Equity in mental health care in Britain

This thesis explores equity issues in the mental health field in Britain by initially developing a conceptual structure to define equity in mental health and then analysing data from three national psychiatric morbidity surveys to measure inequalities and inequities in both mental health and in the use of services. Standard methods are used for measuring income-related and social class-related inequalities with reference to many indicators of mental health which represent 'normative' or 'felt' needs for services. Inequity in the use of mental health services is also examined by relating use of services to needs. Analyses of income-related inequalities and equity are carried out with reference to the general population using data from the Psychiatric Morbidity Survey 2000 and with reference to the minority ethnic groups in Britain using data from the survey of Ethnic Minority Psychiatric Illness Rates in the Community 2000. Changes in social class-related inequalities and equity for the general population between 1993 and 2000 are examined using data from the Psychiatric Morbidity Surveys for those two years, in order to see if the policy and practice changes that took place since the beginning of the 1990s in the health and social care sectors had exerted any impact on equity in mental health. The three mental health surveys being cross-sectional do not permit the study of causal pathways between income and mental health. Therefore, in order to understand the links between living standards, health and health care utilisation patterns further, data from a longitudinal study, the British Household Panel Survey on general health are examined using robust theoretical and empirical models. The assumption is that many of the factors associated with general health are also associated with mental health and much of the model that links income, health and health care utilisation behaviour is likely to be relevant for mental health as well

Costing intensive home care packages for older people. Funded/commissioned by: Social Work Services Inspectorate for Scotland

The amount and type of health and social care services received by older people living in the community varies considerably. A variety of factors influence provision, such as service availability, spending limits, care management arrangements and local relationships between providers. Perhaps the most significant determinant of service receipt however is the needs-related circumstances of older people themselves. The Personal Social Services Research Unit (PSSRU) has examined the relationship between user's needs, service receipt and the cost of care packages in a series of studies spanning several decades (Davies and Knapp, 1981, Challis and Davies, 1986, Davies, Bebbington and Charnley 1990, Challis et al, 1994, Bauld et al, 1998). User characteristics which influence the cost of care are many. Physical health and dependency play an important role, with factors such as functional limitations, visual and hearing impairment, and urinary and faecal incontinence having important implications for the amount of assistance required. Mental health also affects the cost of care. Cognitive impairment and behavioural problems, as well as the user's morale and the presence or absence of depression are all significant factors. Personal environmental factors including the quality of housing, accessibility of transport and adequacy of heating affect package costs. Perhaps most significantly, the availability of informal care is a crucial determinant of the amount of formal services required. The assistance that carers provide reduces the need for formal intervention, and therefore lowers service costs. In many cases, assistance provided by a carer is the key factor in preventing entry to institutional care. Knowledge regarding the needs-related circumstances of users is necessary if package costs are to be compared between individual users or groups of older people, or if the costs of community care services are to be compared with those in other care settings. This report therefore describes the circumstances of older people living in the community, and then outlines the weekly cost of services they are receiving. Twelve case studies are presented. These case studies are drawn from a longitudinal study currently being conducted by the PSSRU at the University of Kent at Canterbury and the London School of Economics. The project is entitled Evaluating Community Care for Elderly People (ECCEP) and is funded by the Department of Health. A brief description of the study and concepts used therein provides the background for the cases presented in this report

Income, health and health care utilisation in the UK

The aim of this paper is to analyse the links between income, health and health care utilisation behaviour using longitudinal data from the British Household Panel Survey. The emphasis is to frame the analysis as a social phenomenon, so that the dynamics of individual health production in the social context can be understood. The study estimates the relationships between income, health and health care utilisation with lag effects. The empirical results support the hypothesis that these three variables influence each other with lag effects and that many social and economic factors influence an individual's probability of having a health problem or making use of health care facilities, even when such facilities are free at the point of use.