City_MH_Needs_Analysis_2003

Mental Health Needs Analysis

2003 Results

Mike WoodallMental Health Information Officer

Steven WyattPerformance Analysis Team Manager

Revised: April 2004


C:\DOCUME~1\EASYPD~1\LOCALS~1\Temp\BCL Technologies\easyPDF 4\@BCL@8805924C\@[email protected]

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Contents

PageIntroduction 3Aims & Objectives 3Executive Summary 5Main Findings

Psychotic Disorders 6Neurotic Disorders 13

Comparisons with Current Supply 21Future Improvements 21Appendix A – Methodology 22



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Introduction

A comprehensive analysis of need is an essential component of a Social Care Commissioning Strategy. Without information about the volume, characteristics and nature of social care needs within a population, it is not possible to plan and organise services to meet those needs.

Although several needs analyses have been carried out in Birmingham, they have been of limited use only. In particular, the needs analyses were derived solely from Census data and therefore contained limited information about the nature of the social care need1. In addition, whilst these needs analyses provided comparative information about population size and deprivation within the city, they stopped short of estimating the current and projected number of people with social care needs.

Resources were made available in 2003 to develop a needs analysis for adults (aged 18-64) with mental health problems in Birmingham which moved beyond broad descriptions of the population, to estimating the numbers adults with different types of mental illness and the characteristics of these people in each city quadrant.

Aims and Objectives

The aim of the needs analysis was to estimate the number of adults (18-64) with a1. psychotic illness2. neurotic illnesseach year from 2003 to 2008.

In addition it was expected that these numbers would be sub-divided by personal characteristics (age, gender and ethnicity) illness sub-types city quadrant.

The results of this needs analysis will be incorporated into the Department’s Commissioning Strategy for Adult’s with Mental Health Problems.

Overview of Methodology

It was hoped that an existing methodology would be available to support all or part of the above work. However, despite extensive reading and literature searches, no such methodologies were located. There were many reports that were described as needs analyses. These reports often featured; descriptions of the population (from Census and population projections) prevalence data information on service demand deprivation indices other measures of poverty. 1 Since the Census contains only broad categories for illness and/or disability.



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But no attempts were made to put these factors together to estimate the numbers of adults with mental health problems and therefore potential customers of social services department.

As such, a decision was taken to develop a new needs analysis methodology.

In developing the needs analysis methodology, the following principles were observed.

that the methodology should use data from reputable sources that data should be selected that allowed other authorities to apply the

methodology without significant additional work (i.e. the data should be national and available at the ward or authority level)

that it was preferable to make assumptions (so long as these were identified) to allow the needs analysis to proceed, than to fall short of the projects objectives.

The needs analysis was built up in the following stages;

1. select a suitable source of national prevalence data2. identify prevalence rates by key socio-demographic determinants of mental illness

in private households3. estimate the proportion of adults (18-64) within the population by the same key

determinants of need in private households4. apply the population proportions to the odds ratios and prevalence rates5. add in those in residential homes, nursing homes and psychiatric hospitals 6. identify the personal and needs characteristics of these people7. forecast the changes to these rates that are likely to occur between 2003 and

2008.

A detailed description of the methodology that was developed is provided in Appendix A.



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Executive Summary

Psychotic Disorders

It is estimated that

There are 5,271 adults aged 18 to 64 in Birmingham with Psychotic Disorders 2,198 or 41.7% are aged 18 to 34, 1,790 or 34.0% are aged 35 to 49 and the

remainder 1,283 or 24.3% are aged 50 to 64 Females make up 52% of those with Psychotic Disorders whilst 48% are

males 58.8% are White, 15.9% are Asian and 22.0% are Black Black adults are over-represented compared to the background population Prevalence rates (13.87 per 1,000) in Heart of Birmingham PCT are

significantly higher than in the remaining 3 PCTs (range 6.30 to 8.36 per 1,000 population)

The age profile of Psychotic Disorders in North Birmingham PCT is markedly different than the other 3 PCTs

There are no real differences in gender between the four PCTs In Heart of Birmingham PCT 36% of those with Psychotic Disorders are Black

and 30% are Asian which is significantly higher than the other PCTs

Neurotic Disorder

It is estimated that

There are 120,017 adults aged 18 to 64 in Birmingham with Neurotic Disorders

54,574 or 45.47% are aged 18 to 34, 38,085 or 31.73% are aged 35 to 49 and the remainder 27,359 or 22.80% are aged 50 to 64

Females make up 62% of those with Neurotic Disorders whilst 38% are males 61.95% are White, 28.31% are Asian and 6.31% are Black Asian adults are over-represented compared to the background population Prevalence rates (295.87 per 1,000) in Heart of Birmingham PCT are

significantly higher than in the remaining 3 PCTs (range 158.19 to 188.54 per 1,000 population)

The age profile of Neurotic Disorders in North Birmingham PCT is markedly different than the other 3 PCTs

There are no real differences in gender between the four PCTs In Heart of Birmingham PCT 58% of those with Neurotic Disorders are Asian

and 11% are Black which is significantly higher than the other PCTs 43% of those with a Neurotic Disorder had a Mixed Anxiety and Depressive

Disorder, 22% had a Generalised Anxiety Disorder and 13% had a Depressive Episode

It is not possible to compare the Needs Analysis with Supply data currently although this will be an area that will need to be improved in the future.



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Main Findings

Psychotic Disorders

Total Number

The total number of people with a psychotic disorder in Birmingham is estimated at 5,271 (4,307 in the community, 338 in residential or Nursing Homes and 626 in hospital beds). The number of adults aged 18 to 64 with a mental health problem in residential or nursing homes and hospital are based on actual figures as at 31st

March 2003 whilst the number in the community is based on the 2001 census and prevalence rates from Psychiatric morbidity among adults living in private households, 2000 - Office for National Statistics.

It has been assumed that all people aged 18 to 64 with a Mental Health problem in a Residential Home, Nursing Home or Hospital have a Psychotic rather than Neurotic Disorder. Although this is unlikely to be precisely true it is the most valid assumption as there is not enough evidence available to apportion these people between the two sets of disorders.

Age Split of Psychotic Disorders2

2,198

1,790

1,283

0

500

1000

1500

2000

2500

18 to 34 35 to 49 50 to 64Age Group

Nu

mb

er o

f P

eop

le

The number of adults in Birmingham with a Psychotic Disorder reduces in the higher age groups.

2 It should be noted that when categorised by age, gender etc. the number of people with a psychotic disorder does not always add up to the total. This is due to rounding



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Gender

Male48%

(2,530)

Female52%

(2,741)

There are slightly more females in Birmingham with a psychotic disorder than there are males.

Ethnicity

Age Group Number of People

Proportion Birmingham Proportion

(Census 2001)

Difference

White 3,100 58.80% 70.35% -11.55Mixed 90 1.71% 2.86% -1.15Asian 840 15.94% 19.52% -3.58Black 1,160 22.01% 6.12% 15.89Other 81 1.53% 1.15% 0.38Total 5,271 100.00% 100.00%

There is a disproportionately large representation of Black adults aged 18 to 64 with a Psychotic Disorder compared to the general population aged 18 to 64 in Birmingham. That is also true, but to a lesser extent, for Other. Whilst White, Asian and Mixed ethnicities have a lower representation than the population would suggest they should.



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By Quadrant

PCTPsychotic

PrevalencePopulation

(Census 2001)Prevalence per

1,000 PopEast Birmingham 1,007 120,404 8.36Heart of Birmingham 2,015 145,281 13.87North Birmingham 595 94,458 6.30South Birmingham 1,655 218,722 7.57Birmingham Total 5,272 578,865 9.11

There is a significantly higher prevalence rate per 1,000 population in Heart of Birmingham PCT (13.87 compared to the next highest 8.36).

Within Quadrant

Age

378

927

203

690

352

683

216

539

277

404

177

426

0

100

200

300

400

500

600

700

800

900

1000

East HoB North SouthAge Group

Nu

mb

er o

f P

eop

le

18 to 34 35 to 49 50 to 64

North Birmingham PCT is the only PCT not to follow the same pattern (i.e. the number per age group goes down as the age group increases). Heart of Birmingham PCT has the highest proportion of younger adults (aged 18 to 34) with a Psychotic Disorder at 46% compared to South (42%), East (38%) and North (34%).



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Gender

East

Female52%(522)

Male48%(484)

HoB

Female51%

(1,030)

Male49%(984)

North

Female53%(318)

Male47%(277)

South

Female53%(870)

Male47%(785)

There are no large differences in the proportion of females to males within each of the four PCTs.

Ethnicity

Ethnicity East HoB North South TotalWhite 717 (71%) 590 (29%) 492 (83%) 1,300 (79%) 3,099 (59%)Mixed 14 (1%) 45 (2%) 6 (1%) 25 (2%) 90 (2%)Asian 100 (10%) 610 (30%) 24 (4%) 107 (6%) 841 (16%)Black 166 (17%) 732 (36%) 68 (11%) 194 (12%) 1,160 (22%)Other 9 (1%) 37 (2%) 4 (1%) 30 (2%) 80 (2%)

Total 1,006 (100%)

2,014 (100%)

594 (100%)

1,656 (100%)

5,270 (100%)

There is a much higher proportion of Asian and Black Adults with a Psychotic Disorder in Heart of Birmingham than in any of the other PCTs (66% compared to 27% in East, 18% in South and 15% in North).



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Ward

PCT AreaPsychotic



1,000 PopAcock's Green 120 15,893 7.54Erdington 117 14,536 8.02Hodge Hill 115 14,306 8.01Kingsbury 75 9,198 8.11Shard End 102 12,616 8.05Sheldon 74 11,460 6.45Stockland Green 149 14,115 10.54Washwood Heath 154 15,075 10.23

East Birmingham

Yardley 102 13,205 7.75East Birmingham Total 1,007 120,404 8.36

Aston 220 15,090 19.77Handsworth 250 14,750 17.79Ladywood 229 16,139 13.80Nechells 186 16,226 12.70Sandwell 180 16,678 13.14Small Heath 197 18,646 9.90Soho 219 15,146 17.53Sparkbrook 188 15,346 12.78

Heart of Birmingham

Sparkhill 168 17,260 9.21Heart of Birmingham Total 1,838 145,281 13.87

Kingstanding 117 14,187 7.81Oscott 85 12,566 6.58Perry Barr 108 14,335 7.92Sutton Four Oaks 104 16,621 5.48Sutton New Hall 115 19,569 5.33

North Birmingham

Sutton Vesey 104 17,180 5.39North Birmingham Total 634 94,458 6.30

Bartley Green 111 13,055 7.67Billesley 123 15,318 7.29Bournville 104 14,746 6.53Brandwood 111 14,412 7.49Edgbaston 178 17,118 10.71Fox Hollies 110 13,583 7.85Hall Green 104 15,373 6.23Harborne 102 13,838 7.20King's Norton 91 12,044 7.45Longbridge 138 18,257 6.94Moseley 120 14,116 7.52Northfield 103 13,851 6.29Quinton 88 11,777 7.20

South Birmingham

Selly Oak 172 18,687 8.55



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PCT AreaPsychotic



1,000 PopWeoley 102 12,547 7.97

South Birmingham Total 1,759 218,722 7.57Birmingham Total 5,271 578,865 9.11

Psychotic Prevalence per 1,000 Population by Ward

The seven wards with the highest prevalence per 1,000 population of psychotic disorders are in Heart of Birmingham PCT whilst the three wards with the lowest prevalence are in North Birmingham PCT.



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Projection of Future Need

Projections of future need are based on the proportional increases in the overall population of adults aged 18 to 64 in Birmingham from the 2002 mid year estimate and 1996 sub-national population projections. There is currently no scope to incorporate projections of future levels of prevalence as there is no evidence available which shows any changes in need. It is believed that the proportion of the adult population in Birmingham from minority ethnic groups will increase. Population projections are produced by age and gender only. If population projections included ethnicity as a factor (which is a major determinant of psychotic and neurotic prevalence) then it is likely that these need projections would show a more marked increase in need.

5,4075,390

5,363

5,3315,308

5,2915,271

5,200

5,250

5,300

5,350

5,400

5,450

2002 2003 2004 2005 2006 2007 2008Year

Nu

mb

er

of

Pe

op

le

If there are no changes in prevalence over the next 5 years it is likely that the number of adults aged 18 to 64 with mental health problems will rise by 116 people from 2003 to 5,407 in 2008.



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Neurotic Disorders

The estimated total number of people aged 18 to 64 in Birmingham with a neurotic disorder is 120,017. As has been stated earlier this number only includes those with a neurotic disorder in a private household and not those in a Residential Home, Nursing Home or Hospital bed.

Age Split of Neurotic Disorders3

54,574

38,085

27,359

0

10000

20000

30000

40000

50000

60000

18 to 34 35 to 49 50 to 64

Age Group

Nu

mb

er o

f P

eop

le

The number of people with a neurotic disorder in Birmingham in each age group reduces as the age group increases.

Gender

Male38%

(45,646)

Female62%

(74,372)

There is a much higher proportion of females than there are males aged 18 to 64 with a Neurotic Disorder. 3 It should be noted that when categorised by age, gender etc. the number of people with a psychotic disorder does not always add up to the total. This is due to rounding



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Ethnicity

Age Group Number of People

Proportion Birmingham Proportion

(Census 2001)

Difference

White 74,349 61.95% 70.35% -8.40%Mixed 2,120 1.77% 2.86% -1.09%Asian 33,981 28.31% 19.52% 8.79%Black 7,579 6.31% 6.12% 0.19%Other 1,989 1.66% 1.15% 0.51%Total 120,018 100.00% 100.00%

There is a significantly higher proportion in Birmingham of Asian ethnicity aged 18 to 64 identified as having a Neurotic Disorder than there is in the general population, this is also true but to a much lesser extent for Black and Other ethnicities. White and Mixed ethnicities show lower proportions than would be expected in the population with White being particularly low.

By Quadrant

PCTNeurotic



1,000 PopEast Birmingham 22,701 120,404 188.54Heart of Birmingham 42,985 145,281 295.87North Birmingham 14,942 94,458 158.19South Birmingham 39,389 218,722 180.09Total 120,017 578,865 207.33

There is a significantly higher prevalence rate per 1,000 population in Heart of Birmingham PCT (295.87 compared to the next highest 188.54).



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Within Quadrant

Age

9,42

5

22,9

86

5,03

6

17,1

26

7,62

7

12,6

19

5,36

5

12,4

74

5,65

0

7,37

9

4,54

1

9,78

9

0

5,000

10,000

15,000

20,000

25,000

East HoB North South

18 to 34 35 to 49 50 to 64

There is a higher proportion of adults aged 18 to 34 with a neurotic disorder in Heart of Birmingham (53%) than any of the other three PCTs (East 42%, North 34% and South 43%). North have approximately the same number of people in each age group, which is a very different pattern to the other PCTs whose number in each age group reduces as the age group increases.



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Gender

East

Female62%

(14,162)

Male38%

(8,539)

HoB

Male39%

(16,770)

Female61%

(26,214)

North

Male37%

(5,579)

Female63%

(9,363)

South

Male37%

(14,757)

Female63%

(24,632)

There are no large differences in the gender distribution of any of the four Birmingham PCTs.



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Ethnicity

Age Group East HoB North South Total

White 17,194(76%)

11,586(27%)

13,326(89%)

32,243(82%)

74,349(62%)

Mixed 365(2%)

989(2%)

126(1%)

640(2%)

2,120(2%)

Asian 3,895(17%)

24,806(58%)

876(6%)

4,404(11%)

33,981(28%)

Black 1,072(5%)

4,702(11%)

492(3%)

1,313(3%)

7,579(6%)

Other 176(1%)

900(2%)

123(1%)

789(2%)

1,988(2%)

Total 22,702(100%)

42,983(100%)

14,943(100%)

39,389(100%)

120,017(100%)

There is a much higher proportion of both Asian and Black people with a neurotic disorder in Heart of Birmingham PCT than in any of the other PCTs and they are the only PCT with a higher proportion than the overall average for Birmingham. Heart of Birmingham PCT also has by far the lowest proportion of White people with a neurotic disorder.

Ward

PCT Area Neurotic Prevalence

Population (Census 2001)

Prevalence per 1,000 Pop

Acock's Green 2,697 15,893 169.68Erdington 2,410 14,536 165.81Hodge Hill 2,491 14,306 174.15Kingsbury 1,665 9,198 181.04Shard End 2,256 12,616 178.83Sheldon 1,823 11,460 159.11Stockland Green 2,572 14,115 182.21Washwood Heath 4,469 15,075 296.48

East Birmingham

Yardley 2,317 13,205 175.46East Birmingham Total 22,701 120,404 188.54

Aston 4,255 15,090 281.97Handsworth 4,671 14,750 316.71Ladywood 3,454 16,139 214.02Nechells 4,944 16,226 304.72Sandwell 4,251 16,678 254.91Small Heath 6,482 18,646 347.63Soho 4,197 15,146 277.09Sparkbrook 5,339 15,346 347.89

Heart of Birmingham

Sparkhill 5,391 17,260 312.34



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Heart of Birmingham Total 42,985 145,281 295.87Kingstanding 2,613 14,187 184.18Oscott 1,990 12,566 158.37Perry Barr 2,354 14,335 164.18Sutton Four Oaks 2,611 16,621 157.06Sutton New Hall 2,851 19,569 145.67

North Birmingham

Sutton Vesey 2,524 17,180 146.92North Birmingham Total 14,942 94,458 158.19

Bartley Green 2,191 13,055 167.80Billesley 2,718 15,318 177.43Bournville 2,319 14,746 157.25Brandwood 2,490 14,412 172.78Edgbaston 3,723 17,118 217.52Fox Hollies 2,692 13,583 198.19Hall Green 2,805 15,373 182.44Harborne 2,358 13,838 170.42King's Norton 2,067 12,044 171.64Longbridge 2,971 18,257 162.71Moseley 2,700 14,116 191.26Northfield 2,123 13,851 153.24Quinton 1,983 11,777 168.38Selly Oak 3,935 18,687 210.59

South Birmingham

Weoley 2,315 12,547 184.51South Birmingham Total 39,389 218,722 180.09Total 120,017 578,865 207.33



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Neurotic Prevalence per 1,000 Population by Ward

The five wards with the highest prevalence are in Heart of Birmingham PCT (Sparkbrook, Small Heath Handsworth, Sparkhill and Nechells). The two wards with the lowest prevalence are in North PCT (Sutton New Hall and Sutton Vesey).



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Type of disorder

These figures do not sum to the total number of adults aged 18 to 64 with a neurotic disorder as it is possible for an individual to present with more than one disorder.

Neurotic Disorder Males Females TotalMixed Anxiety and Depressive Disorder 22096 29824 51920Generalised Anxiety Disorder 13891 12297 26188Depressive Episode 7773 8185 15958All Phobias 4730 6322 11053Obsessive Compulsive Disorder 3230 4014 7244Panic Disorder 2460 1840 4301

Generalised Anxiety Disorder and Panic Disorder are the only Neurotic Disorders to show a higher prevalence in Males than Females.

Projection of Future Need

Projections of future need are based on the proportional increases in the overall population of adults aged 18 to 64 in Birmingham from the 2002 mid year estimate and 1996 sub-national population projections. There is currently no scope to incorporate projections of future levels of prevalence as there is no evidence available which shows any changes in need. It is believed that the proportion of the adult population in Birmingham from minority ethnic groups will increase. Population projections are produced by age and gender only. If population projections included ethnicity as a factor (which is a major determinant of psychotic and neurotic prevalence) then it is likely that these need projections would show a more marked increase in need.

123,099122,711

122,107

121,385120,854

120,466120,017

118,000118,500119,000119,500120,000120,500121,000121,500122,000122,500123,000123,500

2002 2003 2004 2005 2006 2007 2008

Year

Nu

mb

er

of

Pe

op

le

Based on population alone it is predicted that the number of adults aged 18 to 64 will rise by 3,082 people, from 120,017 in 2003 to 123,099 in 2008.



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Comparisons with Current Supply

Attempts were made to compare the needs analysis results with supply in order to identify any gaps in service and over-provision. However, currently it is not possible to provide any comparisons on a citywide, ward or quadrant basis but is hoped this may be available in the future. This is because data is not available on some of the community-based services, in particular from voluntary organisations, as information is only available at service level and not person level. This means that service users who frequent more than one service cannot be identified and therefore any double counting cannot be excluded

As no distinction is made between people with a Psychotic Disorder and those with a Neurotic Disorder when providing Social Care it is impossible to know which services are provided to each.

Future Improvements

It is envisaged that the Needs Analysis will be revisited on an Annual basis and any new evidence or changes in demographic data will be investigated to see if they can improve this document. The document will only be revised when the data can be improved otherwise it will remain the same.

One of the improvements that should be looked at is the marrying of the Needs Analysis with the supply analysis to look at any gaps in service and also where there may already be an over-provision of services. This is not currently possible as there is no evidence to suggest that adults with Mental Health problems require a particular Social Care intervention. If this were possible it would form an important part of the Commissioning Strategy.

Any evidence about the shift in prevalence over time could be used to improve the projections of future need. Currently the projections only look at changes in population and therefore if the number of adults in Birmingham increases the projection of need will increase despite the fact that the prevalence rate may have decreased within that period and vice versa.



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Appendix A - Methodology

Where assumptions have been made, these shown as A1, A2 etc in the text below.

Stage One: Select Suitable National Prevalence Data

The source of the prevalence data was Psychiatric Morbidity Among Adults Living in Private Households, 2000 (ONS). This report had a number of attributes which made it particularly appropriate for this exercise. In particular the report; is considered to be a reputable source is recent contains detailed information on subcategories of psychiatric morbidity contains the relevant data on gender, age and employment status - so matches

base population data provided prevalence rates for each key socio-demographic determinant of mental

illness

The 2000 survey is one of a series carried out by ONS (formerly OPCS) aimed at estimating the prevalence of mental illness. The survey included two-stage interviews with a representative group of adults (16-74) in private households. Stage one contained detailed questions about service use, risk factors, disorder and socio-demographic factors. Stage two, applied to sub-sample, contained more detailed questions to assess the presence of and categorise mental illness.

A report detailing the main results and the methodology of this survey can be found on the Internet4.

This does not cover adults in Hospitals, Nursing or Residential Care but does include those living in the community.

Whilst the survey contained adequate information about the prevalence of psychiatric morbidity in private households, further information was required about adults in hospitals and residential and nursing homes to support a needs analysis.

Although an extensive search has not been carried out, there did not appear to be a directly applicable survey of adults in psychiatric hospitals and residential and nursing homes for adults with mental illness. In order to pursue the needs analysis it was necessary to make a key assumption at this stage.

A1 that adults aged 18-64 in psychiatric hospitals or residential and nursing homes or adults with mental illness had a psychotic illness.

4 http://www.statistics.gov.uk/downloads/theme_health/psychmorb.pdf



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It is anticipated that in future years, appropriate research evidence will be located so that this assumption can be omitted and a more accurate picture of need within psychiatric hospitals or residential and nursing homes can be determined.

Information about the number of adults in residential and nursing homes in Birmingham and their demographics were obtained from Birmingham Social Services Part III system. This system records all residential and nursing placements made by Birmingham Social Services Department. Information about the number of adult inpatients in psychiatric hospitals in Birmingham and their demographics were obtained from Birmingham and Solihull Mental Health Trust ePEX System, which records all mental activity within the Trust.

Stage Two: Identify prevalence rates for each key socio-demographic determinant of mental illness in private households

The Psychiatric Morbidity Among Adults Living in Private Households, 2000 (ONS) report, provides prevalence rates for psychosis and neurosis. Separate tables of prevalence rates are also provided for a wide range of socio-demographic factors. Three of these factors, gender, ethnicity and employment status were selected as key determinants of mental illness.

The prevalence rates by gender are provided by age sub-groups. The age groups relevant to this exercise were selected and prevalence rates for adults aged 18-64 by gender were produced using Birmingham population figures (2001 Census) for weightings.

In order to combine these prevalence rates by gender and employment status, prevalence rates for employment status were transformed into odds ratios. These odds ratios, showed how much more likely members of one subgroup (e.g unemployed) was than the population of experiencing mental illness. By multiplying these odds ratios by the prevalence rates by gender, prevalence rates by gender and employment status were produced.

A2 That there is no association in the prevalence of mental illness between gender and economic status.

Similarly, odds ratios for each ethnic group were produced. These odds ratios were multiplied by the prevalence rates by gender and employment status to produce prevalence rates by gender, employment status and ethnic group.



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A3 That there is no association in the prevalence of mental illness between gender/economic status subgroups and ethnicity.

Prevalence Rates were then available for each of the following categories for both Neurotic Disorders and Psychotic Disorders:

Gender Employment Status EthnicityFemale Economically Inactive WhiteFemale Employed WhiteFemale Unemployed WhiteMale Economically Inactive WhiteMale Employed WhiteMale Unemployed White

Female Economically Inactive BlackFemale Employed BlackFemale Unemployed BlackMale Economically Inactive BlackMale Employed BlackMale Unemployed Black

Female Economically Inactive South Asian & ChineseFemale Employed South Asian & ChineseFemale Unemployed South Asian & ChineseMale Economically Inactive South Asian & ChineseMale Employed South Asian & ChineseMale Unemployed South Asian & Chinese

Female Economically Inactive OtherFemale Employed OtherFemale Unemployed OtherMale Economically Inactive OtherMale Employed OtherMale Unemployed Other



25

Stage Three: Estimate the proportion of adults (18-64) within the population by the same key determinants of need in private households

The 2001 Census was used as the source of the socio-demographic proportions of the Birmingham population. Counts of the population aged 18-64 was extracted using SASPAC V6 at a ward level for each of the following categories.

Gender Employment Status EthnicityFemale Economically Inactive WhiteFemale Employed WhiteFemale Unemployed WhiteMale Economically Inactive WhiteMale Employed WhiteMale Unemployed White

Female Economically Inactive BlackFemale Employed BlackFemale Unemployed BlackMale Economically Inactive BlackMale Employed BlackMale Unemployed Black

Female Economically Inactive South Asian & ChineseFemale Employed South Asian & ChineseFemale Unemployed South Asian & ChineseMale Economically Inactive South Asian & ChineseMale Employed South Asian & ChineseMale Unemployed South Asian & Chinese

Female Economically Inactive OtherFemale Employed OtherFemale Unemployed OtherMale Economically Inactive OtherMale Employed OtherMale Unemployed Other



26

The following groupings were used to combine ethnicities into the required sets.

2001 Census category GroupingWhite: British WhiteWhite: Irish WhiteWhite Other: White WhiteMixed: White and Black Caribbean MixedMixed: White and Black African MixedMixed: White and Asian MixedMixed: Other Mixed MixedAsian or Asian British: Indian South Asian & ChineseAsian or Asian British: Pakistani South Asian & ChineseAsian or Asian British: Bangladeshi South Asian & ChineseAsian or Asian British: Other Asian South Asian & ChineseBlack or Black British: Black Caribbean BlackBlack or Black British: Black African BlackBlack or Black British: Other Black BlackChinese or Other Ethnic Group: Chinese South Asian & ChineseChinese or Other Ethnic Group: Other Ethnic Group Other

Stage Four: Apply the population proportions to the calculated prevalence rates

Prevalence rates produced by stage two were then multiplied by populations estimates for the equivalent groups derived from stage three.

This then gave an estimate of the number of adults aged 18 - 64 with mental health problems with neurosis and psychosis in private households in each ward in Birmingham by gender and ethnicity.

Stage Five: Add in the in psychiatric hospitals, residential and nursing homes for adults with mental health problems.

At this stage the supply data relating to adults in psychiatric hospitals, and residential and nursing homes for adults with mental health problems obtained in Stage One was augmented to the estimated number of adults with psychosis by age group, ethnicity and gender.

These figures then gave an estimate of the number of adults with mental health problems in Birmingham.



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Stage Six: Identify the personal and needs characteristics of these people

The Psychiatric Morbidity Among Adults Living in Private Households, 2000 contains prevalence rates about neurosis sub-categories. Information about the relative prevalence of these sub-categories will assist in specifying services.

The total number of adults with neurosis was then sub-divided according to the relative prevalence rates of the neurosis sub-categories found in the ONS survey.

Stage Seven: Forecast the changes to these rates that likely to occur between 2003 and 2008.

The latest ONS sub-national population projections were published in 1996. These projections are available by 5 year age groups. Since 1996 however, several mid-year estimates have been published. Differences have emerged between the population projections and estimated population. Population projections were therefore adjusted (in absolute terms), to take account of these differences. Two thirds of the 15-19 age group was combined with the 20-24, 25-29, 30-34, 35-39, 40-44, 45-49, 50-54, 55-59, 60-64 age groups to generate projections for the 18-64 age group.

The changes in population from 2003 were then calculated as percentages for 2004, 2005, 2006, 2007 and 2008.

These percentages were then applied to the number adults aged 18 to 64 with a Psychotic Disorder or a Neurotic Disorder to project the future numbers in these categories.

A4 That two thirds of the 15-19 age group are aged 18 or 19.

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