Mental Health Services are changing. The last 20 years have seen a sea change in our thinking about what a modern community mental health system should aim to achieve and a redefinition of our understanding of what it means to live with a major psychiatric diagnosis. Central to the change is the recognition that the secondary damage caused to people with mental health problems, their routine exclusion from normal life, imposed by communities ignorant and fearful of mental illness, is every bit a damaging to them as the illnesses themselves; and often a lot harder to combat.

Increasingly services are founded on the overdue recognition that the basic aspirations and desires of people with mental health problems for a quality life are the same as everybody else's, i.e. somewhere decent to live, adequate income, meaningful work, and a satisfying social network.
Statutory mental health services must of course ensure that service users have access to the best possible support and treatment, but they now have an equally important responsibility to maximise the access of their clients to all community resources. Promoting and sustaining a positive message about mental health to the community as a whole is as crucial to mental health recovery as the treatment individuals may receive from mental health professionals.

Thus while mental health services must ensure that service users have access to the best possible support and treatment that they themselves can offer they have an equally important responsibility to maximise the access of their clients to all community resources.

People with mental health problems no longer allow themselves to be centrally defined by their psychiatric diagnosis and expect full community membership and a leading voice in determining the services provided to help them achieve it.

In Herefordshire these changes are well under way with a positive history of joint working between the statutory and independent sector, a range of good quality services and assertive Service User representation at all levels of service planning and evaluation.

The future ?

What follows is a "vision of success" for community mental health services. This is what it should be like and hopefully one day will be. Shut your eyes for a minute……….

"People with a mental health problem (or label of mental illness) live in integrated housing that they have selected in their community ; work in ordinary jobs they have chosen ; have positive relationships with their families ; and have friends who rely on them for support and upon whom they rely.

These people have services and supports available that they have had a central role in designing, providing and evaluating. All services are focused on successful living in communities and are offered by a mix of professionals and peers, with and without histories of using mental health services.

Services and supports are offered in the context of people's economic, cultural and social situations, are based on the latest relevant knowledge, and are oriented towards successful coping, empowerment, self direction and recovery.

Efforts to change negative public attitudes and resulting behaviours such as discrimination are in place in local communities. Local community resources and opportunities outside of the health and social service systems are seen as an integral part of the framework of support. Users of services have the resources and authority to hold service providers accountable for the quality of services they receive."

(Dr P.J.Carling, Piers Allot).