reported in working practices, in line with a more communityorientated and therapeutic model. Throughout the transition, relatively low levels of stress were reported and job satisfaction was high. Role clarity and low role conflict were predictors of low stress and job satisfaction. Job satisfaction was also predicted by supportive management and job responsibilities. The study demonstrates that major changes in working environments and in job responsibilities can be accomplished ...A longitudinal study of the effects on staff (N =108) of the transition from a Victorian asylum to dispersed community-based services is reported. The majority of staff supported the policy of community care in general and following the closure, two-thirds thought it better for staff, although only half considered it was better for people with mental health problems. Four months after the closure there was little change in perceived job responsibilities, but after a year working in the new services very significant changes were reported in working practices, in line with a more communityorientated and therapeutic model. Throughout the transition, relatively low levels of stress were reported and job satisfaction was high. Role clarity and low role conflict were predictors of low stress and job satisfaction. Job satisfaction was also predicted by supportive management and job responsibilities. The study demonstrates that major changes in working environments and in job responsibilities can be accomplished without undue stress and uncertainty and also that the job satisfaction of mental health staff can be maintained.

Carers and community mental health services

Background There is a growing appreciation of the role and needs of carers for people with mental health problems. Carers are a diverse group, including partners, relatives and friends who are seen as such by service users. Methods Sixty-four carers of people with severe mental health problems served by four different mental health care providers were interviewed using the Experiences of Care-giving Inventory. The districts were selected to differentiate services that are targeted at more severely impaired users from those that include a wider spectrum, and to contrast services that have greater integration between health and social care providers with those whose health and social care agencies operate relatively discretely. Results In the two districts where service users had more severe mental health problems, carers worried more about negative symptoms and thought less about good aspects of the caring relationship. In the two districts where health and social services worked more closely together, carers worried significantly less about the need to back up services. Conclusions These findings suggest that service organisation can affect carers, in particular that integration between health and social care for people with mental health problems may benefit carers in ways that were hitherto unproven. They highlight the needs of carers for younger people. They show that the ECI is a useful instrument in measuring the impact of caring for people with severe mental health problems.

Practitioners as gatekeepers and researchers: family support outcomes

This paper describes the problems and difficulties encountered in a current research project which is attempting to engage practitioners in the collection of data using standardized outcome measures. The aim of the research is to meet the demand for greater clarity about the services and, particularly, the therapeutic interventions delivered by family support practitioners, whilst maintaining a sensitivity to the family support services’ client group. The client group consists of children in need and vulnerable families who might often be described as “in crisis”. The paper explains the family support context and refers to the difficulties encountered by other researchers in this field. The methods and process of engaging practitioners in this research have not been widely used and are, perhaps without precedent. They are described in detail, as are both the reported and perceived problems which have become a research finding in their own right.

An evaluation of the Birmingham University Programme in Community Mental Health: an interprofessional postgraduate course for staff working with people with severe and long-term mental illness

In 1997, the West Midlands Region NHS Executive commissioned a new training programme for mental health professionals who work with people with severe and long term mental illness. It is a part-time, post graduate programme provided by Birmingham University. It can be taken for 1, 2 or 3 years, leading to Certi® cate, Postgraduate Diploma and Masters degrees. The curriculum focuses in particular on psychosocial interventions, including cognitive behaviour therapy and family intervention, team and interagency working and user involvement.