Time machines and revisiting community mental health services

Last Monday I climbed into a time machine and went back to the 1980s. Actually, it was a VW Passat and it was still Monday morning in 2024. But it did feel like I was going back in time. I spent the day visiting our Community Mental Health Teams (CMHT) across Salford. My first stop was Prescott House. This was the first ever purpose-built CMHT facility in Salford, and one of the first in north west England. At the time (1987) I was a Nursing Officer, responsible for acute admission and community services in Salford. It was time where mental health services were closing beds at a huge rate, and where there was greater investment in the provision of community mental health services.

I remember Prescott House being built and the excitement there was at having Community Psychiatric Nurses (CPN) sitting alongside social workers, doctors, occupational therapists, and psychologists. It was absolutely a brave new world. It wasn’t without its problems, mind. Although the multiprofessional team worked together, they were employed by different organisations, all of whom had different employment practices. Indeed, the very first paper I wrote and had published in 1989 was titled Multi-disciplinary teams and line management: practical problems and areas of conflict in clinical psychiatry. The paper was co-authored by a social worker, chief executive, and a psychiatrist. It would be 10 years before I wrote and published my second paper – more of which later.

The psychiatrist was a chap called Som Soni. He became an early mentor for me and certainly whetted my appetite for an academic career. Once a month, I would join him in the hospital library and he would show me how to read a research paper. I learned a great deal from him, and not just about psychiatry. He was a generous man and a people person. In the summer time, he would invite colleagues he worked with to his house in Hale Barns (a very desirable area of Greater Manchester/Cheshire) for a summer party, which included a dip in his swimming pool. He also worked at Cromwell House, the next CMHT facility I visited on Monday.

However, just before we leave Prescott House, I saw a very familiar name on one of the office doors – Gareth Holland. He is now a Senior Practitioner. In 2013 Gareth and I wrote a chapter about decision-making in mental health nursing. It went into an edited book called Understanding Decision Making Skills in Nursing Practice. The book is now in its second edition, revised to show the lessons learnt during the Covid pandemic. Gareth was on holiday so I didn’t get to meet him, but his colleagues said he was very proud of that chapter – and so he should be!

Cromwell House was the second CMHT facility to be built and this was/is a much grander building. More space and a larger team. Unlike Prescott House, which to be honest looked a little tired, Cromwell House still looked a reasonable building and place to work. Of course, much of the CMHT work is done now in people’s homes, but there were good drop-in facilities and therapeutic spaces. Interestingly for me, in my discussions with colleagues, I heard a proposition to develop a mobile service. Again, drawing on the experiences and lessons learnt throughout the Covid pandemic, the idea would be to provide a mobile clinic, which could provide services and care to folk directly within their neighbourhoods. It is a great idea for sure.

My penultimate visit was to Ramsgate House. This was the last to be built and from an architectural point of view, it is the most stunning. It is situated a stone’s throw from HMP Manchester (what used to be called Strangeways prison). It has a working and therapeutic environment that felt safe and welcoming; which, if you know the area, is saying something. I had lunch with one of the psychiatrists and our discussion was far-reaching. He clearly enjoyed his clinical work - sadly did not want to get involved in anything that even vaguely looked like management - but above all, was passionate about transforming clinical services.

It wasn’t so much that the current CMHT weren’t providing a great service, he (and I) felt in the main that they were. But more could be done up stream, to help people stay healthy and reduce the many determinants that impact upon people’s mental health and wellbeing. His ideas as to how we might do this were being fed into our ‘transforming community services’ programme.

My last visit of the day was to our Living Well service. Here, I was able to see some of these ideas being put into practice. The Salford Living Well service was one of the first three such centres in England. There are many more these days. I heard how colleagues were having a real impact and you can see here what this might mean for individuals, communities and other mental health services. It is absolutely the way forward. We will still need in-patient and CMHT services, but the Living Well approach will go a long way to reducing our inappropriate use of such services.

And that second paper? Well, I wrote a critical analysis of what I believed to be the changes, challenges and opportunities arising out of the publication of the New NHS White Paper in 1997. This was the than Labour Government’s grand new plan for the NHS, and introduced NHS Trusts, Primary Care Groups and much of what we see in our NHS today. Darzi 2 is a review that has been commissioned by the current Labour Government into NHS performance and will provide the basis for a 10-year plan which aims to get the NHS back on track and fit for the future. It is due to report by the end of this month. However, I don’t think this time I will be tempted to write another analytical paper on whatever the report might say. Actions, as is often the case, speak more loudly than words.