ABSTRACT
Mark is embarking on a journey that must be mapped out from the start if Models of Care is to have any meaning and not present the patient, as user, with another nostrum for the new century. The successful operation of Models of Care depends on client throughput and availability of treatment slots. Client advocates will then complain of poor access to initial assessment and care managers will find it impossible to move clients from one service to another and therefore from one tier to another. Mark's story offers a clear demonstration of the challenges facing various professionals involved in the care of people like him. Mark's problems are not discussed at a multidisciplinary team meeting. Some consultants are likely to react very badly to the loss of a clearly defined team leadership role. Historically, consultants have been psychiatrists. The behavioural problems accompanying substance misuse, along with the alteration in mental state, has dictated this.
