Mental health policy reforms and case complexity in CMHTs in England: replication study

AIMS AND METHOD: Community mental health team (CMHT) services in many Western countries have been remodelled to focus on people with the most severe illnesses and complex problems. Complexity scores using the Matching Resource to Care (MARC2) measure from CMHT cases in 2004-2005 (n=1481) are compared with scores in 1997-1998 (n=3178) in the same locations, before the introduction of the National Service Framework, and before the impact of the creation of integrated mental health trusts in England. RESULTS: The 2004-2005 baseline complexity scores are all worse than those in 1997-1998. CLINICAL IMPLICATIONS: If increased targeting brought about by the National Service Framework and other reforms has led to a greater proportion of people with complex problems in case-loads, what care services, if any, are now being received by people who were in receipt of CMHT services before the reforms? Adapted from the source document.