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‘Fair Horizons’: a person-centred, non-discriminatory model of mental healthcare delivery

  • Chris Fear (a1), Mark Scheepers (a1), Martin Ansell (a1), Rosemary Richards (a1) and Paul Winterbottom (a1)...
Abstract
Aims and method

Service access is currently determined primarily by age and intellectual function and, unwittingly, is discriminatory. Our aim is to develop a novel, person-centred, non-discriminatory model of mental healthcare delivery. We sought the views of people who use services, carers, commissioners and local politicians.

Results

The model represents a major change programme that commenced in September 2011.

Clinical implications

By integrating specialist mental health services, with a single access point, and mapping of care to the person's needs, rather than their circumstances we hope to have developed a greatly improved and fairer service. A similar model could be adopted in other locations nationally.

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Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Corresponding author
Chris Fear (chris.fear@glos.nhs.uk)
Footnotes
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See commentary, pp. 30–31, this issue.

Declaration of interest

None.

Footnotes
References
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1 Anderson, D, Banerjee, S, Barker, A, Connelly, P, Junaid, O, Series, H, et al. The Need to Tackle Age Discrimination in Mental Health: A Compendium of Evidence. Faculty of Old Age Psychiatry, Royal College of Psychiatrists, 2009.
2 Royal College of Psychiatrists. Looking Ahead. Future Development of UK Mental Health Services: Recommendations from a Royal College of Psychiatrists' Enquiry (Occasional Paper OP75). Royal College of Psychiatrists, 2010.
3 Department of Health. Healthcare for All. Report of the Independent Inquiry into Access to Healthcare for People with Learning Disabilities. Department of Health, 2008.
4 Parliamentary and Health Service Ombudsman. Six Lives: The Provision of Public Services to People with Learning Disabilities. TSO (The Stationery Office), 2009.
5 Department of Health. New Horizons: Towards a Shared Vision of Mental Health Consultation. Department of Health, 2009.
6 Department of Health. Equity and Excellence: Liberating the NHS. Department of Health, 2010.
7 Royal College of Psychiatrists, Mental Health Network, NHS Confederation, London School of Economics and Political Science. Mental Health and the Economic Turndown. National Priorities and NHS Solutions (Occasional Paper OP70). Royal College of Psychiatrists, 2009.
8 Naylor C, Bell A. Mental Health and the Productivity Challenge. Improving Quality and Value for Money. The King's Fund, 2010.
9 Gloucestershire County Council. Gloucestershire Local Projection 2010. Report of Research & Development Team, Chief Executive's Support Unit. Gloucestershire County Council, 2010.
10 Department of Health. Mental Health: New Ways of Working for Everyone. Department of Health, 2007.
11 Royal College of Psychiatrists. Challenging Behaviour: A Unified Approach (College Report CR144). Royal College of Psychiatrists, 2007.
12 Darzi, A. High Quality Care for All: NHS Next Stage Review Final Support. TSO (The Stationery Office), 2008.
13 CSIP Choice & Action Team. Commissioning a Brighter Future: Improving Access to Psychological Therapies Positive Practice Guide. TSO (The Stationery Office), 2007.
14 Department of Health. Confirmation Of Payment By Results For 2010–2011. Mental Health Clustering Booklet 2010–2011. Department of Health, 2010.
15 Department of Health. Living Well with Dementia. A National Dementia Strategy. Department of Health, 2009.
16 The Lord Laming. The Protection of Children in England: A Progress Report. TSO (The Stationery Office), 2009.
17 Department for Children Schools & Families. Children's Trusts: Statutory Guidance on Inter-Agency Cooperation to Improve Well-Being Of Children, Young People and their Families. Department for Children Schools & Families, 2008.
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BJPsych Bulletin
  • ISSN: 1758-3209
  • EISSN: 1758-3217
  • URL: /core/journals/bjpsych-bulletin
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‘Fair Horizons’: a person-centred, non-discriminatory model of mental healthcare delivery

  • Chris Fear (a1), Mark Scheepers (a1), Martin Ansell (a1), Rosemary Richards (a1) and Paul Winterbottom (a1)...
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eLetters

Saving resources verses personalised care

Nik Bhandari, ST4 Psychiatry Registrar
30 January 2012

It is pleasing to note that 2gether NHS Trust management team has come up with an innovative organisational model. However, we must consider the implications of the above on a service user. The patients may not like to be passed between the various levels in the model, based on their presentation and time frame. With different health professionals involved in providing care during varying stages of the illness, there may be little chance for development of therapeutic alliance, besides continuity of care. It is possible that in the name of integrative approach, a more fragmented service is provided to service users, who may not know where they belong in the intricate system.Change is often for the better but a project which seems to have not been piloted as yet may well be a gamble on the mental health of service users.Ultimately, one wonders what drives this project - saving resources, or personalised care. ... More

Conflict of interest: I worked for 2gether NHS Trust until last year, and will be rejoining the organisation in February 2012.

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Those who forget history...

Adam Moliver, Conslutant Psychiatrist
11 January 2012

Fear et al ( Psychiatrist January 2012; 36:1 ) describe the Fair Horizons model of service organisation. It should noted be that this modelhas yet to be tested or indeed actually implemented. It is unfortunate that the authors do not refer to the need for evaluation after this modelis put into operation. I am sure we all look forward to reading a report of an independent evaluation in due course.

Those who forget history are doomed to repeat it. I remember being at a meeting at the Royal College of Psychiatrists on the day the Department of Health confirmed that Old Age Psychiatry would be recognised as a specialty separate form General Psychiatry. Old Age Psychiatry arose because age-blind generic services neglected the particular needs of older patient - and because late-onset illness is or may be clinically different. Discrimination is bad but specialisation is good.

... More

Conflict of interest: Employee of 2gether National Health Service Foundatin Trust writing in personal capacity

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