McCrone Paul, Thornicroft Graham, Boyle Seán, Knapp Martin, Aziz Fayaz
Health Services Research Department, Institute of Psychiatry, King's College London, De Crespigny Park, London SE5 8AF, UK.
Health Soc Care Community. 2006 May;14(3):254-63. doi: 10.1111/j.1365-2524.2006.00618.x.
Wide variations in deprivation exist across England and it is likely that these variations translate into differences in the need for mental health care. Social Services Departments in England account for a substantial proportion of mental health expenditure. It is important that the distribution of expenditure reflects mental health needs. This paper's aims are to (1) describe the development of a new indicator of mental health needs, (2) use the index to explain variations in social services expenditure on mental health, and (3) compare the index with other established measures of need. A principal components analysis of sociodemographic variables considered to be indicators of need was used to produce four distinct factors for 148 Local Authority areas in England. A weighted sum of these factors was used to produce a single index. (Weights were the proportion of variance explained by each factor.) The index was used in a regression model to explain variations in spending on mental health care and was compared with (1) a model containing the four individual factors, (2) the current method of allocating resources, (3) the index used to allocate resources to primary care trusts, (4) the Mental Illness Needs Index (MINI), (5) four indices of deprivation produced by the Office of the Deputy Prime Minister, and (6) the average of the above four indices. The new index could explain 54% of variation, compared with 56% using the current method. The four-factor model could explain 66%, whilst the other models could explain between 37% and 20%. This new index has the advantage that it is not based on previous levels of utilisation or expenditure and yet still explains a comparable amount of variation as the current method. However, a disaggregated model containing individual factors may be preferable.
英国各地的贫困程度差异很大，这些差异很可能转化为心理健康护理需求的差异。英国社会服务部门在心理健康支出中占很大比例。重要的是，支出分配要反映心理健康需求。本文的目的是：（1）描述一种新的心理健康需求指标的开发；（2）使用该指数解释社会服务部门在心理健康方面的支出差异；（3）将该指数与其他既定的需求衡量指标进行比较。对被视为需求指标的社会人口变量进行主成分分析，为英格兰的148个地方当局区域生成了四个不同的因素。这些因素的加权总和用于生成一个单一指数。（权重是每个因素所解释的方差比例。）该指数被用于回归模型中，以解释心理健康护理支出的差异，并与以下各项进行比较：（1）包含四个单独因素的模型；（2）当前的资源分配方法；（3）用于向初级保健信托基金分配资源的指数；（4）精神疾病需求指数（MINI）；（5）副首相办公室生成的四个贫困指数；（6）上述四个指数的平均值。新指数可以解释54%的差异，而当前方法为56%。四因素模型可以解释66%，而其他模型可以解释37%至20%之间的差异。这个新指数的优点是它不是基于以前的利用水平或支出水平，但仍然可以解释与当前方法相当数量的差异。然而，一个包含各个因素的分解模型可能更可取。
