Integration and Targeting of Community Care for People with Severe and Enduring Mental Health Problems: Users' Experiences of the Care Programme Approach and Care Management

Correspondence to Professor John Carpenter, Director, Centre for Applied Social Studies, University of Durham, Elvet Riverside II, Durham DH1 3JT, UK. E-mail: J.S.W.Carpenter{at}dur.ac.ukJ.S.W.Carpenter@dur.ac.uk Summary We report the experiences of different models of community careof random samples of 262 people with severe and enduring mentalhealth problems living in four districts in the north of England.The districts were characterized in terms of the extent of (1)integration between the health service-led Care Programme Approach(CPA) and social services Care Management, and (2) targetingof services on people with severe mental health problems. Themajority of service users felt involved in planning their owncare and considered that they had choice in their care and treatmentwhen in the community, but not in hospital. Although all theseusers were formally subject to the CPA, the proportions of usersin the districts believing they had a written care programmeranged between 37 per cent and 60 per cent. Of these, the greatmajority were very positive about their care programmes andfelt that they were being helped to become independent. Theseresults were replicated when 87 per cent of the original samplewas re-interviewed six months later. There were significantdifferences between the four districts and evidence that userspreferred an integrated health and social care service. In addition,a higher proportion of users in inclusive districts were satisfiedcompared to those in targeted districts. Notwithstanding thesepositive findings, there is still considerable room for improvementin relation to the involvement of family carers and the provisionof adequate information about prescribed medication and makingformal complaints.     

INTERPRETING THE SOCIOLOGICAL CLASSICS: CAN THERE BE A “TRUE” MEANING OF MEAD?

Many sociologists have tried in vain to find the “true” meaning of the classic works in the discipline. An interactionist perspective suggests that this search is not a valid one for sociologists, especially symbolic interactionists. Although there can be no “true” meaning, some authors use conventions of writing that make their work more or less clear. Using Mead's Mind, Self and Society as an example, we discuss the dimensions of clarity. We then argue that the sociological classics should be read to (I) simulate new theories and research (pragmatic analysis), (2) determine how sociologists have used that classic to support or refute particular theories or perspectives (rhetorical analysis), and (3) provide information about the sociological concerns of the author and his/her contemporaries (historical analysis).     

Double machine operation and psychological strain

This study examines the effects of double machine operation on psychological strain. CNC drilling machine operators' reactions to their job were monitored as they rotated between three different work conditions; single machine operation, double machine operation, and double machine operation with additionally high responsibility for products. Results show no effect of double machine operation on strain where responsibility was low. Double machine operation under the condition of high responsibility, however, was found to increase strain.