Service and Resource Management

Abstract

In previous chapters of this book, we have considered the evolution of behavioral health services over time, influenced both by ethical/philosophical and economic factors. On the one hand, we agree that service development should be driven by quality concerns and outcomes. More recently, the choices of the people using services have also become an important source of influence. On the other hand, we have had to recognize that there is expense associated with the provision of quality services and that our resources are not unlimited. Over the last 3 or 4 decades, the conflict between these opposing concerns has been intensifying, and it would appear that this tug-of-war could continue indefinitely. As the costs of providing care rise and economic conditions deteriorate, these issues become even more prominent. Psychiatrists and other behavioral health practitioners, working primarily in publicly funded programs, find themselves in the middle of these struggles, and thus are obliged to think about how they can use available resources wisely and fairly while maintaining a reasonably high quality of care. It is only through these endeavors that we can efficiently use resources to provide sufficient care to the greatest number of people (Frank and McGuire 2005; Pincus et al. 2007).

Portions of this chapter were adapted from an article previously published in the Community Mental Health Journal (Sowers et al. 1999).