Opinion on the value of the proposed national service framework was divided when mental health experts gathered to hear the latest on the government's intentions. Laura Donnelly joined them
In God we trust - everyone else will have to provide outcome measures,' said NHS Executive head of mental health Martin Brown, in a comic turn fresh from the government's 'what works' joke book.
It raised a chuckle among the 200 mental health experts gathered at last week's Sainsbury Centre for Mental Health annual forum to hear him reveal the latest on the national service framework due out in June.
But discussion on the role of evidence-based intervention in the national service framework was to raise more questions than answers.
It also revealed a sharp divide between those professionals who want action now and those pleading for time to build up a firm evidence base and for the flexibility to translate national strategy to meet local circumstances.
Roger Pedley, chief executive of Bath Mental Health Care trust, was adamant that this was no time for hanging about. 'I don't think we deserve or need a great deal of time before we get started.'
And Avon health authority chief executive Pamela Charlwood called on the government to bring mental health further up its agenda.'We lie and cheat and steal our way to meeting crazy objectives such as waiting list targets,' she said, pointing out that chief executives had been 'hauled up in front of ministers' to ensure timetables for setting up primary care groups and waiting-list targets were met.
'I'm not saying that I approve of this way of doing it. But if it is appropriate for what is deemed important why does it not happen in mental health?'
Mr Brown's concession that 'maybe we need to up the sense that this is one of the priorities', was weakened by his immediate reminder that waiting lists remained the national priority as the only 'manifesto commitment'.
Other delegates called for action to force the pace of inter-agency partnership working.
West London Healthcare trust deputy director of nursing Mick Barwood called for 'some kind of mental health czar to make things happen'.
In contrast, Dr Edward Peck, director of the Centre for Mental Health Services Development, was among many pleading for time. 'I must say to the government, don't rush this,' he urged.
Hampshire social services director Terry Butler warned that evidence- based medicine did 'not sit easily with moving at speed'.
A straw poll of all the delegates suggested it would be a while before 'what works' and mental health were natural bedfellows.
Mental health service managers, trust and HA chief executives, clinicians and policy makers were asked who had 'read any research' supporting the value of community mental health teams.
Fewer than 20 people admitted to any awareness of literature backing the teams - arguably the backbone of both current and future mental health provision.
North Yorkshire HA medical director Dr Mark Baker was blunt. 'How is it that most mental health research is so useless and that we know so little about what works?'
He argued that short timescales for research did little to address the needs of long-term mentally ill people, and criticised trials for ignoring complex problems and testing one intervention at a time.
'The ignorance in which our services flounder guarantee that services and resources are misused,' warned Dr Baker.
Others arguing for less haste cautioned against applying the national strategy without taking account of local needs and sensitivities. Sainsbury Centre director Dr Matt Muijen said a national framework with a 'very prescriptive model of care... will be insulting to the needs of local users'.
The 'unique opportunity ahead' could only work if the government trusted local services, he said.
Debate over the pace and style of change aside, there was a degree of consensus in accepting the 'safe, sound and supportive' approach outlined in Modernising Mental Health Services as 'nothing new'.
Managers were determined to shrug off the old debate on the failure or otherwise of community care, and there was only muted resistance to the prospect of compulsory treatment orders.
But there was concern that this commitment to government policy could be compromised by resistance from senior practitioners and staff on the ground, unless recruitment and training issues were fully addressed.
Dr Muijen suggested that 'burnout and fast turnover' were not confined to nursing and social care staff.
'I know of a lot of people not here today because they are applying for new jobs and worrying about existing jobs,' he said. 'We have good leaders - but they are leaving in droves.'