The market and mental health: Intentional and unintentional incentives

Interagency and interprofessional collaboration in community care: the interdependence of structures and values

This paper considers the problems of interagency and interprofessional collaboration in community care in Great Britain from the combined perspectives of UK and US researchers. The research team drew on empirical and theoretical literature from both countries to construct a framework for analysing inter- and intra-organisational theories of joint working. This analysis, supplemented and supported by local case studies conducted by the researchers, generates a framework recommendation against which the government's initiatives for partnership working in the NHS plan 2000 and subsequently can be critically reviewed. In particular, at a time when structural integration--via Care Trusts--is being seriously considered, they highlight the vital importance of integrated systems of goal setting, authority and multidisciplinary service delivery rather than a narrow focus on structural integration alone.

Establishing process indicators for joint working in mental health: rationale and results from a national survey

Effective joint working in mental health is a national concern as indicated by a series of governmental directives and initiatives aimed at improving practice in this area. Joint working is fundamental to the successful implementation of 'community care'. Many people, particularly the public, equate the introduction of the Community Care Act (Department of Health, 1990), with the beginning of community care as a social policy. In reality, however, community care has a much longer history in the UK involving the shift in the 1950s from providing care in the hospital to providing care in the community. Thus, one of the most obvious reasons for this concern expressed in the media and felt by the public is that 'community care' isn't working. While this is an important consideration, it is not the only explanation as to why joint working has come to occupy such a prominent position in the minds of health strategists and politicians. This paper explores our concern with joint working in mental health and proposes one way in which joint working can be effectively monitored and measured.

Joint working in community mental health: prospects and challenges

This paper reviews the opportunities for, and the challenges facing, joint working in the provision of community mental health care. At a strategic level the organization of contemporary mental health services is marked by fragmentation, competing priorities, arbitrary divisions of responsibility, inconsistent policy, unpooled resources and unshared boundaries. At the level of localities and teams, these barriers to effective and efficient joint working reverberate within multi-disciplinary and multi-agency community mental health teams (CMHTs). To meet this challenge, CMHT operational policies need to include multiagency agreement on: professional roles and responsibilities; target client groups; eligibility criteria for access to services; client pathways to and from care; unified systems of case management; documentation and use of information technology; and management and accountability arrangements. At the level of practitioners, community mental health care is provided by professional groups who may have limited mutual understanding of differing values, education, roles and responsibilities. The prospect of overcoming these barriers in multidisciplinary CMHTs is afforded by increased opportunities for interprofessional 'seepage' and a sharing of complementary perspectives, and for joint education and training. This review suggests that policy-driven solutions to the challenges facing integrated community mental health care may be needed and concludes with an overview of the prospects for change contained in the previous UK government's Green Paper, 'Developing Partnerships in Mental Health'.