Suchergebnisse

There have been major changes to mental health services internationally in recent years revolving around the concept of care in the community. Although speed of change and precise service mechanisms differ between countries there is nevertheless increasingly widespread consensus on key components essential to adequate care provision. This in turn provides an opportunity to develop a widely acceptable model framework to direct future developments. There is certainly still room for reform in recognition of specific needs and improvements in treatment and care intervention. This book proposes a simple model which can be used as a guide to increased clinical effectiveness through focused evidence-based reform. Using a time/space framework, it is intended to act as a practical aid to diagnosis of strengths and weaknesses in services that will be used by care providers, trainees and planners both at local and higher levels

A Danish (Aarhus) insitution-based and an Italian (South-Verona) community-based psychiatric service are compared. The incidence rates are 20/10,000 inhabitants in both areas with more psychotics and fewer neurotics in Aarhus. The admission rate as well as the one year rate of persons in in-patient care are about three times higher in Aarhus. Referrals to day and out-patient care, including home visits, are used 1.5 - 3.5 times as often in South-Verona, whereas the rates of persons in each of the three types of care are of similar size in the two centres. Geronto-psychiatric disorders are to a greater extent treated within the field of psychiatry in Aarhus. Compulsory admission rates are higher in Aarhus (3.7/10,000 inhabitants) than in South-Verona (1.3/10,000). Admission rates to private hospitals are 9.4/10,000 inhabitants in South-Verona against 3.0/10,000 in Aarhus.

In South-Verona, where a community-based system of care consonant with the provisions of the Italian psychiatric reform has been operating since 1978, case-register data show that Long-stay inpatient rates are decreasing, while rates of patients treated long-term outside the mental hospital (i.e. those in "continuous care for one year, receiving treatment in the community by the various out-patient and day-patient facilities and in some cases short spells of inpatient care") show a recent increasing trend. Long-stay inpatients on 31.12 1982 have been compared with long-term community patients on the same date. The two cohorts were similar in terms of basic sociodemographic variables and contained a similar proportion of psychotic patients. However, while 88% of the long-stay inpatients were still long-stay after two years, only 45% of the long-term patients in the community remained in long-term treatment over the same period. Using a log-linear model, diagnosis was found to be the variable with the highest association in the long-term cohort with subsequent pattern of use of mental health services.