The organization and delivery of psychological treatments.
This article reviews the major issues which face health providers when they seek to organise the delivery of psychological treatments to best effect. A lack of consensus on efficacy, efficiency and acceptability makes policy decisions difficult. Streamlined focused services offering evidence based interventions for a limited target group are compared with broader enterprises offering comprehensive provision of a range of therapies. The dilemmas that the relative strengths and weaknesses of these two models pose are compared in relation to setting, cost efficiency, patient acceptability, equitable access and the pragmatics of staff training, service delivery and clinical governance. It is suggested that changes in the structure of health service provision more generally and the potential inherent in new technology and innovative ways of working may provide new solutions to some of these difficulties and the successive restructurings of a department of psychological treatments are adduced as an example.
Denman
Chess
C
Complex Cases Service, Addenbrookes Hospital, Cambridge, UK. Chess@denman.me.uk
D003362:Cost-Benefit Analysis; D003695:Delivery of Health Care / Q000191:economics / Q000458:organization & administration*; D019317:Evidence-Based Medicine; D006754:Hospital Restructuring / Q000458:organization & administration; D006801:Humans; D001523:Mental Disorders / Q000191:economics / Q000628:therapy*; D017060:Patient Satisfaction; D010554:Personality Disorders / Q000191:economics / Q000628:therapy; D011613:Psychotherapy / Q000191:economics / Q000458:organization & administration*; D012931:Social Environment; D013222:State Medicine; D016896:Treatment Outcome; D006113:United Kingdom