Development and evaluation of an inner city mental health team.

The objective of this study was to examine the development and activity of a Community Mental Health Team, originally targeted to meet the needs of African Caribbean, Asian and homeless populations in an inner city area. The study was based on all (n = 1046) client referrals to the Bristol Inner City Community Mental Health Team between 1987 and 1994. Additional qualitative interviews were held with general practitioners (GPs) from each of the nine practices in the area. The setting was the inner city area of Bristol, an area with a population of around 35,000 27% of whom are from ethnic minority communities. This is an area shown in previous research to have a high level of mental health problems. Trends in referral rates, demographic characteristics and seriousness of psychiatric illness amongst those referred to the Inner City Mental Health Team were the main outcome measures used. In the years studied there were significant increases in the number and proportion of overall referrals from GPs and psychiatrists and decreases in referrals from other agencies. In particular, there were reductions in the referral both of clients from the originally identified target groups and of patients with serious mental illness. GPs tended to refer a greater proportion of patients with less serious mental illness. The results of the study showed that a team originally developed to meet the needs of the homeless and those from ethnic minorities has, with the removal of special project funding, shifted its focus away from the client groups for whom it was originally developed to those with less serious mental health problems. These changes are partially attributable both to changes in the remit of the team, making it more acceptable to GPs, and to a growing acceptance of community-based mental health services among GPs and their patients. Changes in the geographic catchment area served by the team has also played a role in the observed trends. Commissioners of mental health services need to bear in mind the needs of high-risk groups when making contracts. It may be that in order to meet effectively the needs of inner city populations with a high prevalence of mental health problems, there is a need for specialist teams with a specific remit.