title: Integrated mental health services in England: a policy paradox.
abstract: OBJECTIVE
  The purpose of this paper is to examine the effects of health care policy on the development of integrated mental health services in England.
  
  
  METHODS
  Drawing largely from a narrative review of the literature on adult mental health services published between January 1997 and February 2003 undertaken by the authors, we discuss three case studies of integrated care within primary care, secondary care and across the primary/secondary interface for people with serious mental illness.
  
  
  CONCLUSIONS
  We suggest that while the central thrust of a raft of recent Government policies in England has been towards integration of different parts of the health care system, policy waterfalls and implementation failures, the adoption of ideas before they have been thoroughly tried and tested, a lack of clarity over roles and responsibilities and poor communication have led to an integration rhetoric/reality gap in practice. This has particular implications for people with serious mental health problems.
  
  
  CONCLUSIONS
  We conclude with suggestions for strategies that may facilitate more integrated working.
authors.affiliation: Department of Primary Care, University of Birmingham, Edgbaston, England, UK.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: England
authors.forename: Helen
authors.initials: H
authors.lastname: Lester