Therapeutic community at risk if funding solution not found

The only NHS-run residential therapeutic community for families, the Cassel in Richmond, says it faces closure in March and must submit proposals for future provision of services to West London Mental Health Trust (WLMHT) by the new year.

The Cassel, which provides assessment and treatment for those with intractable personality and family problems, is applying to the Department of Health (DH) National Commissioning Group (NCG) for funding as a specialist service. But it believes that because its work extends beyond the remit of the DH, its application is unlikely to be successful.

The Cassel, which is an NHS centre of excellence, provides therapeutic programmes for severely disturbed adults and young people aged 16-plus through its ESPD (emerging and severe personality disorder) service. Its family service offers therapeutic interventions and residential and community-based programmes to multi-problem families in which children are at risk. It says it has been told by WLMHT that services are unlikely to survive in their present form beyond March 2008.

Clinical director Dr Kevin Healy said the Cassel has faced financial problems, culminating in a £1m deficit in 2006-07. This was covered by WLMHT, which, stressed Dr Healy, has been ‘extremely supportive’ of its work. He said staff had worked very hard to turn round the projected £1m deficit for the current financial year (2007-08).

Cost-cutting measures have included the closure of 10 beds. Residential treatment is, he said, extremely costly, totalling £150,000 for a mother and child for a year.

The Cassel works with those who have often exhausted all other avenues of help from mental health, children’s and social care services. Most referrals to its family service occur when a child is subject to care proceedings, which are in turn legally enforced by section 38 (6) of the Children Act.

But the Cassel’s finances have been hit by an Appeal Court judgement in a case in which Kent county council disputed its legal obligation to fund treatment of a child at the Cassel under the terms of the act. The Lords of Appeal upheld the council’s argument that the legislation only required it to fund assessment rather than treatment.

Dr Healy explained that, as a result of the judgement, family unit referrals dropped, further threatening the Cassel’s financial viability. He explained: ‘It is very frustrating for families to be told you might well benefit from treatment but then not be able to have it.’

Cassel senior registrar Dr Barry Jones said: ‘The decision is at odds with government guidelines for providing for the welfare of a child, which of course the law should reflect. The DH dictates that assessment should include “a realistic plan of action”.

Further funding problems have resulted from changes to the Legal Aid budget which now prohibit social services from using money from this source to fund residential assessments for families.

Local MP Susan Kramer secured an adjournment debate in the Commons earlier this year in which she asked the government to address the consequences of the Kent judgement. But in a written reply, junior health minister Ivan Lewis said ‘the government has no plans to amend legislation’.

Dr Healy said the options to be submitted to WLMHT were splitting the services or moving them in their entirety to a new, as yet unspecified, site – ‘some place else’ – that would be less expensive to maintain. He said  both risked damaging the work of the Cassel. He said: ‘Keeping all age groups together is key to the therapeutic environment.’

Dr Healy said the underlying problem was the lack of central funding for the type of services the Cassel provides. He pointed to the lack of integration and pooling of budgets across relevant commissioning agencies in social care, justice, and health both regionally and nationally.

A WLMHT spokesman said the Cassel’s funding problems were complex because the two part of its service were subject to different cost pressures from different commissioners. He denied that it was unlikely to continue in its present form after March: ‘We are working with the Cassel. The hope is that they will be successful [in their campaign to stay open]. We are not ruling anything in or out.’