Brunel University London Study: Mental Health Services Subject to Postcode Lottery Influenced by Council Politics
Historically, physical health was the main focus of our health care, and mental health issues were often overlooked or mistreated. Thankfully, the importance of mental health services – MHS – and support has now come to the fore, but there are large disparities in the amount of money spent on MHS among England’s local authorities.
Within each local council, decisions are made on the amount of money that will be allocated to MHS from their total health budgets. The MHS expenditure covers all services where the primary reason for care is related to mental health, including nursing, homecare, supported living and direct payments.
In a new study, business economics experts from UK universities, including Prof Francesco Moscone from Brunel University London and Dr Pipat Wongsa-art from City University of London, analysed the presence of disparities in MHS expenditure from total health budgets across England’s councils.
The new study, published in Regional Science and Urban Economics, focused on 149 of England’s councils, which all have a responsibility for social services and MHS.
The researchers inspected each council’s spending between the financial years of 2016-17 and 2019-20 and discovered substantial differences in the budget allocated to MHS across local authorities.
“For example, in 2016-17, the North West London borough of Harrow spent just below 53% of their public health budget on MHS per capita, while the capital’s South West borough of Wandsworth spent 11%,” said Prof Moscone.
“In 2018-19, the Cheshire borough of Halton spent 43% of their total public health budget on MHS per capita, whereas North Somerset Council spent just above 61%. Such disparities grew significantly from 2019-20.”
As well as highlighting how the political spectrum of a local authority impacts MHS at local level, the study also explains the disparity in mental health spending based on a set of risk factors including; population density; percentage of males; percentage of under-14-year-olds; mortality; and weekly wages.
Population density and MHS expenditure
“Regardless of who is in power, the impact of population density on MHS spending is positive and significant,” said Prof Moscone. “Such a finding is not surprising, since we anticipate a higher mental health expenditure in inner-city areas that are more densely populated.
“With regards to political viewpoints, right-leaning authorities tend to respond more generously to an increase in population density.”
Population of males and MHS expenditure
Although politicians on both ends of the political spectrum view and treat MHS as necessary, there might still be some problems associated with gender inequality.
“The percentage male population has a positive impact on MHS in councils that are dominated by centre-left politics,” said Prof Moscone. “However, since many previous studies suggest that females are more likely to be affected by mental health problems, this implies that only right-wing councils are getting this correct.
Single parents and MHS expenditure
The research suggests that the percentage of single parents in a local authority is irrelevant when councils allocate their MHS expenditures.
“Although the number of single-parent families has increased significantly in the UK over recent years, the percentage of single-parent households has not been considered when allocating MHS spending,” said Prof Moscone.
“This finding is quite alarming, particularly given the evidence that a person who takes care of their child or children without a partner is more likely to require mental health support,” he added.
Mortality rates, under 14s and MHS expenditure
“It seems that age-standardised mortality rates – the death rate of a specific population in comparison to the general population – has a positive impact on the MHS in local authorities that are dominated by centre-left politics,” said Dr Wongsa-art.
“For these councils, the allocation of mental health grants is more closely linked to general deprivation indicators and public health conditions.”
The analysis showed that a local authority’s teenage population seemed to be a key determinant for MHS. A high percentage of under-14-year-olds in an area resulted in a higher MHS expenditure from councils when their total public health budget was low.
Average weekly earnings and MHS expenditure
Higher median weekly earnings in an authority resulted in a positive impact on the amount of money allocated to MHS. “It is highly likely that a higher income leads to a better living standard, which in turn helps to lessen other problems within a local authority that require funding,” explained Dr Wongsa-art.
“This makes some extra funding available, which can be spent by the local authority on MHS, and councils at both ends of the political spectrum behaved similarly here.”
Prof Moscone added: “Studying these disparities in MHS expenditure is important because they can lead to unequal access to MHS and result in financial difficulties for local councils.”