Residential and day care services for the mentally ill in Newcastle-upon- Tyne

Abstract

This study examines local authority residential and day care for the mentally ill in Newcastle-upon-Tyne. Fieldwork was undertaken between 1st November 1978 and 31st December 1979.The first part of the study traces the development of the services from the 1959 Mental Health Act to 1979. It demonstrates the way in which the Council responded rapidly to Government prescription for policy making. The Authority developed an extensive service more rapidly than did most other comparable local authorities. The second section investigates characteristics of the staff and clients. Most basic grade staffs were lacking in training and relevant work experience and came from the manual working class. Many senior staff had transferred from nursing. Most clients were over 49 and came from the unskilled working class. The sample comprised of similar numbers of male and female clients. Only half the clients had a recent history of psychiatric hospitalisation, but the majority were diagnosed as suffering from chronic mental illnesses. Clients had been referred for services primarily because of difficulties with inter-personal relationships, or in caring for themselves. The aims of the units are examined (as understood by management, staff and clients). The process of communication of aims is analysed, thus exploring the policy making process, the extent to which the theory of Management by Objectives operated and providing performance yard sticks. Communication was best effected through regular staff meetings and better educated senior staff. Aims commonly identified by staff and clients embraced enhancement of personal relationship skills improvement of self-care and preventing psychiatric hospitalisation. The fourth section ascertains the degree to which these aims were achieved, examining opinions of staff and clients and investigating hospital admission and job acquisition. It culminates in a cost-effectiveness study and comparison of costs of hospital and social services care. Aims which were best attained concerned personal relationships within the unit and prevention of hospitalisation. Poor attainment was acknowledged for most aims external to units. There was a positive relationship between the sharing of aims between clients and staff and client's perception of success. Costs were similar in like units and bore no relationship to achievement.