Interventions and outcomes of health and social care service provision for people with severe mental illness in England

Background Mental health policy in England is undergoing radical change involving the integration of services aimed at improving outcomes for patients. At the same time, there is limited evidence about how conventional services are performing. The present paper reports data on the services provided and shortterm outcomes achieved in eight community services in England. Method A survey of caseloads of nurses and social workers was undertaken using a single-page assessment tool (MARC1) (n = 3024).After 5 months a random sample of psychotic cases was followed up (n = 393). Results A tendency was observed for health and social care practitioners to use the services available from within their own organisation. Over time, in the most severe cases, there was a substantial increase in provision of the services of the other Organisation. Outcomes in terms of changes in HoNOS, GAS and MARC1 scores were similar for both professional groups, and both reported similar amounts of met and unmet need (and in the same categories) at follow-up. Conclusion The most likely explanation for the change in service provision is the separate operation of different professional groups acting as gatekeepers for their own resources.