Mental healthcare Decentralization

Mental healthcare Decentralization
Mental healthcare Decentralization

Mental healthcare Decentralization

Improving mental health efficiency by using of community health workers to decentralize health care services

Overview of healthcare industry, markets and competition

Recent changes in the UK in National mental Healthcare Services (NHS) have introduced new complexities into the accountability arrangements of the healthcare facilities. The current mental health systems are best described as command and control system. The mental budgets as well as policy are strategically set centrally by the Department of Health (DoH) and the government is administered locally by the NHS organization but accountability lies with the DOH.

The situation is more complex than the explanation of the ‘command and control.’  The balances between the central government and the local government have led to fluctuating autonomy and misallocation of resources (Normand, 2011).

 The UK mental healthcare system relies on highly centralized and costly expertise to delivery healthcare services. This type of system relies in intuitive medicine, and is best suited for healthcare issues that are complex and episodic. In addition, this type of healthcare system is associated with mismatch for chronic diseases, preventive measures and wellness care; which results into additional barriers and disparities especially among the underrepresented population. 

It is time for the National Health System (NHS) to depart from a one-size-fits all model and develop channels that will enable better delivery of services that can serve the dynamic needs of the population (Clayton, 2009).

 This study proposes that decentralizing mental healthcare services will aid in lowering cost of care, broaden accessibility and maintain as well as improve quality of care. For instance, the physician specialist will have the capacity to work in outpatient, the nurse practitioner will effectively provide care in retail clinics, and lay community health promoters or workers will improve health education, thereby reducing health complications associated with disease progression.

For example, the system will improve diabetic self management at patient’s residents.  This measure is in line with Institute of Medicine (IOM’s) health disparity vision of confronting ethnic and racial disparities using strategies that improve care delivery and or implement preventive measures and to enhance risk reduction (Black & Gruen, 2005).

Perceived problems in current healthcare systems

The fundamental issue that is believed to affect mental healthcare activities includes quality of care, safety issues, access to healthcare, cost of care, and delivery of services. These issues arise because of the problems that affect healthcare systems which include misallocations of national health resources, allocative inefficiency, and increased inequalities. Most of the health facilities get less proportion of healthcare budgets. An example of healthcare system that suffers from misallocation of resources is the mental healthcare system, which suffers due to misallocation of resources within the sector (Goodwin, Gruen, & Iles, 2006).

 In my facility, funding is done on low cost effective-interventions such as non-essential prevention strategies. For instance, People diagnosed with substance use along with mental health (commonly referred to as dual diagnosis) is associated with many health demands, yet they suffer too much to access quality healthcare services. These patients have complex needs and often experience multiple adversities in their lives including deprivation, childhood abuse, poverty and loss of support from their family members.

These persons are also associated with multiple needs such as homelessness and unemployment that makes them become prone of exploitation. This increases their risk of poor physical health, self harm, suicide and perpetrating violence. Dual diagnosis is unpopular in the UK, partly because the society is entrenched perceptions of substance abuse where most people believe that is a lifestyle choice instead of a health issue that needs urgent care and treatment (Normand, 2011).

 Dual diagnosis is one of the issue facing mental health and substance abuse. In the past one and half decades has lead to development of specific initiatives but all of them have had no improvement. The same changes have been implemented since the 90s. Today, mental health services today still exclude people if the problem is not perceived as substance related disorders. The misallocation of resources is associated with inefficient delivery of care as most of the healthcare resources are wasted (Kirk and Glendinning, 1998).

For example, it is inefficient to give patient a brand name over drugs cheaper generic ones that have same efficacy. The misallocation of resources also results to underutilization of resources which also affects the productivity efficiency. In current type of healthcare system often leads to indiscretions such as specialists handling numerous uncomplicated cases at high cost, cases that primary care centers could handle with ease (Normand, 2011).

 The aforementioned factors have lead to increase on cost of care without matching consumer’s health benefit. In addition, the existing weak monitoring system enables leakages of public subsidies to private sectors and medical covers which are already financially stable. This results to increased health disparities where poor and under-privileged in the society lack care affordability (World Health Organization, 2000).

These affected populations unfortunately are the majority, and often receives low quality of care. One of the best strategies is to train the staff in mental health facility in order to equip them with skills that will help make dual diagnosis by improving their knowledge and skills but have not managed to change the society’s perception and values.

Therefore, the two great challenges in this aspect of mental health a) to increase awareness on dual diagnosis in order to change attitudes people’s attitudes on mental health and b) to provide effective services to people diagnosed with dual diagnosis, especially in this unprecedented mental health crisis (Normand, 2011).

 Change in mental healthcare systems

 Change in the healthcare system is intended to improve the performance by adjusting the way services are delivered and relocating or roles and responsibilities for specific healthcare services and the processes of delivering care to the population including financing, implementation process, monitoring as well as regulation.  There are various drivers of change in the current health care system including the expected shift in political, social and economic factors that will come with new governing system. In addition, the increase in technological advancement should be enhanced to not only improve quality of care, but also the accessibility (Normand, 2011).

The key drivers for the proposed change within the mental healthcare system in NHS includes changes in population growth, demographic characteristics due to immigration, technological advancement, health’s infrastructure conditions, and increased patient level of acuity.  Change in ideologies refers to the modifications of frameworks used by the public health services to deliver care. For instance, new labor in 1997 removed department of health monopoly which created more opportunities for private sector and voluntary services that helped better healthcare system to some extent, at higher cost of care.

Similar changes have been observed with the coalition government in 2009 which removed government agents and gave more roles to local authorities and the private providers, which led to increase misallocation of resources. Therefore, decentralizing delivery of healthcare services using community workers will create freedom for providers to innovate strategic services that meet the specific demands for patient needs (Pickard and Glendinning, 2002).

 In addition, the current infrastructure conditions are too old and are not adaptable to provision of modern care for dual diagnosis. The current healthcare infrastructure demerits include high cost of care, reduced staff retention and inconsistencies in delivery of care. Therefore, vertical integration of decentralized health care in this community is aimed at addressing these challenges by reconfiguring healthcare services to suit the specific community demands.

For instance, technological advancement has made it easy to access patient information and also increased portability of patient’s health information and education of appropriate optional treatment. It is time to tap on the innovative techniques to increase efficiency in delivery of mental healthcare system and manage delivery of care in a way that maximizes population health benefits (Duguid & Pawson, 1998).

 Changes in population growth and the demographic factors is also another driving force for decentralization of mental healthcare services by the NHS. The increase in population has put pressure on the current healthcare system as it has led to dilapidation of healthcare facility caused by congestion due to population growth, which has led into high demands building of bigger healthcare facilities that will accommodate the patients. 

In addition, the gentrification of the low socioeconomic households by the middle class has led to inconsistence in delivery of services. The increased patient level of acuity and knowledge on quality issues is pushing the healthcare providers to improve delivery of care in order to meet their expectations (Clayton, 2009).


Change refers to any alteration of healthcare services with the aim of improving its quality. Changes in healthcare system are wide and ranges from revolutionary technology to refining of health workers responsibilities. There are three types of change namely originates, borrowed and adapted. Borrowed changes are easy and cheap to implement. However, these types of changes are often not appropriate to meet the local needs as no community is similar to another, which implies that one size fits to all may not apply (Goodwin, Gruen, & Iles, 2006).  

The proposed change is adapted change, which mainly implies that the strategies are borrowed from elsewhere and gets modified to fit the community needs. However, factors such as situational circumstances, management approach, wrong adaptation, and changes in political as well as economic environments determines if the change process will be effective or not.

Originated changes would be more effective as it involves more creativity than the adapted changes, but their implementation process is expensive as it requires an organizational climate that promotes innovation and creativity.  The proposed change is a technical change as it modifies the ways in which normal activities are carried out by altering the organization and program structures (Clayton, 2009).

 Decentralization is kind of change that involves dispersal of administrative, political and financial functions. It involves a process of shifting authority, power and responsibility from national to local government levels of the healthcare systems. The main advantages for vertical integration of decentralization in mental healthcare system includes technical benefits such as improving delivery of healthcare services, leading to better health outcomes. In addition, this method eradicates challenges associated with bureaucracy and monopoly that hinders effective delivery of healthcare services to the needy service users (Atun, 2007).

 Political benefits associated with decentralization of healthcare services are that it extends democratic control of healthcare services to the needy individuals at community level. This may also increase opportunity for the citizens and services users to participate in decision making processes. This is effective strategy as it helps the government to identify the specific community needs.

Decentralization process also helps in minimizing financial burden associated with public procurement processes by transferring risks from a central point and distributing them to lower and private sector. This helps promote innovativeness and competition, which further improves the service user’s outcome (Bossert, 1998).

In this context, decentralization is the recommended as an approach of improving administrative activities that will help deliver healthcare services. This is also done for the purposes of achieving effective service delivery. In addition, decentralization helps improve local participation as well as autonomy in healthcare services. This acts as a means of redistributing power when it is effectively done, thereby reducing health disparities associated with tribal and regional tensions. 

Decentralization is also invoked as a means of increasing cost efficiency in mental health care systems, which is attained by giving the local units better and greater control over the available resources as well as healthcare revenues. In turn, this approach sharpens NHS accountability in healthcare services and operations. The approach helps to covertly offload financial burden from resource poor governments to local service providers (Saltman et al., 2007).


The Mental healthcare system relies upon on highly centralized and costly. The optimal for mental healthcare system is based on intuitive medicine, and is best suited for complex and episodic mental health complication. This increases additional barriers to healthcare care disparities and the minority groups.  It is important for the NHS mental health care system to depart from the one size fits all paradigms and to establish better channels that will ensure that healthcare delivery is improved to meet the growing dynamic needs for the underprivileged service users.

 The potential impacts of decentralization intervention are that it creates opportunities that improve the prevention strategies. The balance between the primary and tertiary preventive measures regarding saving. The strategy will also increase access to healthcare services by ensuring that the downstream expenses are balanced. In addition, the approach will help replace the costly unnecessary services with less expensive and quality ones.


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