Published: 04/08/2005, Volume II5, No. 5967 Page 24
Along with heart disease and cancer, mental health remains one of the government's key priority areas in healthcare. Apart from legislation - in the form of the Mental Health Bill progressing through parliament - how does the funding compare with mental health services' priority status?
According to the Department of Health's 2004-05 National Survey of Investment in Mental Health Services, the total spend on services last year reached over£4.5bn in England, a rise of around£600m over the previous year. And since 2001-02, the total rise has been an impressive£1.3bn, 38 per cent in cash terms or 18 per cent in real terms.
But this increase is actually slightly less than the real-term rise for the NHS as a whole, and in 2003-04 the increase in spending barely covered inflation.
The survey identified large variations in spend across strategic health authorities. Even after allowing for differences in need, there was a 73 per cent difference in planned spend per head in 2004-05 between the highest spending (North Central London) and lowest (Kent and Medway) [see first chart). London SHAs are noticeable high spenders: four of the top five biggest-spending authorities are in London.
Research into spending variations in London's mental health services by the King's Fund in 2003 suggested that different areas attach different priorities to mental health services compared with other services. Variations in the efficiency with which services are delivered could also account for some of the variation (see second and third charts).
What is perhaps more worrying is that some of the money allocated to mental health may not be being spent effectively. In The National Service Framework for Mental Health: five years on, national director of mental health Professor Louis Appleby accepts that some of the money reaching frontline services has been spent on the 'wrong things', such as shoring up out-of-date services and out-of-area admissions.
His report states that one area for action needs to be an increase in financial investment by local services in mental health promotion. A shift of resources to promotion and prevention is crucial if the huge demand for services are to be better managed and the prevalence of mental health problems are to be reduced in the long term.
But persuading commissioners and mental health service providers of this may be difficult, given the current pressures on mental health budgets and variations in spending. .
John Appleby is chief economist at the King's Fund.
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