Priorities, "street level bureaucracy" and the community mental health team

In the United Kingdom a combination of high profile incidents and reports personally critical of mental health policy in general and individual practitioners' actions in particular (Sheppard 1995) highlight the pressures which operate on mental health professionals in the community (Mechanic 1995a). These pressures are exacerbated by policy contradictions and resource limitations. Consequently community mental health practitioners (e.g. psychiatrists, community psychiatric nurses and social workers) can be sensitive to political and managerial agendas which may have a negative impact on their implementation of individual care programs (Marks et al. 1994). Using the concept of ‘street level bureaucracy’ (Lipsky 1980), this paper examines recent literature. It is argued that practitioners' reception and implementation of policy is influenced by the need to balance the tension between four elements: the political and policy imperatives, the agenda of local management, the professional and peer cultures in which practitioners operate and the balance of perceived personal advantage. It is further postulated that managers and policy makers may have a vested interest in not scrutinizing practitioners' implementation of policy too vigorously as a way of deflecting responsibility for its consequences. The ‘Care Programme Approach’ and recent legislative changes regarding community supervision (Department of Health 1995a) highlight the important and sometimes negative consequences for the service user that may result.