Intended for healthcare professionals

Head To Head Maudsley Debate

Should NHS mental health services fear the private sector? No

BMJ 2010; 341 doi: (Published 04 October 2010) Cite this as: BMJ 2010;341:c5385

Patients, not NHS should fear the private mental health providers

Any commercial transaction involves a contract between two or more
parties, each of whom is able to make decisions and able to advance their
interests. In a world where the mental health care is provided by the 'for
profit' companies the stake holders will be the executives whose jobs and
bonuses depend on the profit margins, the share holders who want maximum
return for their investment, the commissioning agencies who want to get
the service for the lowest price and the patient who, due to the mental
illness, may lack the motivation and mental resources necessary to advance
his interests. Financial profitability trumps patient care in such a

A large proportion of patients in the mental health system are
detained under the Mental Health Act and their discharge is dependant on
the decisions made by employees of the detaining hospital. A conflict of
interest is apparent when your profit margins depend on your bed
occupancy. Any financial transaction where the seller decides what the
buyer buys cannot be fair and cannot represent the best interests of the
buyer. The potential for exploitation is even more when the buyer is a
vulnerable person. Any assertion that the 'good-will' of private companies
or the government regulation will protect the patients' interests will
have to ignore the recent banking crisis, the Enron scandal and the state
of mental health services in USA.

In this country the private sector has already started to get into
the more profitable parts of the mental health care, mostly in the form of
specialist inpatient units. Money has been diverted from generic services
(which in addition to providing inpatient care also provide care in
community, educational and research benefits) to private units with a very
limited role of inpatient care. The patients always come back to the NHS
for costly follow ups. There has been a mushrooming of private units with
USPs that range from non evidence based inpatient personality disorder
units to units more suitable for an apartheid mindset e.g. segregated
black and minority ethnic units. Such units are an example of the extremes
to which the independent sector can go to maximise their profits.

In a system where the private companies take over the mental health
care the main casualty, in addition to the care of the most vulnerable in
our society, will be education and research and the tax payer will end up
footing a separate bill for such endeavors.

Competing interests: The author is a NHS doctor

10 October 2010
Sajid Muzaffar
Speciality Registrar
Norvic Clinic