Mental health rehabilitation services in the UK in 2007

In 1999, the National Service Framework for Mental Health1 set targets for the implementation of specialist community mental health services across England (335 crisis resolution, 220 assertive outreach and 50 early intervention services by 2003). Five years later, there were 263 assertive outreach teams employing around 3000 staff, 168 crisis resolution teams employing around 2000 staff and 41 early intervention services employing 174 staff.2 Most of these staff moved from existing mental health services into the new teams. These services have succeeded in reducing reliance on in-patient services overall,3 although English assertive outreach services were not shown to be effective in this regard4 and a proportion of users of these and other community mental health services still require lengthy hospital admission.5 The majority of people requiring lengthy admissions have a diagnosis of schizophrenia complicated by treatment resistance6 and/or comorbidties such as cognitive impairment, substance misuse and challenging behaviours.7^9 Many do not meet eligibity criteria for specialist community teams since they are unable to manage community living.10,11 At any one time it has been estimated that around 1% of people with schizophrenia receive intensive in-patient rehabilitation in order to recover adequate social function to live outside hospital.8 Rehabilitation services provide ‘a whole system approach to recovery from mental ill health which maximises an individual’s quality of life and social inclusion by encouraging their skills, promoting independence and autonomy in order to give them hope for the future and which leads to successful community living through appropriate support’.12 Service users tend to be referred for rehabilitation once the National Institute for Health and Clinical Excellence guidance on the treatment of schizophrenia13 has proved unsuccessful and other approaches have failed.8 Over the past 3 years, the Faculty of Rehabilitation and Social Psychiatry of the Royal College of Psychiatrists has received reports from its members of rehabilitation service reconfigurations and losses. Some, such as the rebadging of 25% of community rehabilitation teams as assertive outreach teams (C.Wright, personal communication, 2009) appear to be a direct consequence of the implementation of the National Service Framework for Mental Health.1 In order to investigate these reports further, the Faculty carried out a survey of its members across the UK, coordinated by its regional representatives.