Provision of decentralised mental health services - an option appraisal

This paper consists of the report of an option appraisal. It is exactly in the form in which it was presented to the Management Team and the Authority in the DIstrict to which it relates. The only changes are that ficticious names have been substituted for the originals to maintain anonymity. The purpose in publishing the report is to provide an example of how an appraisal may be conducted and presented. The appraisal is not claimed to be a "model" one in the sense that others should slavishly follow it or in the sense that it is perfect. However, we do believe it was adequate for its purpose - aiding a decision on a fairly complex service development and that others may find it useful to follow its spirit. At present, services for the mentally ill in the north Midshire area are centralised to a considerable degree in a large institution, High Ridge hospital. This centralisation is consistent with the aims of the Joint Strategy for Mental Illness services in Midshire agreed bwteen Midshire Health Authority and Midshire County Council, and with the objectives of the Midshire Health Authority's Strategic Plan. The thrust of the Strategic Plan is towards better integration of patients with the community, and increased liaison between clinical specialties. The Plan envisages the development of decentralised acute services in the Almhurst sector as forming an early part of the strategy and acting as a pilot scheme for the north Midshire mental health unit. This paper identifies the options available to carry this strategy forward; the criteria by which they should be judged; and makes an appraisal of the alternative. A project team was set up to carry out the option appraisal, consisting of two planners, a nursing officer, a local authority representative, the unit administrator directly affected, two consultant psychiatrists, works and finance officers and two consultant economists.