Published: 18/08/2005, Volume II5, No. 5969 Page 26

Stuart Shepherd talks to Patrick Geoghegan and Lisa Rodrigues, two mental health champions with a passion for improving services

If you had suggested to a young Patrick Geoghegan when he started his psychiatric nurse training that he would one day be awarded an OBE and honorary doctorate, he would have said you were 'definitely certifiable'.

But more than two decades later the South Essex Partnership trust chief executive has received both for his services to mental health.

Patrick joined the health service in the 1970s. Many practices from the period have since been consigned to history, and the beliefs that widespread reform have helped to fashion continue to inform a management approach that underpins almost every decision he makes. 'I never liked the old institutions - custodial care and patients wearing each others' clothes - and I was forever asking why things couldn't be different, ' says Patrick. 'Working in the community reinforced that conviction.' Colleagues encouraged a move into management to make real the changes he sought. 'My early experiences as a nursing officer showed me how management and clinical work could complement each other. Now, in meetings with my executive team and trust board, the clinician in me always wants to know how our plans will improve patient care.' Getting out and about is also important.

Patrick gets valuable feedback from meetings with staff and visits to care services, where he also does the occasional shift to keep his registered mental health and general nurse qualifications up to date.

The trust - a partnership with its local authority providers since 2002 - is in the preparatory stages of its application for foundation status. 'The most important thing about the new status will be community empowerment and ownership, ' argues Patrick. 'Service users will become members who tell us what their local needs are, not the other way around.' Investment in service users and staff does not merely focus on processes. Large capital projects mean that facilities in the trust are being modernised to create homely environments and safe workplaces.

'Colleagues from acute services say how wonderful our new buildings are, ' says Patrick. 'I usually respond by asking why they shouldn't be. The days of hiding away mental health and learning disability services are over. Our clients deserve the same standards as anyone else.' A 24-hour helpline offers counselling, financial and domestic advice to staff and immediate family. Since the service was implemented, sickness levels across the trust have dropped to 4.5 per cent.

In Patrick's view, chief executive is still a position to which mental health nurses can aspire. 'The pathway might be different nowadays, ' he says, 'but the NHS's commitment to ability has not changed.' Lisa Rodrigues is another clinician who made the move into management with a vision shaped by past experience.

'Stigma-busting is a big job, ' says the former nurse and health visitor who, since 2002, has been chief executive at West Sussex County Health and Social Care trust. The job got even bigger in February this year when Lisa also took the helm at East Sussex County Healthcare trust.

'Reducing stigma means increasing social inclusion, ' says Lisa. 'People with mental health problems face huge discrimination, particularly when it comes to employment. That deprives them of things like a regular income, and the ability to choose where we live and how we spend our time. And they suffer an incredible paucity of social networks.

Most of us make our friends at work.' Core values like this were instilled when Lisa started her health career as a nursing assistant in learning disabilities.

'Even then I knew it was wrong that the children I cared for didn't have any clothes or toys of their own, ' she says.

'Those children are adults now, living in places they can call home with the support of services organised around their needs. Their lives are not perfect, but things are so much better than before.' The partnership status that East Sussex enjoys is an essential element in the fight against inequality. 'We have three important sets of partners: our staff, our local authority colleagues and our service users and carers, ' says Lisa.

She talks enthusiastically about the practical outcomes of working closely with West Sussex county council. 'We needed a site for a new hospital near Crawley and were able to buy land on which we had already secured planning permission. We could never have done it otherwise.

People object to new mental health units.' A close involvement with the National Mental Health Partnership allows Lisa, along with senior colleagues across the country, to develop ideas and responses to policy initiatives. 'The organisation has been operational for two years and is going from strength to strength. Ministers are now starting to ask us for comments.' Service modernisation in all its guises will form one of the principal challenges to chief executives in mental health over the next five years. 'The adult social care green paper will challenge how we provide services, ' says Lisa, 'as will payment by results, unscheduled care and foundation status.' The possible merger of East and West Sussex trusts will add to the challenge.

'Partnership arrangements may become more complex, but I am hopeful we can build on what we have already achieved.'

Lisa Rodrigues CV

1973-1982 - general and paediatric nurse training followed by clinical experience, specialist training and health visiting in Brighton

1982-1990 - Attends Sussex University, gaining BA in psychology, and spends time raising family. Returns to nursing part time

1990-2000 - community nurse manager before appointment as executive director of nursing at South Downs Health trust

2000 - director of emergency care, NHS Executive South East. Transfers to West Sussex County Health and Social Care trust as project director, subsequently appointed chief executive

Patrick Geoghegan CV

1974-1985 - nurse training in mental health and general medicine followed by community experience and ward management. Appointed nursing officer at Shenley Hospital

1985-1994 - nurse management at Whittington Hospital before appointment as director of nursing at Basildon Hospital

1994-2000 - moves to Thameside Mental Health trust as executive nurse and director of operations. Becomes chief executive in 1996.

2000 - oversees merger of Thameside with neighbouring Southend community trust. Becomes South Essex Partnership trust chief executive in 2002