Justice in Access to and Distribution of Resources in Psychiatry and Mental Health Care

  • Ruud ter Meulen
Part of the International Library of Ethics, Law, and the New Medicine book series (LIME, volume 45)


This chapter presents an overview of general ethical principles of justice to health care, an application of these principles to resource allocation in relation with mental health care, an introduction of the concepts of necessary care and solidarity, as well as need and outcome based approaches. While the needs of mental health patients are widely recognised, needs are generally seen as subjective and difficult to distinguish from preferences or wishes of individuals. A new approach is the concept of ‘burden of disease’ which gives a measurable indication of the problems of individuals in need of treatment. Burden of disease should be combined with evidence on the effectiveness of treatments, as produced in randomised controlled trials (RCTs). The use of evidence on effectiveness and cost-effectiveness studies has become increasingly prominent in so-called evidence-based policies on resource allocation in health care, including mental health care. However, the use of evidence-based medicine in the allocation of scarce resources may lead to a one-sidedness and to unfair priorities within mental health care. The author concludes that out-come oriented approaches should be mixed with a measurement of the burden of disease and should also take into account our solidarity with the most vulnerable groups.


Mental Health Mental Health Service Gross Domestic Product Mental Health Problem National Health Service 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



College voor Zorgverzekeringen (Dutch Health Insurance Council)


Diagnostic and Statistic Manual, American Psychiatric Association


Evidence-Based Medicine


Gross Domestic Product


National Health Service


National Institute for Health and Clinical Excellence


Organisation for Economic Co-operation and Development


Quality Adjusted Life Years


Randomised Controlled Trial


Selective Serotonin Reuptake Inhibitor


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Copyright information

© Springer Science+Business Media B.V. 2010

Authors and Affiliations

  1. 1.Centre for Ethics in MedicineUniversity of Bristol, Hampton HouseBristolUK

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