Describing mental health services: the development of a mental health census in the North-West of England

In the United Kingdom, national policy and local service provision both direct provision towards people with a severe mental illness (NHS and Community Care Act, 1990; Department of Health, 1993, 1994). An independent report by the Mental Health Foundation (1994), a leading mental health charity, recommended that the Department of Health “promulgates a practical definition of severe mental illness (SMI) in order to concentrate attention and services on those in greatest need”. In order to assess the extent to which a provider or a purchaser has focused attention upon the SMI, definitions are being developed in most services in the UK; this will facilitate the quantification of the number and proportion of SMI in contact with services. The definitional approach uses a (variable) number of criteria to determine status as a severely mentally ill person. It is essentially categorical because the individual is placed in one of two categories, SMI or not-SMI.