International News
England Health Agency Devising National Mental Health Standards
Psychiatric News
Volume 39 Number 18 page 20-20

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 leaders.

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 explained.

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 said.

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 Beinecke.

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 suicide.

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>.

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