Suicide rates among young men in Manchester are twice the national average. Psychiatric readmissions are higher than in comparable cities. And the cost of anti-depressant drugs is rising faster than that of any other type of drug prescribed by GPs.
With such problems, the provision of mental health services is vital. Yet the city has long recognised that there has been substantial room for improvement.
The opening in October of a citywide provider of mental health services, the Manchester Mental Health Partnership, is the latest attempt to improve services for some of the city's most vulnerable residents. It aims to eradicate inequalities in services across the city.
The partnership, which brings together NHS sevices and social care services provided by Manchester city council, follows earlier initiatives to improve the coordination and user focus of services, such as the creation of a joint commissioning board and the development of a single specification for mental health services.
All eyes are now on the Manchester partnership, the flagship initiative arising from flexibilities introduced by the Health Act 1999, which aims to remove obstacles to joint work between the NHS and council-run social services. It is far and away the biggest attempt to set up joint provision arrangements.
The new joint provider integrates services previously provided by four NHS trusts and the council's social services department. Its commissioning executive will have a pooled budget of more than £50m.
The journey that began with a consultation exercise in 1999, which confirmed that users were unhappy with current arrangements, has not been easy, particularly as the partnership has broken new ground. The legal agreement that set out the respective functions of the two original partners - the health authority and the city council - has had to be adapted. Since April, three primary care trusts (PCTs) have been established in the city, taking over commissioning responsibilities from the health authority.
This has added to the complexity of the process. One of the aims of the partnership: to ringfence mental health service funds, had to be squared with the PCTs' desires to flex their muscles by spending their budgets in any way they saw fit. A compromise that safeguards investment in mental health services, subject to targets being met, has been reached.
Some issues could be anticipated. On October 1, around 1,500 staff moved to the new body. About 1,200 health employees are now employed by the lead partner, the health authority, while local authority staff have been seconded to the partnership for the time being. Transferring staff have their basic terms and conditions protected by transfer of undertaking (TUPE) regulations, but some of the predecessor trusts had local pay arrangements and the partnership has inherited a wide range of policies on issues such as disciplinary procedures and sick leave. Talks are already under way to standardise terms.
Other problems have been more specific. Agreeing on the partnership's contribution to overhead costs in the trusts that continue to house many of the services has been a challenge. And hopes that the partnership could operate without owning any buildings have been tempered as a result of a clause in the Mental Health Act concerning the detention of patients. Following legal advice, the partnership has, over the summer, been forced to sign formal leases for the relevant buildings.
According to Vanessa Coomber, the partnership's director of human resources and corporate services, the effort has been worthwhile. "It has been hard work, particularly because of the volume of organisational and managerial systems which we had to bring together," she says. "But we've never lost sight of the reason we are doing this. The dissatisfaction among users with the existing service was a tremendous motivation."
The partnership faces annual reviews of its performance. But, with the partnership agreement signed until 2003, it now has two and half years to prove itself.
