ASSESSING QUALITY IN MENTAL HEALTH CARE The United Kingdom Experience

Quality assessment in mental health services is undergoing change in the United Kingdom following the introduction of market reforms. Traditionally, service quality was monitored by professional practitioners with reference to user satisfaction. This became formalized, and the two main forms of quality assurance currently used are outlined. However, the government is concerned that this may be inadequate for the monitoring of quality standards, specified in contracts between service purchasers and providers, and that existing systems provide an insufficient indication of service outcome. As a consequence, the government financed the development of a new set of health outcome scales. The importance of these scales are discussed. In April 1993, quasi-market reforms of public sector welfare services, including those for mental health, were put in place in much of the United Kingdom (NHS and Community Care Act 1990). At the center of these reforms was a distinct split between purchaser and provider functions of services. The aim is to allow competition to develop in the supply of services that will result in increased efficiency and a greater responsiveness to clients’ needs. Although the market may be more efficient, there are difficulties in terms of quality assurance (Bartlett 1991). In particular, there is a central problem of the relative access to information of the purchasers and providers of services. The separation of these functions has led to a situation in which the main source of information for the evaluation of the providers ’ activity (including service quality) is actually from data supplied by the provider