In a special guest blog, Rethink Mental Illness'CEO Paul Jenkins outlines the challenges that Clinical Commissioning Groups must address to provide improved care to mental health service users:

I had the opportunity to chair a debate at the recent Mental Health Forum 2012 about the development of mental health commissioning under the new arrangements set out in the Health and Social Care Act.

I asked the audience whether they were optimistic or pessimistic about the changes. To my surprise, the optimists were in the(small) majority.  I have always believed that, for mental health, the new arrangements for commissioning are capable of delivering improvements for patients and carers. The challenge is how to ensure that while the good get better, the bad do not get worse.

Regardless of whether or not you think Clinical Commissioning Groups are the best way forward for the NHS, now that they are here, we must do what we can to ensure that they work. There are,however, some important things for Clinical Commissioning Groups to get right, especially in terms of their structure and composition.

First, there has to be clear leadership. I believe it is absolutely essential that each Clinical Commissioning Group appoints a lead for mental health to try and ensure that menta lhealth gets 'parity of esteem' among other commissioning priorities. There are some real champions for mental health among primary care, and having a lead for mental health can help channel that enthusiasm and knowledge to help drive improvements incare.

Second, Clinical Commissioning Groups must demonstrate real commitment to involving service users and carers in the design ofservices. Rethink Mental Illness led the campaign with other healthcharities to strengthen the formal provisions of the Act around patient and carer involvement. This must not be just a tick box exercise; clinicians must recognise that the unique insightsservice users and carers offer will be essential to effectiveservice redesign.

Finally, Clinical Commissioning Groups must nurture their relationships with local authorities and health and wellbeingboards. Nowhere is the boundary between health and social care moremeaningless than in mental health. Social care provision and itseffective integration with clinical care is the bedrock of recoveryin mental health. Much progress has been made over the years inhealth and social care services working more closely together. Thenew arrangements for NHS commissioning must not undermine this.

Aside from questions of structure, Clinical Commissioning Groupsalso face a number of serious issues with regards to serviceprovision. These will inevitably vary by geography, but threeissues in particular strike me as particularly relevant.

The first relates to how services are best organised in thecommunity to keep people well, to promote recovery and to intervenequickly when individuals become unwell. GPs will have a stronginsight into what this means in terms of the patients they see intheir surgeries. There is a case for reviewing the traditional roleof community mental health teams in a way that promotes continuityin therapeutic relationships and ensures that services users getwider help than just support with medication including access,where appropriate, to talking therapies. Redesign could alsosignificantly reduce the numbers held permanently on the caseloadsof mental health services if effective systems were in place forrapid re-entry into care if service users become unwell again.

The second priority relates to acute and crisis care. The reportListening to Experience, produced last autumn by an independentpanel established by fellow mental health charity Mind, highlightedmajor concerns about the acute and crisis care provision, with aparticular focus on the poor experience that many service usersreceived in these services. We need to rethink the whole role ofacute care so we are clear what therapeutic purpose it serves - andwhere it has none we must consider how we might address the needsof service users in other ways.

Finally, we have to address the appalling physical healthinequalities that result in people with a severe mental illnessdying on average 20 years younger than the general population. Allsorts of issues are involved, including the often poorly-managedconsequences of antipsychotic medication and very high rates ofsmoking (without the commissioning of appropriate interventions toaddress them). Mental health services and primary care need to takea co-ordinated approach to physical health - where better forprimary care commissioners to make their mark?

These are not easy times, with unprecedented levels of changeand the impact of cuts in the NHS, social care and many otheraspects of the lives of people with a mental illness such ashousing and benefits. New commissioners, however well intentioned,will need to be careful that in pushing for change they do notupset the fragile net of support that keeps some very vulnerablepeople just about well enough in the community. The needs of peoplewith mental illness too often go unmet, and commissioners must becareful that improved access to services for one group does notcome at the expense of essential support for another.

But most importantly, we all have to do what we can to help thenew commissioners make the best job of improving mental healthservices, and we must all be in this together. The stakes for aretoo high not to be.

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