Service innovation: development of a primary care-based assessment service

Abstract

The care of those with mental illness has moved away from asylums and in-patient care facilities. Community mental health teams (CMHTs) now deliver care but these vary widely in terms of personnel and function (Simmonds et al, 2001). Evidence suggests that CMHT management is not inferior to non-team standard care in any important respect, and that it may even be superior in promoting greater acceptance of treatment, reducing hospital admission and avoiding death by suicide (Tyrer et al, 2000). Despite this apparent improvement, there are problems for the CMHTs and the general practitioners (GPs) who refer individuals. CMHTs are often overstretched, with large workloads, increasing amounts of administration and lack of resources, leading to concerns that individuals with more severe illness may be neglected (Harrison, 2000). Various initiatives have been undertaken to combat these problems, including forging stronger links between the CMHT and GPs, by having an on-site mental health worker (Hamilton et al, 2002; Bower & Sibbald, 2003).