This document summarizes a study that investigated health professionals', service users', and carers' opinions about having separate consultants for inpatient and community mental health settings. The study found mixed opinions, with some concerns that the functional model could negatively impact continuity of care, therapeutic relationships, and training of professionals. While it may improve efficiency, respondents felt it could undermine patient trust and care. The study highlights the need for further research on the long-term impacts of this model.

1. Functional model: Mind the GapDr AnkushSinghalMBBS, MD (AIIMS), MRCPsychST6 (General adult psychiatry)BIPA Annual Conference 2010

3. My ContributionConceived the idea and led the study.Literature review, the protocol and ethics approval. Collected the data. Co-ordinated.Merged the data & analysed it.Prepared the manuscript and sent for publication. Revisions as first & corresponding author.Presented in RCPsych AGM, Liverpool and in my Trust.

4. BackgroundNWW: enabling consultant psychiatrists, among others, to deliver effective and person-centred care.Acute care pathway – CRHT + In-patient.Functional model.Acute in-patient psychiatry – a subspecialty?Mind the gapCommunity consultantIn-patient consultantService user

5. AimTo investigate health professionals’, service users’ and carers’ opinions about the provision of separate consultants for in-patient settings and the community

6. DesignMulticentre study : North Hertfordshire; the south lakes region of Cumbria; and Winchester. Tool semi-structured semi-qualitativequestionnaire (paper and online version)An information leaflet (without introducing any bias).

7. Data CollectionPersonally, by post and online.Through CMHTs, out-patient clinics, mental health wards and other places (e.g. the local centre of MIND).Admitted patients were not invited.Reminder - after a month.

8. AnalysisQuantitative data – descriptive statistics. Qualitative data – framework analysis.Carers: too few to be included in the analysis.

9. Results

10. Quantitative: Service providers170/330 responded - response rate about 50%.56 participants left after introductory questions.72% participants having > 6 years experience in mental health.

12. Distribution of Respondents

13. Results:contd...

14. Satisfaction of service providers

15. Quantitative: Service users20/43 respondents had a history of admission.Duration of contact with mental health: 2-10 years.Awareness: 16/43 (36%) aware

16. Satisfaction of service users

18. Qualitative resultsNeed of functional model: Unaware; divided opinions.to save money and/or time to reduce workload on consultantsto improve patient care.Service need, no clinical need.Long-term future:driven by financial issues, so will stay (2/3)would be reversed (1/3)

19. Qualitative resultsAdvantages 1/3 : no advantages of this changeDisadvantagesIn-patient psychiatry – NOT a separate sub-specialty.Skills Training

20. STRESS, SKILLS & TRAININGLess stress, more time.

21. De-skilling Vs specialisation,

22. Poor training.Suggestion: RotationCONTINUITY/COMMUNICATIONBoth consultants attend CPA

23. Care-coordinators

24. Shared electronic recordsQualitative dataDYNAMICSDisagreements

25. ResponsibilitySuggestions:Communication

26. Shared decisionsSU’s SATISFACTIONPoor engagement