Solutions not problems

摘要

Readers will find that this issue contains a range of articles that cover a significant breadth of mental health nursing interests. On closer reading, one article will, I am sure, appeal to a very large proportion of our readers. The commentary by Jeff Fernandez (p9) is, at first sight, very relevant to substance misuse services. However, he makes arguments that are generalisable to a whole range of mental health services. The article gets one thinking about economic models for funding mental health services and the need to truly integrate funding from both health service and social care. This is particularly important in the case of those with long-term mental health problems, whose social care needs are often greater that their mental health care needs. Many of those entering substance misuse services have very significant levels of mental health problems underpinning their substance misuse problem-to simply look at either substance misuse or mental health services as separate units is clearly fallacious. Fernandez's model depends on great integration, and what is particularly attractive about his argument is the prospect of reducing the burden on secondary care services by locating mental health services more in primary care. Many years ago, the move to locate mental health services in primary care was implemented with haste and not properly thought through. What happened then was a focus on a population with common mental disorders, many of which proved to be transient and not requiring professional interventions. Fernandez's proposals that complex problems can be effectively managed in primary care rests on the proposition of shared care between nurses and GP-with an increasing emphasis on nurse-led care. Such a model, if extended to some of the population that currently occupy a space in secondary services, would lead to the burden on secondary services being much reduced. We all know that there are many patients in secondary care service who have long-term mental health problems, but whose condition is relatively stable-albeit that their social and physical health needs are significant.