Community psychiatric nursing services in Britain: the need for policy and planning

Only with a solid base in evaluative research can there be any hope of a firmer commitment from government and clear and coordinated policy-making at both local and national level.

Abstract

Community psychiatric nursing (CPN) shares with other British social and health services a common history of isolated, experimental development leading incrementally, and without the benefit of clear policy guidelines, to a nation-wide provision. Though in existence in Britain for more than 25 years, the growth of CPN services was most rapid in the 197Os, a decade in which the tenets of ‘community care’ gained increasing currency. By 1978 there were 341 separate services distributed, albeit unevenly, throughout the whole of the country (Community Psychiatric Nurses’ Association, personal communication). There is a great diversity in the range of patients managed, in therapeutic settings and in forms of intervention. Most services are full-time operations but only in a small proportion is the number of nurses sufficient to guarantee a ratio of one nurse per mental health team. Continual experimentation in the style of service delivery is to be commended. But there is equally a need to take stock, for the benefits actually accruing from CPN care remain largely unassessed. Only with a solid base in evaluative research can there be any hope of a firmer commitment from government and clear and coordinated policy-making at both local and national level. Psychiatric nursing in the community has attracted comparatively little attention in official quarters. It was excluded, for example, from the remit of the important report of the Central Health Services Council, submitted in 1968, on the future of psychiatric nursing, although the members of the Joint Sub-Committee opined in passing that CPN care was worthy of ‘more general study’ (CHSC, Ministry of Health, 1968). The 1975 document ‘Better Services for the Mentally Ill’ did contain some concrete recommendations. However, these were limited to urging that the community psychiatric nurse should retain a base in the mental health team when working in primary care and be