Health authority patterns of hospital discharge rates for poisonings in the RHAs of England and the DHAs of Yorkshire, and their relationship to social deprivation

Currently, resources for acute mental illness services are allocated on the basis of the age, sex and marital status profiles of the catchment population. How ever, it has been argued (Hirsch, 1988) that mental illness budgets and bed provision should also be weighted according to the socio-dA©mographie characteristics of the local population. Correlations have been observed between psychi atric admission rates and Jarman 8 under-privileged area (UPA) scores for two regional health authorities (RHAs) and a district health authority (DHA) (Hirsch, 1988; Hacking, 1988). It has been suggested (Hirsch, 1988)that if these correlations are replicated elsewhere, the use of Jarman 8 UPA scores for weighting purposes might become a powerful tool for estimating the potential demand for psychiatric services in every district. The Jarman 8 Index (Jarman, 1983; 1984)is a com posite measure of social deprivation incorporating individual scores on eight indicators identified as reflecting the extent of demand for primary care services, and is based on 1981 census data. The indi cators comprise the following variables as a percent age of the resident population in the DHA, as defined by Rice, Irving & Davies (1984): ethnic minorities; the highly mobile; one parent families; overcrowded households; pensioners living alone; residents under 5; the unskilled and the unemployed. The index is now accepted by most NHS planners as a fair measure of social deprivation, and UPA scores have been calculated for all DHAs in the country (Hirsch, 1988). The NHS Management Board have accepted that the demands made by patients on acute general hos pital services are influenced by social deprivation, and recommended the introduction of the Jarman 8 Index into the Resource Allocation Working Party (RAWP) formula for the planning and financing of such services; but the Board rejected a similar intro duction into the RAWP formula for mental illness services. However, the Government White Paper (Workingfor Patients) has intimated that RAWP is to be replaced by a different system for allocating resources, although it is unclear if social deprivation will be taken into consideration. One reason given by the NHS Management Board for the rejection of a social deprivation factor is that the rapidly changing patterns of care occurring at present, such as the closure of large psychiatric hos pitals and the development of community services, make the interpretation of current activity data on the use of general psychiatric services difficult. We have therefore attempted to avoid this criticism by examining possible correlations at an RHA and