'Take a picture of this' - Steve Morgan and David Juriansz

The full article is available as a PDF here, the first section of the article is availale below.

View-from-above

What's the difference between the Sahara desert and the UK mental health system? If you spent 15 years in each, the likelihood is that you would have a better grasp of the process of change occurring in the Sahara. When taking a wide-angled view-from-above, the desert appears as a vast never-changing entity.

However, the up-close view on the ground, examined through the zoom lens, shows change is always happening, slowly and in a way that maintains the ecological balance. Now contrast the same perspectives of the mental health landscape - the wide-angled view is similarly one of a vast entity of constantly shifting sands. However, the detail afforded by the zoom lens does little to clarify the picture for the service users or mental health practitioners - there appears to be little stability and balance afforded by the ever-changing patterns and textures.

One issue at the centre of mental health service delivery appears to be the obsession of management with large-scale policy change; but the focus tends to be on the broad landscape much more than the detailed portraits. We are provided with the National Service Framework (Department of Health, 1999) and the NHS Plan (Department of Health, 2000) drawing our attention to the need for comprehensive and integrated mental health systems characterised by assertive outreach teams, crisis response teams, and early intervention teams. This has merely moved the spotlight away from the community mental health team and the in-patient unit, despite these remaining the 'bread-and-butter' heart and soul of the whole system.

Does this drive for change bring about any real difference? Yes, it does, but arguably at the margins, or at least small isolated pockets of the whole entity that constitutes the complex web of the mental health system. The training initiatives commonly aligned to the push for this type of change rarely manage to bring about anything more than a marginal difference in the 'knowledge base' of individual practitioners and managers, with little if any impact on the difference in skill base.

Unfortunately this thinking has more to do with 'credentialing' through a narrow focus on bringing staff out of their workplace into the workshop, and plying them with monologues on service configurations and lists of research evidence, without a true connection to the realities of their practice experience (Morgan and Juriansz, 2002a). This approach to training has its place, and is frequently evaluated very highly, but we should not allow it to mask the needs for practice development initiatives, which are more specifically targeted to individuals and teams. The 'big picture' generates expectations, but the difference lies in the close detail, and changing this is only possible through presence in the workplace beyond the artificial reality of the workshop (Morgan and Juriansz, 2002b).

To keep reading get the full PDF.