A needs index for mental health care

Abstract

The study aimed to develop a mental illness needs index to help local managers, district purchasers and national policy makers in allocating resources. Formulae were developed by regression analysis using 1991 census data to predict the period prevalence of acute psychiatric admission from electoral wards. Census variables used were chosen on the basis of an established association with mental illness rates. Data from one English Health Service region were analysed for patterns common to wards at hospital catchment area level and patterns common to district health authorities at regional level. The North East Thames region was chosen as the setting for the study, with 7096 patients being admitted during 1991. In most, but not all, catchment areas reasonable prediction of the pattern of admission prevalence was possible using the variables chosen. However, different population characteristics predicted admission prevalence in rural and urban areas. Prediction methods based on one or two variables are thus unlikely to work in both settings. A Mental Illness Needs Index (MINI) based on social isolation, poverty, unemployment, permanent sickness and temporary and insecure housing predicted differences in admission prevalence between wards at catchment area level better than Jarman's Underprivileged Area (UPA) score [1] and between districts at regional level better than the UPA score and comparably to the York Psychiatric Index [2] (adjusted r2 at regional level (MINI 0.82, UPA 0.53, York index 0.70). District admission prevalence rates vary by a factor of three between rural and inner city areas; this difference may not fully reflect the variation in the cost of providing care. It did not prove possible to incorporate factors related to bed availability in the models used; reasons for this are discussed. Data covering other aspects of mental health care in addition to hospital admission are needed for more satisfactory modelling.

The Rehabilitation Effectiveness for Activities for Life (REAL) study: a national programme of research into NHS inpatient mental health rehabilitation services across England

“…However, the psychiatric morbidity of the local area had a greater impact on service quality than the nature of the users placed there, although it influenced only one quality domain, namely the living environment. As areas with greater deprivation tend to have higher levels of psychiatric morbidity, 45 there may be a greater pressure on resources in these areas, with less available for investment in the built environment. Community-based units appeared to fare better than inpatient units on only one domain of quality (therapeutic environment), corroborating previous reports of the less 'institutional' culture of non-hospital settings.…”

“…Low secure unit (n = 601) 117 (19) Prison (n = 600) 110 (18) Risk Assault on others ever (n = 599) 349 (58) Assault in last 2 years (n = 599) 127 (21) Serious assault last 2 years (n = 568) 43 (8) Self-harm ever (n = 604) 271 (45) Self-neglect (n = 604) 295 (49)…”

“…A rating of the psychiatric morbidity of the area served by the unit was also made using the Mental Illness Needs Index (MINI) 45 relevant to the postcode for each unit. This index provides a rating of psychiatric morbidity based on socioeconomic demographic data from the 2001 census, with a standardised mean of 1.0.…”

Impact of a fast-track assessment clinic on waiting times and non-attendance rates for new referrals to a community mental health centre

“…The team serves a catchment population of 78 000 with a mixed social demography and a mean Mental Illness Needs Index (Glover et al, 1998) score of 100.5 (indicating an above average level of social deprivation).…”

Threshold 3: the feasibility of the Threshold Assessment Grid (TAG) for routine assessment of the severity of mental health problems

“…The study took place between June 1999 and September 2000 in 10 mental health teams in London, chosen to represent a range of locations (3 inner London, 7 outer London), deprivation (MINI scores (Glover et al 1998) ranging from 98 to 124, indicating deprivation at or above the national average of 100) and services (8 adult, 1 adult day care, 1 elderly).…”