Planning a psychiatric service

   Tweet   

---

Locality planning for psychiatric service

In most counties, service planning is centered on a geographical area, often called a locality in the UK , a catchment area in the USA , and a sector in Europe . In Europe , sectors vary in size from about 15 000-50 000 in Sweden to 250000 in Germany (see Thornicroft and Tansella 2000). . Locality planning has advantages since it:

•  Allows for local variations in the population, for example, an unusually large proportion of elderly people;

•  Integrates different parts of the psychiatric services, for example, services for adolescents and adults;

•  Integrates psychiatric and medical services, for example, services for child psychiatry and mental retardation;

•  Integrates medical, social and voluntary services.

Locality planning also has disadvantages:

•  It may not be cost-effective to provide services for conditions which require specialist care but are of low prevalence, for example, patients needing medium or high security;

•  The quality of services may differ between sectors;

•  Health service and social service sectors may not be co-terminous.

These disadvantages can b~ reduced by collaboration between sectors in service provision and by the setting of national minimal standards.

The planning process for psychiatric service

Thornicroft and Tansella (2000) have listed seven steps in planning services for a locality:

•  Establish principles - This is especially important when planning involves representatives from several professions who may have different values and aims. If these differences are not identified and discussed at the start, the may be the unexpressed reason for failure to reach agreement in later meetings. Thornicroft and Tansella have suggested nine planning principles.

•  Set boundaries to define responsibilities between parts of the psychiatric service (e.g. between general adult services and substance abuse services), between primary and secondary care (e.g. in treating the less severe psychiatric disorders), and between medical and social services (e.g. in the provisions for conduct disordered adolescents).

•  Assess population needs .

•  Assess current provision - This requires a consider ation of the service components. Alternatively, a more formal schedule can be used, for example, the International Schedule of Mental Health Care (World Health Organization 1990).

•  Formulate a strategic plan with a review of the deficits of the current provisions, a statement of the planned provisions, and short term and long term goals. This plan should be discussed widely and modified appropriately in response to the comments received.

•  Implement the plan as far as resources allow, according to the priorities in the plan.

•  Monitor and review the service Funds should be identified in the original budget for an evaluation to determine whether changes in services have benefited patients and their families.

Users and relatives should be involved in several of these stages.

Nine principles of service planning

1. •  Autonomy patients should be able to make choices
2. •  Continuity over time and between different parts of the service
3. •  Effectiveness evidence that the intended benefits are achieved
4. •  Accessibility care should be provided where and when it is needed
5. •  Comprehensiveness in relation to the various needs and users
6. •  Equity the distribution of resources, and the way this is decided should be fair and explicit
7. •  Accountability to the users and funding persons of the service I
8. •  Coordination within the mental health service, and between it and other services
9. •  Efficiency the maximum reduction of need from the available resources