© 1998 Faculty of Public Health Medicine of the Royal Colleges of Physicians of the United Kingdom
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More alike than different
Comparing the mental health needs of London and other inner city areas
Steve Kisely, Consultant
Department of Public Health, Birmingham Health Authority Vernon Road, Edgbaston, Birmingham B16 5RQ
BACKGROUND: In the absence of epidemiological data, mental health services planners often rely on routinely available sources to estimate needs including comparative and deprivation weighted approaches.
METHODS: This paper reviews available methods using the King's Fund review of mental health services in London as an example. Alternative sources of data to those chosen by the King's Fund report are also reviewed.
RESULTS: Results can vary depending on the comparative populations and methods used. The King's Fund report concluded that London's needs were uniquely high in relation to the rest of the country including other inner city areas, but the use of differing comparison populations in different areas of the document made it difficult to assess whether levels of need were actually higher. Often, London was compared with the national average rather than with inner cities elsewhere in the United Kingdom. There were also shortcomings in the report's assumptions underlying the estimation of services required for London. Alternative sources of data suggest that the needs of cities such as Birmingham, Manchester, Liverpool, Leeds and Newcastle are at least as great as those of London.
CONCLUSIONS: This paper illustrates how the use of different techniques on routinely available data can lead to differing conclusions, and offers guidelines to help analyse reports that rely on such methods. Rather than discussing the relative merits of different inner city areas, issues of equity should be addressed by the use of an agreed set of data to ensure that like is compared with like.
Keywords: health needs assessment, mental health services, service planning
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