Organisation of Services 3775 Find the right balance between prevention and cure. Prevention is such an
attractive option that planners often assume that spending money on
prevention is bound to be better value than spending money on a
cure. This is not necessarily true. Some preventative approaches are
not particularly effective (see Chapter 36). In some instances, it is cost-
effective to invest money in prevention; in other instances, it is better to
invest resources in early detection and effective treatment. Taking the
example of the Triple P parenting intervention noted above, a universal
prevention trial in several counties in North Carolina in the USA showed
that it reduced the incidence of child abuse.
6 Employ labour-saving devices. Mental health assessments and treatments
are very labour-intensive, and they probably always will be. There is
room, though, for using computer technology to improve productivity
while preserving quality. There are a growing number of options for
computer-assisted assessment and treatment; the general aim is for the
computer to take over the routine and repetitive parts of the job, leaving
the professionals freer to do the interesting and innovative parts. For
example, computer interviews can ask the routine questions, thereby
identifying areas of concern to be explored in more detail by a mental
health professional (for example, http://www.dawba.info/f1.html)..) In effect,
computers can do much of the boring work that used to be done by
underpaid junior staff – and do it cheaper!
7 Prioritise the most cost-effective treatments. If, despite the measures described
above, it still is not possible to meet all child and adolescent mental
health needs within the available budget, then provision will need to
be rationed. The need for rationing is increasingly acknowledged in
all areas of health care since there is widespread (but not universal)
agreement that needs and wants are bound to outstrip the resources for
meeting them. If rationing is necessary, one solution is to concentrate
on the most cost-effective treatments, since doing so provides the
greatest overall benefit for the available money. Others would argue,
however, that this is not necessarily the fairest approach to rationing
since it may result in individuals with mild but easily treated disorders
getting more treatment than individuals with serious but hard-to-treat
disorders.
Built-in improvement
It is important to design services so that they can improve with time. Two
key ways to do this are ‘continuing professional development’ programmes
for staff and routine outcome monitoring. All professionals need to commit
themselves to lifelong learning, and services need to facilitate this. In ad-
dition, services need to monitor how much the people they treat improve
as a result. This does not have to cost much – standard questionnaires
completed by parents, teachers, children or adolescents are often sufficient.
These ‘customer’ reports supplement clinician ratings of improvement and
are arguably less prone to bias. Through routine outcome monitoring,