Residents of England may have greater access to mental health services due
to reforms taking place in the National Health Service (NHS).
The NHS manages the vast majority of health, mental health, and social
service systems in England. These services are provided free to residents and
are paid for by taxes. There is little private practice or private-sector
funding of health care, including mental health care, said Richard Beinecke,
D.P.A., at the Mental Health Policy Roundtable meeting held last month at APA
headquarters. There is private insurance for care provided by private doctors,
but few people purchase it.
The roundtable is an educational forum designed to foster interest in
mental health policy and transfer knowledge to the next generation of
Beinecke is an associate professor of public management at Suffolk
University in Boston. He recently returned from a three-month sabbatical in
the United Kingdom, which encompasses England, Scotland, Northern Ireland, and
Wales. However, his talk concentrated on England's mental health system.
There is a shortage of psychiatrists, psychologists, and psychiatric social
workers in England. As a result, specialty care is limited to severely
mentally ill people, Beinecke said.
"Psychiatrists run the mental health system in the U.K. and direct
most psychiatric inpatient units in public general hospitals and community
clinics. Nearly all psychiatrists provide consultations for primary care
physicians, and many engage in direct clinical care," Beinecke
He interviewed numerous clinicians, researchers, NHS leaders, and consumers
in the United Kingdom to learn about the organization and delivery of general
health, mental health, and substance abuse services. "Substance abuse
services are minimal due to the government's reluctance to tackle the `pub
culture,'" Beinecke said.
The preferred mental health treatment is cognitive-behavioral therapy
(CBT). Different forms of brief counseling are often combined with family
therapy in many settings including primary care. "Talk therapy is rarely
used, and individual and group therapy is limited," Beinecke added.
"The U.K. is ahead of the United States in integrating mental health
care with primary care," he noted. Primary care doctors are trained to
recognize mild to moderate mental illnesses and treat them. "Their
licensing exam includes questions about mental health," Beinecke
Psychiatric nurses provide a significant amount of mental health care in
community and home-based settings, Beinecke said. Children, in particular, are
generally treated at home rather than hospitals.
Hospital care is the bedrock of the mental health system in the United
Kingdom, Beinecke said. The Sainsbury Centre for Mental Health, a nonprofit
research group in London, recently conducted a survey of the quality of care
in acute psychiatric wards. The results released this year showed a lack of
clear goals for acute care, a lack of individualized treatment approaches, and
too few staff and beds, said Beinecke.
These problems are being addressed by local health authorities and the
National Institute for Mental Health in England, an agency that provides
mental health consultation for the NHS Modernisation Agency (see story below)
and is growing in influence in England, said Beinecke.
The "National Service Framework for Mental Health"—issued
in 1999 and 2001—was the first framework developed by England's
Department of Health with the input of clinicians, health care managers, and
patient groups, Beinecke said. It focuses on adults up to age 65.
The framework sets national standards for a specific service or care group,
proposes strategies to implement the standards, and establishes performance
indicators and specific timetables to measure progress of local programs, said
The national mental health standards are designed to promote mental health
and combat stigma, increase access to mental health services, improve services
for persons with severe mental illness, support caregivers, and prevent
Funding continues to be a barrier to implementing the national framework
for mental health in England. While the government stopped decreasing mental
health funding, it isn't increasing funding either, so mental health services
remain inadequate, according to a 2003 Sainsbury Centre report.
The "National Service Framework for Mental Health: Modern
Standards and Service Models for Mental Health" is posted online at<www.nelh.nhs.uk/nsf/mentalhealth/standard1.htm>.▪