| Introduction |
| The Mental Illness Specific Grant provided, from April 1991, the only source of ring-fenced monies for the implementation of community care. It takes the form of a revenue grant to be used for the social care of individuals with mental health problems. Seventy per cent of costs are met through a central allocation; the local authority contributes the remaining thirty percent of costs. Initial allocation of £3m In 1991-92 rose to the current level of £18m in 1995-96 (retained in 1996-97 and 1997-98). |
| The aim of this evaluation was to examine the impact of the grant during its initial three years and to assess its effectiveness in meeting the needs of the target groups, individuals with enduring mental health problems, those with dementia and those who had experienced head injury. |
| Research methods |
| A two-stage evaluation was conducted, focusing on those projects funded under the first three years of the grant. An initial mapping exercise was undertaken during which a questionnaire was sent to all projects funded up to and including 1993-94 (n=209; response = 195). |
| The mapping sought to develop a profile of protects throughout Scotland, collecting details from each project including: aims and objectives; target user group and sources of referral; the services provided; the number of users and the nature of their mental health problems; and the funding arrangements. |
| For the second phase of the evaluation, a sample of 40 projects was selected : 28 mental health projects, 11 dementia projects and one head injury project. Interviews were conducted with key informants from local authorities (pre reorganisation), with project leaders, and with a sample of users (n= I 1 0) from mental health projects. |
| Users also completed the General Well Being Index (GWBI). Dementia Care Mapping was undertaken in four day care projects. A questionnaire was distributed to carers across all project types, yielding 158 responses. |
| Project profile |
| The mapping exercise found that MISG funding in the first three years of implementation supported a wide range of projects contributing to the care of people with mental health problems, dementia and head injury. Projects were covering wide geographical areas limited resources. The voluntary sector areas made substantial use of the grant, managing two-thirds of the funded projects. There was little development, however, of joint projects, with only one jointly managed and financed project identified. |
| The majority of projects worked with fewer than 50 individuals. Projects were responding to the needs of users with a wide range of mental health problems; three-quarters of projects, however, considered that 70 percent or more of their service users experienced serious mental health problems. |
| The majority of mental health projects were providing practical, emotional and social support, day care/activities and drop-in facilities. Dementia projects focused on more structured day care/activities, carers' support and respite care. The head injury project emphasised the one-to-one support offered to people with head injuries. Many projects appeared to be providing flexible and specialised services in an innovative and informal manner. User involvement was an evolving process, with the level of participation being determined by user interest, their health, and project encouragement and support. It was more likely in voluntary sector projects. |
| Most projects were fully supported by MISG, with little evidence of other significant sources of funding. Local authority managed projects felt they benefited from a recognised credibility and access to a wide range of services, yet felt constrained by bureaucracy and stigma. Voluntary organisations felt they had more scope to be creative with less bureaucracy, yet felt limited by their financial vulnerability and not having direct access to other resources. |
| Project planning |
| Strategic planning in the mental health field had been constrained by a lack of finance, lack of assessment of need, difficulties in obtaining agreements amongst the competing stakeholders, and difficulties in achieving a co-operative strategy with health. MISG was considered to have made a significant impact on mental health services, mainly attributed to the ring-fenced nature of the grant. However, the annuality and uncertainty over the future of the grant was perceived to have restricted developments. There was a fear that if the grant ceased then many existing projects and future developments would be lost. |
| Few authorities had adequate financial information on mental health expenditure prior to and subsequent to the introduction of the grant to measure the impact of the grant on expenditure. However, prior to the grant, mental health expenditure primarily consisted of designated social worker posts and mental health officers with little in the way of direct mental health service provision. The contribution of MISG to mental health service developments was considered, therefore, to be significant. |
| Mental health project users |
| Most protect users had a diagnosis of depression or schizophrenia. The majority had a previous psychiatric hospital admission, with almost half of them having had an admission in the past two years. The majority of individual admission episodes had lasted less than a year. |
| User contact with the projects was regular, with most coming at least once a week and most having experience of the project for two years or more. Initially users became involved with projects to get help and support and to get out of the house. As time progressed, the social contact and company became important reasons for continuing their involvement. Users were involved with projects in a variety of ways, from sitting and chatting to engaging in recreational activities. Most users had regular contact with both their family and friends; half of the users were engaged in other social activities apart from the project. For the majority of uses the MISG project was their only project contact. |
| Project experiences had been positive, with most users stating that they would recommend the project to other people in similar situations. It was clear that projects had made substantial differences to the lives of users in sustaining them within the community, assisting them to keep well and to mix with other people. More resources, more extensive services and greater flexibility in opening hours would improve projects from the perspective of users. |
| Dementia project users |
| The Dementia Care mapping technique (DCM) was used in four day care settings to assess the level of well-being of users. The level of well-being for individual users was found to be high. Moreover, taking staffing levels into consideration, the dementia quotient for each of the settings was also high, suggesting that a high quality of care was being provided to these MISG users. |
| Carers |
| The majority of carers responding to the questionnaire were caring for older people who attended dementia projects. Most carers were middle aged and older. Most carers were female, although male carers did account for more than one-quarter of carers. The majority of carers had a close family relationship to the person being cared for, either spouse/partner or parent. |
| People caring for someone with dementia were heavily involved in providing all types of care. Providing personal care or physical care to someone with mental health problems was not common, whilst keeping an eye on them and helping with paperwork and financial matters were more common types of assistance. Projects were supporting carers in a variety of ways, the provision of information and advice and emotional and practical support being the most common. |
| Carer satisfaction with projects was high, with the majority feeling pleased or delighted with the sense of security and peace of mind provided and with the feeling of contentment and enjoyment experienced by the person they cared for. |
| MISG projects were considered to be vital, not only to the life of the user but also to the carer in feeling less isolated and giving them time to themselves. Getting out of the house and meeting other people were perceived as important for the user. The practical and emotional support and the break given to carers were considered to be positive features of MISG projects. Financial constraints and lack of staff were felt by carers to be the main limitations of projects. More money and more staff to extend the range of activities and services were felt by carers to be necessary improvements. |
| Conclusion |
| The availability of MISG has allowed for the creation of a wide range of innovative and flexible projects contributing to the care of individuals with mental health problems, dementia and head injury. The groundwork in terms of planning and collaborative working provides a springboard for the development of the local mental health strategies required under the Framework for Mental Health Services in Scotland. In order to capitalise on these initial achievements, it is considered essential that mental health service development retains the protection of ring-fenced monies for a further period. In the absence of any such security in the context of severe budgetary constraint the likelihood is that the service provision which has been seeded will disappear. |
| The study was carried out by the Nuffield Centre for Community Care Studies at the University of Glasgow. It was funded by the Social Work Services Group of The Scottish Office. |
|
| Bernadette Laffey and Alison Petch |
|
| 'Dedicated Resources, Dedicated Responses: Evaluation of the Mental Illness Specific Grant, the research report summarised in this Research Findings, may be purchased (price £6.00 per copy). |
| Cheques should be made payable to The Stationery Office and addressed to: |