More alike than different. Comparing the mental health needs of London and other inner city areas.

BACKGROUND

In the absence of epidemiological data, mental health services planners often rely on routinely available sources to estimate needs including comparative and deprivation weighted approaches.

METHODS

This paper reviews available methods using the King's Fund review of mental health services in London as an example. Alternative sources of data to those chosen by the King's Fund report are also reviewed.

RESULTS

Results can vary depending on the comparative populations and methods used. The King's Fund report concluded that London's needs were uniquely high in relation to the rest of the country including other inner city areas, but the use of differing comparison populations in different areas of the document made it difficult to assess whether levels of need were actually higher. Often, London was compared with the national average rather than with inner cities elsewhere in the United Kingdom. There were also shortcomings in the report's assumptions underlying the estimation of services required for London. Alternative sources of data suggest that the needs of cities such as Birmingham, Manchester, Liverpool, Leeds and Newcastle are at least as great as those of London.

CONCLUSIONS

This paper illustrates how the use of different techniques on routinely available data can lead to differing conclusions, and offers guidelines to help analyse reports that rely on such methods. Rather than discussing the relative merits of different inner city areas, issues of equity should be addressed by the use of an agreed set of data to ensure that like is compared with like.