Background: Equitable access to mental healthcare is a priority for many countries. The National Health Service in England uses a weighted capitation formula to ensure that the geographical distribution of resources reflects need.
Aim: To estimate local need for secondary mental health, learning disabilities and psychological therapies services for adults in England.
Methods: We used demographic records for 43,750,558 adults registered with a primary care practitioner in England linked with service use, ethnicity, physical health diagnoses and type of household, from multiple datasets. Using linear regression we estimated the individual cost of care in 2015 as a function of need and supply variables in 2013 and 2014. We sterilised the effects of the supply variables to obtain individual need estimates. We aggregated these by GP practice, age and gender to derive weights for the national capitation formula.
Results: Higher costs were associated with: being 30 to 50 years old, compared with 20 to 24; being Irish, black African, black Caribbean or mixed ethnicity, compared with White British; having been admitted for specific physical health conditions, including drug poisoning; living alone, in a care home or in a communal environment; and living in areas with a higher percentage of out-of-work benefit recipients and higher prevalence of severe mental illness. Longer distance from a provider was associated with lower cost.
Conclusion: The resulting needs weights were higher in more deprived areas and informed the distribution of some 12% (£9bn) of the health budget allocated to local organisations in 2019/20 to 2023/24.