There are various potential sources of funds for the provision of healthcare. Patients can pay directly themselves for the provision of their own care or that of their families. Healthcare can be funded by insurance, which can be purchased voluntarily or be required by government-sponsored schemes. Public funding can provide for part or for the totality of the population and for partial or total payment for the range of treatments available. All of these systems impose some form of constraint upon the range and extent of care available. Self-payment is of course dependent upon the ability of the patient to pay, but illness itself can prevent many people from being able to fund their own care; this is particularly true of mental illness, both because it frequently affects the ability of patients to support themselves and because poverty can be a precipitating factor. Insurance schemes are sometimes available only to the working population and their dependants; even where they are government-sponsored and designed to provide coverage for the poor and the non-working population, they can create restrictions on access to care, depending on what is covered by the policy. That can have the perverse consequence that it is necessary for people to become quite ill in order to become eligible for funding for treatment, and immediately after that treatment is concluded the insurance coverage ceases to fund their care. Consequently, such funding systems make more difficult the maintenance of well-being, the prevention of relapse and early intervention in mental illness.

Where do resources for mental health services come from?

Publicly funded healthcare systems confront most directly the problem of the allocation of finite resources between competing health needs across the population as a whole. That can lead to rationing, either by the restriction of access to certain forms of treatment, for example high-cost drugs, or by the imposition of waiting times for treatment for non-urgent conditions. It can lead to different priorities being accorded to different types of illness, sometimes influenced by stigma and discrimination – sometimes referred to as ‘disparity of esteem’.