London's Mental Health states that the problems of London are not due to under-investment by HAs but are a result of the perceived greater level of needs. Comparison of spending on mental health revealed that 'inner deprived' London authorities spent 18.6 per cent of their budget on mental health and 'mixed-status' outer London authorities 15.4 per cent. The report calls for extra investment in London.
We have obtained 1997-98 annual reports and accounts from HAs in greater London, as well as Manchester, Liverpool and Birmingham.
The table shows a comparison of spending for those HAs that have submitted the details, broken down into inner London areas, mixed-status outer London areas and other large deprived cities.
We are not suggesting that Birmingham has sufficient resources and we maintain that a small percentage increase in resources (targeted in the community) would yield huge benefits.
In 1995, a detailed study of mental health funding in Birmingham was undertaken by the York health economics consortium.5 The study noted that per capita spending in north and south Birmingham was higher than the West Midlands average, by 7.6 per cent and 21.6 per cent respectively. But neither area's spending was at the level suggested by the national formula. North Birmingham should, in principle, receive an allocation for psychiatric spending which is 34.5 per cent higher and south Birmingham 32 per cent higher than the average for the region as a whole. This would be an extra£8.6m, or 1.6 per cent of the HA's allocation.
But clearly there are major disparities in mental health spending between London and elsewhere, and such differences cannot be accounted for in terms of social deprivation or other factors related to service use. The most likely explanation for the fact that mental health services in London cost more than twice as much as, say, Birmingham, is historical.
Given the current emphasis on a national strategy and a national service framework for mental health, it is time to address this inequity.
Furthermore, because of the fragmented nature of much mental healthcare in parts of London there is a clear risk that new money will be channelled disproportionately to London on the basis that London has 'special' problems.