Adult Community Psychology Services: Tiering and its seams

Abstract

Stratification and hierarchical arrangements are ubiquitous aspects of societal organisation, sometimes welcome, sometimes less so. They may both facilitate a good life and psychological well-being and contribute to human unhappiness and everyday psychological problems. As counselling psychologists this is familiar to us, both from our everyday work with people in distress and closer to home in struggling for our own professional recognition and a niche within the market, especially the NHS. Tiering, as one form of stratification, has served to order services, supposedly distinguishing clients according to needs and marshalling human resources in turn, through skillmix for example. Knowledge of such boundaries, together with an informed view on their validity or otherwise, is important in attempting to match specific clients to the most appropriate workers and in clarifying and developing professional roles.