Organisation of Services 371hospitals might be able to sell expensive in-patient care to families who
don’t know that out-patient treatment would have been cheaper and
more effective.
2 Except in large cities, specialist providers may have local monopolies.
This could allow them to overcharge, thereby undermining the effi-
ciency of a free market.
3 Private services are often unevenly distributed across a country, being
concentrated in affluent areas, particularly in large cities. Exclusive
reliance on free market forces will often leave some regions seriously
underprovided.
4 For low-income families, the costs of prolonged treatment or in-patient
admission will be prohibitively expensive, and even a brief out-patient
consultation may be unaffordable. Since poverty is a powerful risk factor
for psychiatric problems in many countries, exclusive reliance on the
free market would cut off some of the most vulnerable children and
adolescents from the help they need.
5 Even when parents are wealthy enough to afford private help for their
children’s mental health problems, they may prefer to spend their
money on other things. Parental willingness to pay may be undermined
by exactly those parental characteristics that contributed to their
children developing problems in the first place. Imagine, for example,
that Mr and Mrs Smith particularly dislike their son Joe and that their
constant criticism of him has contributed to his developing behavioural
problems. They may not be strongly motivated to get help for him even
it is free, and they will probably be even less likely to do so if they have
to pay.
6 Mental health is not just a private affair. You may be robbed or raped
by Joe when he grows up – a disaster that could perhaps have been
averted if only his family had been provided with help early on. Health
care is what economists describe as a ‘merit good’ since it is not just
the person who receives the health care who benefits – there are wider
benefits for society as a whole. Merit goods are characteristically under-
provided by a free market. The same often applies even more strongly to
prevention.
7 ‘Joined up’ working between health, social services and education is
often an important part of the management of children and adolescents
with psychiatric disorders, reflecting the complex interrelationship be-
tween mental health problems, social problems and learning difficulties.
Free market forces may promote inter-professional and inter-agency
rivalry rather than collaboration.
For these and other reasons, it is probably unwise for any society to
rely exclusively on the ‘invisible hand’ of the free market to provide and
allocate mental health provision and children and adolescents. To provide
optimal care, the free market needs to be regulated, supplemented or
replaced – but this will only improve matters if interventions are well
planned.