Rickard, Wendy Joy
(1994)
Community care for the long term mentally ill: An evaluation of the community mental health team approach.
PhD thesis, London School of Economics and Political Science.
Abstract
The thesis addressed two research questions: 1) Why has community care of long term mentally ill people been so difficult to implement. and 2) Do Community Mental Health Teams (CMHT s) provide an intellectually viable and practically sustainable model of service provision. These questions were approached by an analysis of the wider literature and a multi-method case study evaluation of an innovative CMHT in one inner city area of London from 1979-1992. The thesis concentrated on interchanges between theory, policy and local practice. It was found that community care of the long term mentally ill was difficult to implement during the 1980s because adoption of new approaches depended on their delayed acceptance by the psychiatric profession and even then, the required social and environmental approaches to care were only partially adopted. Policy became dominated by professional and managerial influences and clients continued to have a low political profile. Administrative inadequacies were severe and deep rooted and there were unreconcilable differences between Health and Social Services. The collectivist ethos of CMHTs was undermined. The CMHT approach can provide a practically sustainable approach to service provision when certain conditions are met. The CMHT service must: be comprehensive, or supported by a full range of complementary services in the local community; receive genuine political commitment to the long term mentally ill client group and an on-going level of adequate funding; be introduced with a clear acknowledgement of where lead responsibilities rest; and harness the enthusiasm of professionals and catalytic individuals. The CMHT approach is a system of care and in so far as a new care model emerged during the 1980 s, it was the Care Programme Approach. Yet the CMHT approach provided a vital source of experimental energy during the 1980 s and now needs to be formally recognised by central government as a valuable vehicle for change.
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