Efficacy, effectiveness and efficiency in mental health service delivery

Objective: The aim of this paper is to review the status of treatments in psychiatry. Method: The criteria for good treatment are defined and then treatments in psychiatry are examined for efficacy, effectiveness and efficiency. Results: A large number of treatments were listed by Nathan and German as having satisfied the criteria for efficacy: that is, they had been shown to be superior to placebo in randomised controlled trials. The problem of effectiveness (does the treatment still work when used by the average clinician with the average patient?) is a general one in medicine, but the evidence in psychiatry is not outstanding. The problem of efficiency (what level of resources are required to produce benefit?) is being addressed in a piecemeal fashion, and again this is no different to the situation in general medicine. Conclusions: A considerable number of treatments have been shown to satisfy the criteria for efficacy. Effectiveness requires that psychiatrists apply such proven treatments and demonstrate benefit through the use of outcome measurement. A system that separated the health budget into segments for prevention, cure and care might ensure that these three goals were pursued equitably and efficiently.