Exploring the implications for the voluntary sector in rural communities of a changing commissioning environment in mental health

Abstract

Many small voluntary organisations provide publically funded community mental health services, in rural communities. Changing national policy has led to changes: in the rural definition with 50% of local authorities now rural; in commissioning, including competitive tendering; moves to better integrate service users and to personalise services. This thesis explored the impact of these changes on small local Mind associations in England using quantitative methods and then across two neighbouring midland counties using a qualitative method. A widening gap was confirmed between declining numbers of small local Mind associations and larger associations that had grown in size and number. However the £250,000 threshold used to define small voluntary organisations was found not to be a meaningful measure of an organisations ability to survive. Many small associations were found to lack the capacity to adapt and there was no evidence of increased partnership working in these circumstances despite some key criteria being met. Personalisation underpinned by recovery and well being with competitive tendering is having a significant impact on voluntary organisations that provide public services. More personalised services might provide better access for people in rural communities; however public expenditure reductions would likely adversely impact on the capacity of commissioners.