A diagnosis of conflict: theoretical barriers to integration in mental health services & their philosophical undercurrents

In the UK there has been much talk of "integrating" mental health services in recent years--a topic usually couched within a broader government agenda of assimilating health and social care. Parallel movements towards service integration can be found in North America [1] and throughout the developed and developing world [2]. In the UK, pathways towards integration have been paved by the Health Act Flexibilities (1999), which removed financial and legal constraints hindering service integration, and the Health and Social Care Act (2001), which created Care Trusts aimed to deliver a whole spectrum of services within a single organization.The topic of service integration gains much of its appeal by appearing to make sense virtually "across the board," from the politicians and commissioners focused on partnerships and integrated budgets, to the practitioners focused on integrated working and service delivery, right down to the service user accessing a more convenient and reliable set of services provided by a "team" of professionals. Indeed, service integration has repeatedly been promoted in this sweeping manner [3-5].Those in the midst of such integration, however, realize that it carries a number of conflicts, many of which are hardly new. One longstanding conflict poised to come to the fore by recent integration measures lies within divergent theoretical orientations towards the phenomena being treated. By "theoretical orientations" I wish to connote those views generally held among practitioners, either as a result of educational training or area of work (or both). Nowhere is this arguably more prevalent than in the formation of "community mental health teams" (CMHTs)--a hallmark of service integration over the past decade--whereby diversely trained practitioners are placed under one roof and, ideally, in regular contact with each other to exchange ideas and skills. As promising as this multidisciplinary, team-based approach may seem, the reality within such teams