Objectives and communications in community mental health services

Abstract

Some steps towards defining objectives and improving communications in community Mental Health Services, are discussed. Important among them are:— (1) Careful assessment of the clinical condition of the patient and of his social and interpersonal circumstances as a first requirement, before community care is attempted. Such assessment is best undertaken in the setting of a case conference in which doctors and social workers take part after seeing the patient together. (2) It may be better to devise limited schemes shaped to the needs of particular groups of patients than to try to plan an all-inclusive scheme from the start. (3) We must learn as we go, but the indications so far are, in my view, that we should concentrate on the following groups:—Neuroses; recent but relapsing mental hospital admissions; elderly people; alcoholics; and long-stay mental hospital patients. Any one of these groups could be the subject of an ad hoc scheme in itself. Well-found community services have a good chance of avoiding the admission of many neurotic and some elderly patients to hospitals and of preventing chronicity in many of the recent but relapsing group. I am not persuaded that discharge to community care is very frequently in the best interests of chronic schizophrenic patients and not very sanguine about extensive success in that group. (4) The chief requirement among ways and means is a sufficient number of psychiatrically oriented social workers; a second desideratum is more mental health centres, some of which might include a day hospital and all of which should provide a counselling service as well as being the venue of periodic follow-up professional consultations and conferences; and a third is small hostels for ex-long-stay patients. (5) The attendance of Local Authority Social Workers for adequate periods of time at psychiatric outpatients and case conferences can form the basis of a sound apprenticeship in the course of in-service training, as well as improving communications. (6) Ideally, family doctors should be right in the picture throughout, but limitations of time are often considerable. Even if they cannot attend conferences and the like, they should be given regular up-to-date information about what is happening to their patients. And those whose interests lie towards psychiatry could themselves carry out much of the clinical supervision of patients in the community.