Assessing current provision

Step four is the assessment of current service provision. Having examined local population needs for mental health care, we now need to move to address existing services. Two separate exercises are necessary: (i) the best possible description of available services (structure), which will need to allow for the fact that the definitions or categories applied to services may be inconsistent between sites, and (ii) the use of these resources (functioning) needs to be described. The key point here is that, over time, both the structure and the functioning of the service will change in relation to each other.

For the description of local services in quantitative terms, we need to have an adequate method to describe their categories. Many standardized instruments have been established to measure individual psychiatric pathology, but in fact there is no accepted standard classification of mental health service components. An ambitious approach has been taken by de Jong et al.(l8) who, under the aegis of the World Health Organization (WHO) developed the International Classification of Mental Health Care (WHO-ICMHC). It is a tool for classifying services providing mental health care, which is based upon what are called the 'modules' of care. A module of care is defined as a type of care made available with patients with comparable histories of psychopathological and social problems. There are now two editions of this schedule, and the first edition has been used in a comparison of mental health services in South Manchester and South Verona. (19)

An alternative scheme for classifying types of service, proposed by the Department of Health in the United Kingdom, is called the Spectrum of Care. It uses three main categories for services according to their functions, namely home-based care, day- and outpatient care, and residential (inpatient and non-inpatient) services. Each of these main headings also allows for further specific subtypes to be defined. These services types are then further divided into 'acute' and 'long-term'.

A third possible approach, is the European Service Mapping Schedule ( ESMS),(29 which is being developed to allow international comparisons to be made. The ESMS allows the following tasks to be carried out in a standardized way:

1. compiling an inventory of the mental health services serving the adult mentally ill population in a particular catchment area, with descriptions of their major characteristics;

2. listing the provision of health services, social services, and voluntary and private sector services;

3. recording changes over time in the services of a particular catchment area;

4. delineating and comparing the structure and range of services between catchment areas;

5. measuring and comparing the levels of provision of the major types of mental health service between catchment areas. Box 5

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