This briefing paper, published by The King’s Fund, explores the context and factors that have enabled change to happen in mental health services in the past 30 years. It includes 10 lessons for service transformation based on these experiences.
Mental health services have gone through a radical transformation over the past 30 years – perhaps more so than any other part of the health system. A model of acute and long-
term care based on large institutions has been replaced by one in which most care is being provided in community settings by multidisciplinary mental health teams. These teams
support most people in their own homes but have access to specialist hospital units for acute admissions and smaller residential units for those requiring long-term care.
Some commentators have drawn parallels between the process of transformation in mental health services and what is now desired in other parts of the health system.
However, there has been little detailed exploration of how far that comparison is valid or of the lessons that can be learnt.
- Transformation of mental health services was not an easy, consistent or linear process. The research and workshops pointed to a combination of factors playing a key role in overcoming resistance and driving transformation.
- There was no single driver of change. Key drivers included an increasing optimism about the ability to treat, rather than contain, people with acute and chronic mental health conditions, coupled with a belief that long-term institutional care had detrimental effects.
- Social movements and practitioners became increasingly vocal in criticising the care in institutions, exerting pressure for change.
- There were innovations in service delivery (eg, needs-based care models, user-led and recovery-orientated community services) underpinned by the principle of case management.
- Specific financial models enabled change (eg, double-running costs, ‘dowry’ systems, joint finance initiatives), as did changes in management culture – from a team approach at community level to wider organisational influence among chief executives.