As political parties commence their official campaigns and citizens gear up to cast their votes, the National Health Service (NHS) membership body is urging the new government to prioritize the health and wellbeing of the nation in its plans. The significance of healthcare as a national priority has been reaffirmed by a recent study conducted by market research firm Ipsos. This should not come as a surprise, given that the NHS, a cornerstone of the UK’s societal fabric, has encountered substantial hurdles in the last decade. Issues such as the pandemic, escalating patient demands, an aging population, critical workforce shortages, and successive rounds of industrial action have placed immense strain on health and care services. Additionally, the expenditure and financing of local authorities have sparked a lively debate in the political arena. The austerity measures introduced by the UK government in 2010 have squeezed council budgets, leaving them struggling to manage finances.
My recent study *, conducted in collaboration with Pipat Wongsa-art from the City University of London and Namhyun Kim from the University of Exeter, shows huge differences in the money spent on mental health services (MHS) among England’s local councils, and the impact of their political leanings and ideologies. Figure 1 presents a per capita measure of the standardized MHS expenditure for persons aged between 18 and 64 for all the local authorities during 2016/17 and 2019/20. It is evident that MHS tends to be distributed in clusters, with the highest concentrations in metropolitan areas such as Greater London and Manchester. We analyzed each council’s spending 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, whereas the capital’s South West borough of Wandsworth spent 11%.
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.
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, and how their impact vary across the political spectrum of local authorities.
Regardless of who is in power, the effect of population density on MHS spending is positive and significant. 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.
While it’s evident that politicians across the ideological spectrum recognize the necessity of mental health services, issues persist regarding gender inequality within this area. The observation that the male population percentage positively influences MHS expenditure in councils dominated by center-left politics raises questions about the nuanced understanding of gender-specific mental health needs. Despite numerous studies indicating the higher prevalence of mental health issues among females, the allocation of resources appears to favor male-centric perspectives. This discrepancy underscores the importance of critically examining how gender dynamics intersect with policy decisions in mental health provision.
Furthermore, the apparent disparity in response between center-left and right-wing councils highlights broader ideological differences in addressing gender-specific health concerns. While right-wing councils may be more attuned to gender disparities in mental health, it’s essential to explore the underlying motivations and implications of this discrepancy.
Addressing gender inequality in mental health provision requires a comprehensive approach that considers diverse perspectives and experiences. By acknowledging and addressing these disparities, policymakers can ensure that mental health services are truly inclusive and responsive to the needs of all individuals, regardless of gender.
The revelation that the percentage of single parents in a local authority does not influence the allocation of mental health services expenditure raises concerns about the adequacy of support for this vulnerable demographic.
Despite the substantial increase in single-parent families across the UK in recent years, the absence of consideration for their demographic in MHS spending allocation is alarming. Single parents often face unique challenges, juggling the responsibilities of childcare, household management, and often sole breadwinning, which can significantly impact their mental wellbeing.
Moreover, research consistently underscores the heightened likelihood of single parents requiring mental health support due to the stresses and strains inherent in their circumstances. The failure to address the specific needs of this demographic in MHS funding allocation represents a glaring oversight in mental health policy.
Addressing this discrepancy requires a re-evaluation of how MHS funding is distributed to ensure that it adequately meets the needs of single-parent households. By incorporating considerations for the unique challenges faced by single parents, policymakers can better allocate resources to provide targeted support and promote the mental wellbeing of this vulnerable population. Failure to address this issue risks exacerbating existing disparities in access to mental health services and perpetuating inequalities in health outcomes.
The positive impact of age-standardized mortality rates on mental health services expenditure in local authorities governed by center-left politics underscores the intricate relationship between health outcomes and policy priorities.
In such councils, the allocation of mental health grants appears to be intricately linked to broader indicators of deprivation and public health conditions. This alignment reflects a commitment to addressing underlying socioeconomic factors that contribute to mental health disparities, aligning with the social welfare and collectivist ideologies often associated with center-left political orientations.
Furthermore, the analysis highlights the significant influence of a local authority’s teenage population on MHS expenditure. A high percentage of under-14-year-olds in an area correlates with increased spending on mental health services, particularly in councils with limited public health budgets. This finding underscores the recognition of adolescence as a critical period for mental health intervention and the importance of allocating resources accordingly.
By recognizing and responding to these key determinants of MHS expenditure, policymakers can better address the diverse needs of communities and promote equitable access to mental health services for all individuals, regardless of age or socioeconomic status.
The positive association between higher median weekly earnings and increased allocation of funds to mental health services underscores the intricate interplay between socioeconomic factors and healthcare provision.
It’s reasonable to infer that higher incomes contribute to an improved living standard within a community, thereby alleviating other social problems that may require financial support from local authorities. This, in turn, frees up additional funding that can be redirected towards bolstering mental health services, enhancing accessibility and quality of care.
Remarkably, this pattern of behavior transcends political ideologies, with councils across the spectrum demonstrating similar responses to the influence of median weekly earnings on MHS expenditure. This suggests a shared recognition among policymakers of the importance of investing in mental health resources to address the needs of their constituents, irrespective of political affiliations.
Understanding and addressing disparities in MHS expenditure is crucial as they have significant implications for equitable access to mental health services and the financial stability of local councils. By identifying and mitigating these disparities, policymakers can foster a more inclusive and sustainable healthcare system that prioritizes the mental wellbeing of all individuals within the community.
As political parties launch their campaigns, they must prioritize addressing the postcode lottery in mental health services. The NHS, strained by the pandemic, rising patient demands, an aging population, workforce shortages, and industrial actions, requires urgent attention. Research shows significant disparities in mental health spending across local councils, influenced by political leanings and factors like population density and socioeconomic conditions. To ensure equitable access to mental health services, the new government must develop policies that account for these disparities, support vulnerable demographics such as single parents, and address gender-specific mental health needs, fostering a more inclusive and effective healthcare system.
* Wongsa-art, P., Kim, N., Moscone, F. and Xia, Y. (2024) ‘Varying coefficient panel data models and methods under correlated error components: Application to disparities in mental health services in England‘. Regional Science and Urban Economics, 0 (in press, pre-proof). pp. 104009 – 104009. ISSN: 0166-0462
Francesco Moscone, with a bachelor’s and master’s degree in economics from the University of Essex and a PhD in health economics from King’s College London, is a Full Professor of Business Economics at Brunel University London and an Associate Professor of Public Economics at Ca’ Foscari University of Venice. He has taught at the University of Cambridge and the University of Leicester and has been a researcher at the London School of Economics and a visiting scholar at the University of Berkeley. He has published in numerous international scientific journals in economics and medicine and has won several European, Italian, and British research grants.