The market and mental health: Intentional and unintentional incentives

Abstract

The NHS and Community Care Act (1990) introduced market forces to the NHS and local authority social services. The changes made to the two systems were not always compatible, a feature which particularly affected areas such as mental health, where there is an overlap in the responsibilities of social services departments, NHS trusts' specialist mental health services, primary care and other providers. This legislation and subsequent regulations have achieved the intended incentives towards competition and a greater emphasis on efficiency. However, these incentives are spread across three purchasers and a large number of providers, each responsible for poorly defined and overlapping segments of the market. Consequently, a number of unintentional and perverse incentives have been created, encouraging agencies to pass on responsibilities and costs to each other in areas such as acute care, housing and employment. This inhibits the development of well co-ordinated and seamless mental healthcare.

Key Words:

• community care
• mental health
• social services
• primary care
• incentives