Mental health services in the NHS: using reform incentives

Our aim in this report is to review the strategic outlook for improving services for people with severe mental illness and to make some positive proposals for ensuring that patients can benefit from the new agenda of choice and quality. We write with a sense of great urgency. The Five Year Review of the National Service Framework (NSF) conveys a somewhat favourable impression which verges on wishful thinking. The difficult question of whether incremental change – a mixture of new teams and a propping up of the old acute services – can lead to the radical change in the quality and range of services which are required is completely ignored.

There has been some progress in improving services which is covered in the Five Year Review, in particular the starting of new teams and high levels of patient satisfaction. However progress has been slow. A Healthcare Commission Survey showed that 77 per cent of patients in mental health services were satisfied with the service they received. But such response, though welcome and a tribute to the dedication of staff, must be treated with caution if the expectations of patients are very low.

There is a much clearer focus on social inclusion as the most important aim for patients. Treatment outcomes may have improved through the availability of new drugs and better support.

But will these produce real gains for patients in terms of life chances? Often in the past patients have become career patients cut off from society with few relationships and little access to opportunities in housing and employment. It is the realistic potential of moving towards a real improvement in choices for patients which adds some urgency to the search for a different model.