Objective:To provide background information on the approach of area based funding models for mental health services, to describe the considerations which have come to bear in the development process of the Victorian model, to explore the impacts of different models, and to suggest courses for further development.
Method:The history of this approach to funding in the UK and the USA is summarised, then an account is given of the development of the Victorian model. The position is put that the validation of such models is hampered by having only sparse relevant data. Suggestions are made for improving this situation.
Results:The Victorian model has come to include adjustments for socioeconomic disadvantage, the age, sex and marital status structure of the population, and a variable discounting for estimated substitutive activity of the private sector. Different methods of combining these adjustments into a working formula can be seen to have very different impacts.
Conclusions:The approach taken in development of this model can be expected to have major influence on funding within Victoria, but also more widely in Australia. The impacts of differing assumptions within these models are significant. Specifically targeted epidemiological research, and activity analysis of the private sector will be necessary to enhance the validity of models of this type.
BebbingtonP.Assessing need for psychiatric treatment at the district level: the role of surveys In: ThornicroftGBrewinCRWingJ, eds. Measuring mental health needs. London: Gaskell, 1992:99–117.
2.
FarisRELDunhamHW.Mental disorders in urban areas. An ecological study of schizophrenia and other psychoses. Chicago: University of Chicago Press, 1939.
3.
EatonWW.Residence, social class, and schizophrenia. Journal of Health and Social Behavior1974; 15:289–299.
4.
WeyererSHafnerH.The stability of the ecological distribution of the incidence of treated mental disorders in the city of Mannheim. Social Psychiatry and Psychiatric Epidemiology1989; 24:57–62.
5.
JarmanBHirschSWhitePDriscollR.Predicting psychiatric admission rates. British Medical Journal1992; 304:1146–1151.
6.
ThornicroftG.Social deprivation and rates of treated mental disorder: developing statistical models to predict psychiatric service utilisation. British Journal of Psychiatry1991; 158:475–484.
7.
ThornicroftGBisoffiGde SalviaDTansellaM.Urban-rural differences in the associations between social deprivation and psychiatric service utilization in schizophrenia and all diagnoses: a case-register study in Northern Italy. Psychological Medicine1993; 23:487–496.
8.
BurgessPMJoyceCMPattisonPEFinchSJ.Social indicators and the prediction of psychiatric inpatient service utilisation. Social Psychiatry and Psychiatric Epidemiology1992; 27:83–94.
9.
CiarloJATweedDLShernDLKirkpatrickLESachs-EricssonN.Validation of indirect methods to estimate need for mental health services: concepts, strategy and general conclustions. Evaluation and Program Planning1992; 15:115–131.
10.
TweedDLCiarloJA.Social-indicator models for indirectly assessing mental health service needs: epidemiologic and statistical properties. Evaluation and Program Planning1992; 15:165–179.
11.
ShapiroSSkinnerEAKramerMSteinwachsDMRegierDA.Measuring need for mental health services in a general population. Medical Care1985; 23:1033–1043.
12.
JarmanBHirschS.Statistical models to predict district psychiatric morbidity. In: ThornicroftGBrewinCRWingJ, eds. Measuring mental health needs. London: Gaskell, 1992:62–80.
13.
Psychiatric Services Division, Department of Health and Community Services Victoria.A funding framework for mental health services in Victoria, Report 94/0019. Melbourne, Victoria: Health and Community Services Victoria, 1994.
14.
JarmanB.Identification of underprivileged areas. British Medical Journal1983; 256:1587–1592.
15.
CampbellDARadfordJMCBurtonP.Unemployment rates: an alternative to the Jarman index?British Medical Journal1991; 303:750–755.
16.
CiarloJAShernDLTweedDLKirkpatrickLASachs-EricssonN.The Colorado social health survey of mental health service needs: sampling, instrumentation and major findings. Evaluation and Program Planning1992; 26:133–147.
17.
Sachs-EricssonNCiarloJA.Determining ‘cases’ of mental health-related dysfunction from continuous scales of everyday functioning. Evaluation and Program Planning1992; 15:149–164.
18.
TweedDLCiarloJAKirkpatrickLAShernDL.Empirical validity of indirect mental health needs-assessment models in Colorado. Evaluation and Program Planning1992; 15:181–194.
19.
CiarloJATweedDL.Implementing indirect needs-assessment models for planning state mental health and substance abuse services. Evaluation and Program Planning1992; 15:195–210.
20.
HorvathD.The ethics of medical resource allocation. Canberra: Australian Health Ethics Committee, 1992.
21.
AndrewsGHickieC.The people seen by Sydney psychiatrists. Australian and New Zealand Journal of Psychiatry1986; 20:492–495.
22.
AndrewsGHadzi-PavlovicD.The work of Australian psychiatrists, circa 1986. Australian and New Zealand Journal of Psychiatry1988; 22:153–165.
23.
JormAFRosenmanSJJacombPA.Inequalities in the regional distribution of private psychiatric services provided under Medicare. Australian and New Zealand Journal of Psychiatry1993; 27:630–637.
24.
Psychiatric Services Division, Health and Community Services Victoria.Purchasing better mental health services in Victoria: 1996–1997, Report 95/0376. Melbourne, Victoria: Department of Health and Community Services Victoria, 1996.
