Personal responsibility, empowerment and medical utilization: a theoretical framework for considering counselling and offset costs

Abstract

The problem of effectively managing patients with functional somatic symptoms remains huge in both primary and hospital care, although the potential bene ts of mental health interventions such as counselling or psychotherapy are still not widely accepted. Unfortunately, the cost-effective evaluation of counselling has been beset by methodological problems, which stem from attempting to make comparisons between counsellors with different types of training, therapeutic approach and case mix. Since these real-world variations in counselling practice are likely to remain, it is proposed that a different approach to the evaluation of cost-effectiveness should be adopted in the hope of accelerating acceptance of the value of psychological interventions for the army of patients who are currently labelled as 'dif cult' or 'heartsink' and who do not receive the treatment they deserve from the health-care services. It is proposed that, since the common aim of almost all mental health interventions is to engender or enhance a sense of 'personal responsibility' in patients/clients, this core objective should form an agreed 'yardstick' against which to evaluate the impact of various mental health interventions. Furthermore, since personal responsibility and future health-care utilization (and associated costs) can be assumed to be directly causally related, it is proposed that offset costs should form the basis for future cost-effectiveness evaluations.

Counselling in primary care: A study of the psychological impact and cost benefits for four chronic conditions

“…On the basis that psychological well-being and health-care uptake are related (Spurgeon & Barwell, 2000), the wider impact of these results for the health service may be assumed.…”

“…On this basis, it would seem reasonable to suppose that any patient who has assumed the mantle of personal responsibility might be less likely to seek advice and care from health care professionals. Therefore, besides improving the psychological status of the patient, an additional outcome of counselling might be a reduced dependence on health care services and a consequent reduction in GP costs (Spurgeon & Barwell, 2000). This suggestion, coupled with the psychological component of many medical conditions, would support the argument that other categories of patient might similarly profit from counselling intervention.…”

“…Borus et al, 1985;Cummings, Dorken, Pallak, & Curtis, 1993). As Spurgeon and Barwell (2000) note, such studies do not translate readily into a British NHS context, nor are they always rigorous in their design and definitions.…”

Cognitive and affective factors predicting daily somatic complaints in college students.

“…Keywords: somatic complaints, expectancy, negative affect, symptom, health Congruent with a shift away from the traditional medical model to a biopsychosocial model of health and well-being (e.g., viewing physical complaints and health status in relation to such criteria as bodily functioning, affective and mental states, and markers of the ability to love, work, and cope with stressors; see Engel, 1978;Spurgeon & Barwell, 2000), counselors have come to play a larger role in the physical health of clients (Altmaier et al, 2003;Klippel & Dejoy, 1984;Tucker, 1991;Watkins, 1985). For instance, trends in some facilities (e.g., college counseling centers) indicate that counselors are increasingly encountering clients presenting healthrelated difficulties (e.g., chronic pain; Benton, Robertson, Tseng, Newton, & Benton, 2003).…”