The risk of severe mental illness is highest in the younger age group. In north Birmingham, which has a population of 565,000, 42 per cent are aged between 15 and 45. This compares with 36 per cent for inner London and 29 per cent for England and Wales as a whole. The King's Fund report points out: 'The younger generation who predominate in London have generally grown up without the experience of long-term institutionalisation and with different expectations. They may be less willing to accept the same conditions and appear to have a particularly disrupted clinical course marked by frequent crises, failure to engage consistently with the services, impulsive behaviour, high rates of substance misuse and disruptive social histories.'
The report argues that they need particularly intensive and highly staffed services to engage them. This applies as much in Birmingham as it does in London.