Abstract
It is in the nature of Health Services that there should exist a balance between the general and the specialised; between the treatment of common conditions with generally applicable techniques and the handling of more unusual diseases. Services which require scarce skills and treat less patients who need more time are expensive. In a cost-driven situation, these skills are likely to be constrained in favour of more generally applicable, lesser standards which are cheaper.
Highlights
It is in the nature of Health Services that there should exist a balance between the general and the specialised; between the treatment of com mon conditions with generally applicable techni ques and the handling of more unusual diseases
Not all psychiatric dis orders can be adequately handled by general psychiatrists and the primary health care team, some disorders require a higher level of expertise
At present there is no robust machinery for identifying national, or regional needs, and potential resources for some of the highly specialised services when these do not resonate with the aim of local purchasers and providers (Crisp, 1995)
Summary
It is in the nature of Health Services that there should exist a balance between the general and the specialised; between the treatment of com mon conditions with generally applicable techni ques and the handling of more unusual diseases. Reasons for psychiatric specialisation (i)The skills required for diagnosis and treatment are beyond the experience of general psychia trists, as in psychiatry for deaf people, child and adolescent psychiatry, and forensic psychiatry, (ii)The treatment facility is costly and needs to be regional or sub-regional; for example, a regional secure unit, an adolescent unit, a mother and baby unit, or an in-patient service for behaviour difficulties following severe brain injury, (iii) The specialised team acts as a catalyst for service improvements, developing a focus of excellence where medical and nursing students and other professionals can best be trained and where research can be promoted This is true of the psychotherapies, eating disorders and the addic tions as well as the other specialised services mentioned above. In the main conurbations, which often act as a focus for services and training for popula tions as large as, or even larger than, many European nations, the aim should surely be to provide a full range of all the necessary special ities
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