Lessons from community mental health to drive implementation in health care systems for people with long-term conditions.
This paper aims to identify which lessons learned from the evidence and the experiences accruing from the transformation in mental health services in recent decades may have relevance for the future development of healthcare for people with long-term physical conditions. First, nine principles are discussed which we first identified to guide mental health service organisation, and all of which can be potentially applied to long term care as well (autonomy, continuity, effectiveness, accessibility, comprehensiveness, equity, accountability, co-ordination, and efficiency). Second, we have outlined innovative operational aspects of service user participation, many of which were first initiated and consolidated in the mental health field, and some of which are now also being implemented in long term care (including case management, and crisis plans). We conclude that long term conditions, whether mental or physical, deserve a long-term commitment from the relevant health services, and indeed where continuity and co-ordination are properly funded implemented, this can ensure that the symptomatic course is more stable, quality of life is enhanced, and the clinical outcomes are more favourable. Innovations such as self-management for long-term conditions (intended to promote autonomy and empowerment) need to be subjected to the same level of rigorous scientific scrutiny as any other treatment or service interventions.
Department of Public Health and Community Medicine and WHO Collaborating Centre for Research and Training inn Mental Health and Service Evaluation, University of Verona, Verona 37134, Italy. michele.tansella@univr.it.
Michele
M
Tansella
Health Service and Population Research Department, Centre for Global Mental Health, Institute of Psychiatry, King's College London, De Crespigny Park, London SE5 8AF, UK. graham.thornicroft@kcl.ac.uk.
Graham
G
Thornicroft
Clinical Trails Group/Academic Rheumatology, School of Medicine, King's College London, Weston Education Centre, 10, Cutcombe Rd., London SE5 9RJ, UK. heidi.lempp@kcl.ac.uk.
Heidi
H
Lempp
D003153:Community Health Services / Q000458:organization & administration*; D003156:Community Mental Health Services / Q000458:organization & administration; D003695:Delivery of Health Care / Q000458:organization & administration*; D008134:Long-Term Care; D001523:Mental Disorders / Q000628:therapy