CHAPTER 43
Organisation of Services
Imagine you are in charge of drawing up a plan for your area’s child
and adolescent mental health services (CAMHS). Depending on which
country you come from, you might have been asked to do this on behalf
of the government, a health maintenance organisation, or an international
charity. This chapter cannot tell you exactly what to do, partly because
the right answer will depend on local circumstances, and partly because
there may be several good answers rather than one right answer. What
this chapter does instead is introduce you to some of the key points you
will need to consider in order to draw up your plan.
Why plan at all?
A good plan is better than a bad plan, but is it better than leaving
the development of services to market forces? As far as the provision
of consumer goods is concerned, free market economies have generally
outperformed planned economies, at least in terms of quantity and choice.
Could the ‘invisible hand’ of the free market do as well for child and ado-
lescent mental health services? For some families who are well informed
and wealthy, the free market can provide a good service. For society
as a whole, though, it would probably be a mistake to leave child and
adolescent mental health care to the free market without any planning or
governmental involvement. Here are some of the reasons:
1 Families are good at shopping around for apples or shoes because they
know what they want and they can judge what they are getting. By
contrast, if an adolescent becomes depressed, how can the family know
if they should be seeking psychoanalysis, cognitive-behavioural therapy,
herbal remedies, inter-personal therapy, medication, family therapy or
nothing at all? And even if they do know, how can they tell a good
provider from a bad provider? Inadequate information can be a major
barrier to the efficient operation of market forces. For example, private
Child and Adolescent Psychiatry, Third Edition. Robert Goodman and Stephen Scott.
©c2012 Robert Goodman and Stephen Scott. Published 2012 by John Wiley & Sons, Ltd.
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