Abstract
BackgroundThere is evidence of geographical variation in the use of mental health services in the UK and in international settings. It is important to understand whether this variation reflects differences in the prevalence of mental disorders, or if there is evidence of variation related to other factors, such as population socioeconomic status and access to primary care services.MethodsThis is a cross-sectional ecological study using Public Health England data. The unit of analysis was the population served by clinical commissioning groups (CCGs), National Health Service (NHS) catchment areas. The analysis explored associations between area characteristics and the number of people in contact with mental health services using regression modelling. Explanatory variables included age, gender, prevalence of severe mental illness (SMI), prevalence of common mental disorder (CMD), index of multiple deprivation (IMD), unemployment, proportion of the population who are Black and Minority Ethnic (BAME), population density, access to and recovery in primary care psychological therapies. Unadjusted results are reported, as well as estimates adjusted for age, prevalence of CMD and prevalence of SMI.ResultsThe populations of 194 CCGs were included, clustered within 62 trusts (NHS providers of mental health services). The number of people in contact with mental health services showed wide variation by area (range from 1131 to 5205 per 100,000 population). Unemployment (adjusted IRR 1.11; 95% CI 1.05 to 1.17; p < 0.001) and deprivation (adjusted IRR 1.02 95% CI 1.01 to 1.04; p < 0.001) were associated with more people being in contact with mental health services. Areas with a higher proportion of the population who are BAME (IRR 0.95 95% CI 0.92 to 0.99 p = 0.007) had lower service use per 100,000 population. There was no evidence for association with access to primary care psychological therapies.ConclusionsThere is substantial variation in the use of mental health services by area of England. Social factors including deprivation, unemployment and population ethnicity continued to be associated with the outcome after controlling for the prevalence of mental illness. This suggests that there are factors that influence the local population use of mental health services in addition to the prevalence of mental disorder.
Highlights
There is evidence of geographical variation in the use of mental health services in the UK and in international settings
In accordance with the recording of data by Public Health England (PHE), secondary mental health services are defined as National Health Service (NHS) funded adult secondary mental health services and does not include services situated in primary care such as the Improving Access to Psychological Therapies (IAPT)
Areas with a higher proportion of people in contact with secondary mental health services compared to the proportion for the whole of England tended to be in North West England, West Midlands and coastal areas of the South East (Fig. 1)
Summary
There is evidence of geographical variation in the use of mental health services in the UK and in international settings. It is important to understand whether this variation reflects differences in the prevalence of mental disorders, or if there is evidence of variation related to other factors, such as population socioeconomic status and access to primary care services. Geographical variation in the use of mental health services has been observed in multiple international settings [1,2,3,4] [5]. It is important to understand whether this variation reflects differences in the prevalence of mental disorders, if it is related to population characteristics such as socioeconomic status and ethnicity, or whether access to services rather than need might be associated with this variation. There is an extensive literature looking at how an individual’s local environment may influence individual risk of both psychosis and common mental disorders [8] [16], with mixed results
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