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Funding of mental health services 

Funding of mental health services
Chapter:
Funding of mental health services
Author(s):

Dan Chisholm

and Martin Knapp

DOI:
10.1093/med/9780199565498.003.0151
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date: 22 July 2019

Whether it is a case of setting out to develop, reorientate, or just maintain existing levels of community-based mental health services, policy-makers and planners will run up against the inconvenient but inescapable question of resource constraints. How much money will it take, for example, to build up service coverage and capacity, to introduce effective new intervention strategies, to overhaul prevailing modes of service delivery, or to cater for the changing needs of the population? Decisions made at this strategic level of mental health policy and planning exert a powerful influence over the extent to which those people in need of services will actually be able to access and use them, as well as shape the way in which provision is organized and paid for.

Mental health financing is a far-reaching topic that not only addresses the specific question of what services to purchase and how, but also more normative questions around how much should be allocated to (say) community mental health care (e.g. what can be afforded, given the extent of mental health and broader other health needs in the population?), as well as equity issues (e.g. are funding arrangements fair, in the sense that people in need are not prevented from accessing services on financial grounds?). Indeed, alongside meeting the reasonable expectations of service users and actualizing mental health improvements in the population, fair financing does or should represent a key goal of a mental health system (WHO, 2006). In this chapter, we endeavour to cover these diverse questions under a number of central financing themes— resource generation and revenue collection, risk pooling and financial protection, plus resource allocation and purchasing — to highlight key funding issues that need to be considered when planning, implementing, or evaluating community mental health services.

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