The central role of human resources

This book is written for the range of people who are interested in improving mental health services, and this particular chapter will probably be of more interest to clinicians than to administrators and planners. Having already discussed in the last two chapters how to establish the overall needs for information and services, our aim here is to suggest how the staff who constitute the service can be directly involved in formulating plans and putting them into practice. Our main guiding theme is the question: how can the human resources in any existing mental health service best be deployed for the benefit of patients? We take again as our frame of reference the public health approach, which we have outlined in somewhat idealised terms in Chapter 10. In this chapter we shall concentrate upon more pragmatic and day-to-day issues, and in effect we shall base our comments upon the evidence of our experience, rather than the evidence of research. This is simply because there is a striking poverty of relevant research.

To a much greater extent than most other areas of medicine and health sciences, mental health services rely almost entirely upon human technology rather than upon instrumental technology, both for diagnosis and for therapy. For example, the best way to validate a questionnaire as a screening instrument is still by comparison with a clinical interview. In spite of the progress made recently in biological markers, none are yet available as clinical tests for the diagnosis of mental disorders. In terms of treatment, it is clear that the human factor is also central to how far, for example, patients comply with prescribed medication.