The impact of community mental health reform on service users: a cohort study

British mental health services have undergone considerable reform in recent years. This paper reports a study designed to assess the impact of these c hanges on service users. The functioning of 100 randomly selected users of community mental health services in a North Wales town was assessed before the advent of two significant service changes - the establishment of a loca l Community Mental Health Team (CMHT) and the introduction of the main comm unity care reforms in April 1993. Repeat assessments of sample members were made on three further occasions over the following 27 months, with a 9-mon th interval between each. Comparison of baseline and follow-up data suggest ed that services were appropriately targeted on users with a severe and end uring mental illness and that the functioning of this client group was succ essfully maintained over the study period. However, the establishment of a CMHT was associated with a temporary fall in social functioning, quality of life and satisfaction with services and there was no evidence to conclude that organizational reforms had led to an improvement in user outcomes in t he medium term. Future mental health reorganization should be based on the evidence of research which includes an assessment of the impact of reforms on service users.