Organisation of Services 375Providing value for money
Child and adolescent mental health needs are extensive but budgets are
limited. Consequently, we need to find ways of doing more for less –
without undermining quality. Here are some of the ways of providing
value for money without compromising quality:
1 Some help is free or can be purchased at low cost by families them-
selves. It will often be appropriate to encourage families to use self-
help books and websites (which can be located, for example, via
http://www.youthinmind.info)..) Some self-help material is excellent, and for
mild problems and resourceful families, this may be all that is needed.
Telephone helplines, parents’ organisations and other voluntary organi-
sations can also be very helpful. Randomised controlled trials indicate
that self-help by parents using books and manuals can be effective.
Sometimes, this self-help is even more effective when parents are also
provided with a little guidance and supervision from mental health
professionals.
2 Provide help in the most cost-effective setting. Services to improve child
mental health can sometimes be delivered more appropriately and
economically outside specialist mental health settings. For example, it
may be cheaper and more convenient for families if family doctors
and paediatricians have the skills to prescribe stimulants for all but the
most complicated or treatment-resistant cases of ADHD. Similarly, if
high levels of bullying in local schools mean that child mental health
services currently have to spend a lot of their time treating the resultant
stress-related disorders, the cheapest and best solution may be greater
investment in school-based programmes to reduce bullying. To facilitate
this sort of work, child and adolescent mental health professionals can
contribute to the training of teachers, paediatricians, social workers
and other professionals, or work alongside them in schools, paediatric
clinics, residential care homes and other settings. However, caution is
needed since there is a growing literature on the need to use skilled and
well-trained therapists to obtain a significant therapeutic effect. There
are many innovative schemes to disseminate skills, but each of these
should be evaluated in terms of both cost and effectiveness before they
are widely adopted.
3 Optimise the skill mix. Specialisation and division of labour can greatly im-
prove productivity. The scope for this depends on the size of the mental
health team: the smaller the team, the less room there is for speciali-
sation. If the team is potentially large enough to support specialisation,
it is generally a waste of money not to do so. Imagine a team staffed
entirely by child and adolescent psychiatrists – it would almost certainly
be more expensive than a mixed team of psychiatrists and psychologists,
and it might not provide as good a quality of psychological therapies
either. Doctors are usually the most expensive team members and they
should be used sparingly for delivering the things they can do best, for