Improving community mental health nurse targeting of people with severe and enduring mental illness: experiences from one English health district

Background. Successive governments have urged mental health service provide rs to target their attentions on people with severe and enduring mental ill ness (SEMI). However, community mental health teams (CMHTs) in general, and community mental health nurses (CMHNs) in particular, have been criticized for failing to meet this requirement. This paper reports selected findings from a wider study that assessed the impact of an initiative designed to f acilitate service targeting: the establishment of registers of patients wit h SEMI ill general practices throughout an English health district. The pap er describes changes in the nature of community mental health nursing conta cts with a sample of patients on these registers. Methods. Six general practices were randomly selected from the 65 practices in the district and comparisons made between patients on the six mental he alth registers who either had, or did not have, community mental health nur sing contact. These comparisons related to the year before the establishmen t of the registers, the year during which they were being established and t he year following this. Results. A total of 274 patients were included on the sample registers, wit h practices varying considerably in relation to proportions of mental healt h registered patients with community mental health nursing contact. Overall , the number of patients in contact with CMHNs was found to hale decreased over time, except for those on level 2 of the Care Programme Approach. Conclusions. No evidence was found to support the hypothesis that the estab lishment of the registers had improved CMHN targeting of patients with SEMI , However, findings were inconclusive because shortages of CMHNs and the di sruption associated with widespread service reorganization meant the regist ers were never fully implemented in practices during the study period.