Community care

Community care involves treating patients as far as possible in their own homes, with emphasis on a prompt, individualized, multidisciplinary response to problems. Community care is recommended on the grounds that it is as effective as hospital care, is preferred by patients and their families, minimizes the stigma of mental illness, and prevents institutionalization. These are real advantages, provided the systems are well organized, and adequately funded; good community care is not necessarily cheaper than hospital care.

Proper funding and good collaboration between the different professional groups is essential for good community mental health care. Unfortunately, staff shortages and vacancies, and morale problems are frequently reported, especially in deprived urban areas with high morbidity. Introduction of the 'care programme approach' (see below) was partly to try to make sure that the care of individual patients was properly organized so as to withstand such difficulties.

Community care for patients with long-term mental illness used to be the responsibility of local authority social services departments, but these have now, to a greater or lesser extent, been merged into community mental health teams in many areas. Each patient must have an individual needs assessment, and then appropriate services are arranged, although clients with sufficient financial means may have to contribute to the cost of these.

Social workers and community psychiatric nurses (CPNs) now work in similar ways ('generically') as care coordinators. As well as general support and advocacy, the care coordinator provide advice about the following:

• Financial benefit entitlements.

• Employment: this includes sheltered employment, or a gradual return to the work routine through activities in the voluntary sector.

• Accommodation: this means residential and nursing homes care for people with mental health problems, not only the elderly. Supported accommodation, including group homes, hostels, and other forms of accommodation, may be provided by health services, social services, or the voluntary sector, with varying degrees of resident or non-resident supervision. Such accommodation might be a group of self-contained flats, with a warden present during the day, and telephone support during the night. The supported lodgings scheme allows social services to pay landlords extra in exchange for some care of their tenants. Private rented accommodation is home to many with chronic mental illness; some of the landlords involved may be open to criticism, but their tenants might otherwise be homeless.

• Day centres provide a focus for regular supervision, activities, and rehabilitation.

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