Published: 24/03/2005, Volume II5, No. 5947 Page 1

It is just over five years since the national service framework for mental health was published. Aided by a list of targets aimed at modernising mental health provision, the government promised the framework would stop it perennially holding the dubious position of being the NHS's Cinderella service.

And those five years have seen mental health services under go immense change.

In this HSJ supplement we take a look - through national director for mental health Professor Louis Appleby's fiveyear review of the NSF - at what has been achieved in improving the service and what work still has to be done (page 2).

Many improvements have already been made; rates of death by suicide have fallen while the number of psychiatrists has increased, as has the availability of modern drug treatments. There has also been considerable success in setting up early intervention and crisis resolution teams designed to provide care in community settings and prevent people who suffer from mental illness having to go into hospital to get appropriate care.

Much of this can be attributed to what Professor Appleby believes is the single biggest increase in spending on mental health ever seen in this country.

So a lot has been done. But with historical patterns of under-spending on mental health persisting in many parts of the country, some trusts are still unable to meet targets on new teams, and high vacancy rates dog the sector.

Professor Appleby also acknowledges that there is much still to be done in improving care in huge areas of the population: black and minority ethnic patients often get a raw deal from their experience of mental healthcare. Many inpatient wards are inadequate for the provision of care and the standard of IT systems in mental health trusts is prehistoric compared to the acute sector.

In the face of such daunting challenges it can be easy to forget that mental health is as capable of being innovative as the rest of the NHS.

So in this supplement we take a look at a trust which, faced with bed usage rates regularly topping 100 per cent and rising numbers of patients having to be sent out of area for treatment, adapted the Modernisation Agency's 10 high-impact changes to care for its patients in settings other than an inpatient bed (page 10).

There is also best-practice guidance on treating patients with personality disorders, helping service users access benefits more efficiently and the recruitment of primary care mental health workers (page 12).

In a look to the service of the future, we also examine how mental health is looking to adapt payment by results to its own services (page 6); a massive challenge to a sector currently working with rudimentary finance systems.

Lessons that should be learnt from the acute sector on how to implement financial flows should be carefully heeded.

The inclusion of mental health trusts in the latest round of foundation trust hopefuls would suggest that mental health and acute hospitals are going to start having more in common than ever before.