Mental health policy and practice across Europe: an overview

92 Mental health policy and practice
better serving rural areas and encouraging patient decision-making (McDaid
et al. 2005b). None of these is remotely easy, but might be supported through an
equity audit (Who gets what? At what personal cost?) and surveys of service
users’ needs, satisfaction levels and preferences, as well as explicit national or
regional allocation formulae for the appropriate and transparent allocation
of funding and capital investment. Mapping the mixed economy of mental
health – both provision and the arrangements for financing – has potentially
many uses, as discussed earlier. Mappings are obviously not solutions in themselves,
but they provide a platform for discussions about how to improve the
availability, distribution and deployment of resources.
Where information is available on the level of psychiatric need within countries,
this can be used to allocate resources more equitably from central to local
level, as in England (see Box 4.3). Local purchasers or service providers would
then receive a share of the national health budget, based not only on the age
and gender composition of their local populations but also on the basis of mental
health need. With regular surveys, particular areas of concern might be
addressed and budgets adjusted to reflect the changes. Nowhere might such an
approach be more appropriate than in some of the countries that still are heavily
reliant on institution-based services, with funding tied up in beds. Funding
tied to individuals rather than institutions would help to break down one of the
barriers to deinstitutionalization.
Box 4.3
Funding mental health care in England
The annual budgets of local purchasers (primary care trusts) for health
care are determined on the basis of weighted populations, assignment of
recurrent resources, together with some special allocations and redistributions.
Weightings are based on age profiles and measures of health care
need, including a specially developed mental health need index. This
index combines a number of indicators of population need used to allocate
funding to local government together with evidence on patterns of
mental health care need from the Health Survey of England. Mental
health as a proportion of total local purchaser allocations in 2003/4 varied
from 22.5 per cent to 8.1 per cent, around an average of 11.6 per cent
(Glover 2004). Some of this variation is due to the additional finance
provided for remaining long-stay institutions.
Local purchasers are free to spend more or less on mental health than
determined by the mental health needs allocation, but in providing services,
local planners must ensure that services are available that meet the
needs of the National Service Framework for Mental Health (Department
of Health 1999), ensuring that resources are targeted in evidence-based
ways to mental health. Small amounts of additional money for mental
health can be earmarked through special allocations: in recent years
these have included funds for mentally disordered offenders and to help
implement mental health aspects of the NHS Plan.