EFFECTS OF MENTAL-HEALTH-SERVICES REFORM ON CLINICAL-PRACTICE IN THE UNITED-KINGDOM

In the last few years, the British National Health Service, local gove rnment social services departments, the welfare benefits system, and t he organization of primary health care in the United Kingdom have unde rgone major reforms that have had significant effects on mental health services. Local social service departments were given the lead role i n purchasing and coordinating community supports for persons with ment al illness, but were not given enough funds to arrange adequate servic es. In the National Health Service, an internal-market approach, in wh ich local health authorities could contract with any provider or group of providers, was introduced. This purchaser-provider split has creat ed a climate of competition in a traditionally collaborative environme nt and has reduced staff morale. Similar but separate case management models were introduced in both the health service and the social servi ce departments, which has led to inefficiency in planning care for ind ividual patients. Opportunities were created for general practitioners to use capitated funds to purchase specialty care directly from provi ders. This arrangement resulted in an initial emphasis on care for les s severely mentally ill patients, although some general practitioners are beginning to explore new approaches for supporting severely ill pa tients in the community. On the positive side, the reforms have led to greater involvement of patients and their families in planning servic e delivery. However, the authors suggest that policy makers in the U.K . seem to be repeating many of the mistakes made by American mental he alth systems in the 1960s and 1970s.