Clinicians in the field of mental health are met with the dual challenge of increased accountability and shrinking resources. Funds are often allocated through the use of crude administrative monitors. This is of little solace to the clinician faced with unmet patients’ wants and needs. A set of clinical monitors is outlined requiring the practitioner's cooperation. The presentation of an accurate composite picture is a must in the process of resource allocation. Such clinical monitors include the analysis of characteristics of patients such as the repeaters at emergency, “the revolving door” pool of patients and those falling in between networks. Reviews of waiting lists and lengths of stay, an evaluation of nursing care variables, the auditing of the choice of therapeutic modalities and the use of restraints are other suggested contributors to the assessment of service needs.
References
1.
TalbottJ.A.The impact of Proposition 13 on mental health services in California.Hosp Community Psychiatry1979; (30)10: 677–83.
2.
HathawayB.CMHC's face hard times.Psychiatric News1982; 17(8): 1, 22, 23.
3.
ToewsJ.Mental health service priorities in a time of restraint.Canada's Mental Health1980; 28(4): 2–4.
4.
ScherlD.J., MachtL.B.Deinstitutionalization in the absence of consensus.Hosp Community Psychiatry1979; 30(9): 599–604.
5.
BachrachL.L.The effects of deinstitutionalization on General Hospital Psychiatry.Hosp Community Psychiatry1981; 32(11): 786–90.
6.
FiferW.L.Quality assurance in health care. In: AwadA.G., DurostH.B., McCormickW.O. eds. Evaluation of quality of care in psychiatry.Toronto: Pergamon Press, 1980; 123.
7.
Statistics Canada: hospital information system, 1977, pp. 32.
8.
KieransT.E.Issues and alternatives, update.Ontario Economic Council, 1979.
9.
Bassuk EllenL.The impact of deinstitutionalization on the general hospital psychiatric emergency ward.Hosp Community Psychiatry1980; 31(9): 623–7.
10.
RuizP.The fiscal crisis in New York City: effects on the mental health care of minority populations.Am J Psychiatry1979; 136(1): 93–6.
11.
PilisukM.The future of human services without funding.Am J Orthopsychiatry1980; 50(2): 200–4.
12.
PattisonE.M., ElpersJ.R.A developmental view of mental health manpower trends.Hosp Community Psychiatry1972; 23(11): 325–8.
13.
MadenlianR., PattisonE.M., SaxonS.Economic viability of the mental health worker.Hosp Community Psychiatry1980; 31(5): 328–31.
14.
AstrachanB.M.Regulation, adaptation and leadership in psychiatric facilities.Hosp Community Psychiatry1980; 31(3): 169–74.
15.
MayP.R.A.Cost efficiency of mental health delivery system. 1. A review of the literature on hospital care.A.J.P.H.1970; 60(11): 2060–7.
16.
EwingC.P.Crisis intervention as psychotherapy.New York: Oxford University Press, 1978: 129.
17.
American Psychiatric Association, Peer Review Committee (2nd edition): Manual of psychiatric peer review.American Psychiatric Association, Washington, 1981.
18.
CottonP.G., Bene-KociembaA., ColeR.The effect of deinstitutionalization on a general hospital's inpatient psychiatric service.Hosp Community Psychiatry1979; 30(9): 609–12.
19.
CaplanG.Principles of preventive psychiatry.New York: Basic Books, 1964.
20.
WhiteS.L.The impact of mental health services on medical care utilization: economic and organizational implications.Hosp Community Psychiatry1981; 32(5): 311–19.
21.
Canadian Psychiatric Association - Guidelines regarding the limitation of freedom in adult psychiatric units, Position Paper, 1982.
22.
NurbyR.B., FreundL.E., WagnerB.A nurse staffing system based upon assignment difficulty.Journal of Nursing Administration1977; Nov.: 2–24.
23.
GillespieE.H., BakerJ.D., MoskowitzM.J.102 ways to contain hospital costs.Dimensions in Health Service1979; September, 24–25.
24.
EisenbergL.Mental health services: equity, quality, and constraints.Hosp Community Psychiatry1978; 29(12): 781–7.
25.
LevinsonH.A.When executives burn out.Harvard Business Review, May-June 1981, 73–81.
26.
GinzbergE.The competitive solution: two views -competition and cost containment.N Engl J Med1980; 303(19): 1112–15.
27.
LiptzinB.The effects of national health insurance on Canadian psychiatry: the Ontario experience.Am J Psychiatry1977; 134(3): 248–52.
28.
WeinsteinM.C., StasonW.B.Foundations of cost-effectiveness analysis for health and medical practices.N Engl J Med1977; 296(13): 716–21.
29.
MayP.R.A.Cost efficiency of treatments for the schizophrenic patient.Am J Psychiatry1971; 127(10): 1382–5.
30.
SharfsteinS.S., ClarkH.W.Economics and the chronic mental patient.Schizophr Bull1978; 4: 399–414.
31.
SteinL.I., TestM.A.Alternative to mental hospital treatment I. Conceptual model, treatment program, and clinical evaluation.Arch Gen Psychiatry1980; 37: 392–7.
32.
WeisbrodB.A., TestM.A., SteinL.I.Alternative to mental hospital treatment II. Economic benefit-cost analysis.Arch Gen Psychiatry1980; 37: 400–5.
33.
TestM.A., SteinL.I.Alternative to mental hospital treatment III. Social cost.Arch Gen Psychiatry1980; 37: 409–12.
34.
GrossS.M., SciarraJ.J.Why it's important to analyze drugs’ cost-effectiveness.Pharm Times1980; 46(10): 30.
35.
WolbergL.R.Cost-Effectiveness in psychotherapy.J Am Acad Psychoanal1981; 9(1): 1–5.
36.
HudsonJ.I., BraslowJ.B.Cost containment education efforts in United States medical schools.J Med Educ, 1979; 54: 835–40.
37.
RusseH.P., KnappR.M., BentleyJ.Cost containment education efforts in U.S. teaching hospitals, 1979.J Med Educ1981; 56: 133–4.
38.
MartinA.R., WolfM.A., ThibodeauL.A.A trial of two strategies to modify the test-ordering behaviour of medical residents.N Engl J Med1980; 303(25): 1330–6.
39.
KellyC.Learning to cut health care costs.Can Med Assoc J1981; 124: 934–6.
40.
Canadian council on hospital accreditation — Guide to accreditation of Canadian mental health (Psychiatric) centres, Ottawa, 1981: 137.
41.
KaufmanE.The right to treatment suit as an agent of change.Am J Psychiatry1979; 136(11): 1428–32.
