Abstract
The purpose of this paper is to examine the effects of health care policy on the development of integrated mental health services in England. Drawing largely from a narrative review of the literature on adult mental health services published between January 1997 and February 2003 undertaken by the authors, we discuss three case studies of integrated care within primary care, secondary care and across the primary/secondary interface for people with serious mental illness. We suggest that while the central thrust of a raft of recent Government policies in England has been towards integration of different parts of the health care system, policy waterfalls and implementation failures, the adoption of ideas before they have been thoroughly tried and tested, a lack of clarity over roles and responsibilities and poor communication have led to an integration rhetoric/reality gap in practice. This has particular implications for people with serious mental health problems. We conclude with suggestions for strategies that may facilitate more integrated working.
Highlights
Health care services in England have been subject to a series of significant policy imperatives in the past decade
Data sources: Drawing largely from a narrative review of the literature on adult mental health services published between January 1997 and February 2003 undertaken by the authors, we discuss three case studies of integrated care within primary care, secondary care and across the primaryysecondary interface for people with serious mental illness
We suggest that while the central thrust of a raft of recent Government policies in England has been towards integration of different parts of the health care system, policy waterfalls and implementation failures, the adoption of ideas before they have been thoroughly tried and tested, a lack of clarity over roles and responsibilities and poor communication have led to an integration rhetoricyreality gap in practice
Summary
Health care services in England have been subject to a series of significant policy imperatives in the past decade. There has been a shift in the theoretical debate around the ways in which healthcare organisations should deliver services to improve quality of care through extending patient choice and access to care and a particular focus on issues of partnership working and integrated care. The evidence base sources quoted in this paper are largely drawn from a narrative review of the literature on adult mental health services published between January 1997 and February 2003 undertaken by the authors w5x. This has been supplemented by discussions with clinical leaders in the field of adult mental health, in Early Intervention Services where the authors are involved with a national evaluation of services
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