Published: 17/02/2005, Volume II5, No. 5943 Page 31

I was warily eyeing my new healthy lifestyle breakfast the other morning. It consisted of crushed cardboard and shredded doormat with a grapefruit segment. In a flight of understandable escapism, that lonely relic of a once proud and noble fruit had my mind turning to a distant lecturer who in years past had taught me all there was to know about segments - market segments.

You can segment any market.

Let's stick with food: Fortnum and Mason and Tesco are in the food business but hardly competitors, because they and their products occupy different market segments.

So it is with any other type of market. In healthcare, local hospital specialties can be viewed as having three broad 'product' segments.

First, the emergency services that we operate through the accident and emergency departments of the great disease palaces. By and large they are not that susceptible to competition in the traditional sense.

This is simply because of the difficulty that any provider has of establishing the complex infrastructure needed to cope with whatever comes through the door at any hour of the day or night.

There are two other segments which lend themselves much more to traditional competition: the more familiar area for choice - elective treatment; and the apparently burgeoning market in long-term conditions.

Both these latter segments have undergone radical change in the recent past with the arrival of overseas providers swelling capacity for elective work, and the importation of approaches such as that epitomised by Evercare in the long-term conditions field.

Does any of this have any relevance for mental health? Well, we have our emergency work - with the need for crisis resolution teams, inpatient psychiatric beds available for acute admissions, court referrals, and so on.

Then we have what we might call, if not exactly elective, simpler or more manageable conditions: anxiety and panic disorders, phobias, mild to moderate depression.

Third, we have more severe, longer-term conditions:

schizophrenia, bi-polar disorder and so on. These can often require years of specialised care, but have significant aspects of 'manageability' on a relatively predictable long-term basis.

So can we have genuine competition in these major market segments in the same way as we are seeing it in our district general hospital specialties? I suspect the Evercare model could be adapted for mental health, as it has in the US.

For the simpler mental health conditions, we should be looking to replicate the approaches of the diagnostic and treatment centres with elective surgery. We should make available, on a large scale, purpose-built accommodation for the provision of specialist psychological interventions on a group or individual client basis, offered by a range of providers.

Minds R Us? A gleaming glass and steel cognitive behavioural therapy 'shed' on the M1? Why not? Shouldn't mental health services be ubiquitous and accessible too?

Shouldn't mental health service users have access to modern and efficiently delivered services? Or, as someone once mischievously put it, is this just a move from padded cell to padded sell?

At the end of the day, wouldn't the patients quite like a choice? As I would, I mused, with my lowcalorie, high-fibre breakfast. At that thought, I leapt from the breakfast table and sped to work. It was Tuesday - and that meant curry and chips on the cafeteria lunch menu.

Jeremy Taylor is chief executive of Nottinghamshire Healthcare trust, one of the country's largest providers of mental health and services.