Constraints on the development of mental health services

In some countries, the law is too rigid concerning compulsory detention of mental patients. Unnecessary deprivation of personal liberty in order to provide treatment for mental disease leads to fear and delay in seeking help, and reduces use of the service by persons in need. Furthermore, it militates against the public health principles of early recognition and treatment.

The method of financing mental health care may hold back the development of units in general hospitals and day hospital treatment. Comprehensive health care systems where all the money is funded from the state may be more flexible in their approach and more likely to encourage experimentation than those where financial provision is over-rigidly related to the number of beds available. Where a large private section exists, the public mental health services are in a disadvantageous position. The private sector tends to be very selective in the type of patient treated, as few people can afford to pay for treatment of the prolonged illnesses so characteristic of mental disorder. Because the private sector can be selective, it is able to offer salaries and working conditions which are better than in the public sector. Moreover, where there is a private sector, this often results in people who might otherwise be active in pressing for reform, being treated outside the publicly provided service. In short, two standards of service may develop and, in the ensuing competition for staff, the private sector is at an advantage, with serious consequences for the majority of the mentally ill.

Conservatism also impairs development. There are many large institutions where outmoded custodial attitudes persist and whose staffs see no need for change. While new methods of working are professionally more exciting, they are also more demanding. New techniques such as multidisciplinary team-work, and group and individual psychotherapy, should be acquired by all the staff concerned, but many lack motivation or are reluctant to learn these new techniques. The lack of trained manpower appears to be the principal constraint on the further development of psychiatric services. In claiming resources, psychiatry is at a disadvantage compared with other health services such as, say, renal dialysis or cardiac surgery which make a more spectacular appeal. By contrast with these, the needs of the mental health services appear to be lacking in urgency and public interest. Too often low priority has been given to the mental health services for so many years that the morale of staff and standards of care have fallen as a consequence.

(F) Fuzzy exceptional problems