Birmingham has made massive investment in community services at the expense of hospital services. Each of the six localities (covering about 100,000 people) in the North Birmingham Mental Health trust catchment area has a home treatment team, an assertive outreach team and a primary care liaison team covering GP practice populations. But there are vast differences in needs, and therefore in investment in community resources, across the city. In Handsworth, Soho and Ladywood - with a population of 105,000 - 260 people have been identified who meet the criteria for assertive outreach and require very assertive follow-up. In Sutton Coldfield, with a population of 116,000, the figure is just 16.
In 1994, the then North Birmingham HA decided that resolving its serious bed problems simply by increasing bed numbers would not be effective. Acute inpatient beds only help people when they are in them. Instead, comprehensive and targeted services in the community are needed - that is where most people are, most of the time.