Money for mental health care in 2003/4

Glover (Psychiatric Bulletin, April 2003, 27, 126–129) has served patients well, delineating the failure of the Department of Health to instruct the Primary Care Trusts to finance the National Service Framework documents. May I suggest a minimum compulsory target of 15% for urban areas, and 11% elsewhere, to be achieved within 5 years? A sector basis for distribution would be the Mental Health Needs Index (MINI; Glover, 1998). This index, most successful for urban areas, originated in NE Thames, and can be calculated on an electoral ward basis by a programme from Glover, and gives numbers needed for acute and psychiatric intensive care unit beds, as well as community 24 hour nursed homes, and other supported accommodation. The latter are vital, as the 40-50% homeless in-patients of the under-funded Tower Hamlets testify (Turner & Priebe, 2003).

Personally, I doubt if a reasonably civilised service can be provided on less than £1 × MINI per capita per annum. A simpler measure is a district count of the number of residents (including homeless and hostel residents) known to have suffered with schizophrenia, though they may be temporarily out of contact with services. This group is most likely to cost long-term money, and its needs are recognised in the calculation of a 20% spend in the long-stay belt of the former Epsom hospitals, whose patients came from all over London. The lowest spend of 8% in East Devon is made up for by the 15% spend in Exeter, where the ex long-stay residents from all over Devon were resettled.