Geographic location and state hospital utilization

[Distance Decay Effects in a Swiss Mental Health Services System]

OBJECTIVE

To investigate psychiatric service use depending on distances (travel times) to inpatient and outpatient service sites.

METHODS

Retrospective cohort analysis of all patients aged 18-64 years who had been treated in a Swiss psychiatric services system in 2022.

RESULTS

Outpatient service utilization rates decreased statistically significantly with increasing distance (travel time by public transportation) between the place of residence and the responsible outpatient clinic. For inpatient utilization, the distance decay effects were much less strong and did not always reach a statistically significant level.

CONCLUSION

In an easily accessible and economically reasonable psychiatric services system, inpatient and specialized services should be organized centrally, while general outpatient psychiatric services should be planned decentralized and close to the communities where people live.

The gravitational force of mental health services: distance decay effects in a rural Swiss service area

BACKGROUND

Previous research suggested a distance decay effect in health services systems, with people living closer to service facilities being more likely to use them.

METHOD

In this ecological cross sectional study, we conducted spatial and statistical analyses in a Swiss mental health services system being legally bound to provide primary mental health care to approximately 620,000 inhabitants. We examined a cohort of all patients who were over 18 years old and who were treated in the mental health services system between January and December 2011.

RESULTS

There were 5574 treatment cases during the 12-month period, 2161 inpatient cases and 3413 outpatient cases. Travel time by public transportation between patients' residence and the closest mental health service facility negatively predicted the utilization of outpatient services for all mental disorders, even after controlling for variability in ecological (e.g. socioeconomic) characteristics of the communities in the service provision area. For utilization of inpatient wards no geographical distance decay effect was observed, except for organic mental disorders.

CONCLUSIONS

Based on these findings, outpatient clinics should be most effectively located decentralized and in the largest communities to meet the needs of the population as close as possible to where people live and to avoid remote areas being insufficiently supplied with mental health care. For mental hospitals and inpatient services decentralized location seems to be less important.

Case management for schizophrenic patients at risk for rehospitalization: a case control study

In many countries deinstitutionalization of psychiatric patients is accompanied by fragmentation of care, giving responsibility to an array of different services and providers. One of the possible side effects of this is an increased rehospitalization rate and length of stay. The need to coordinate the services involved for the benefit of individuals has led to the conceptual development of case management. However, despite an apparent belief in the effectiveness of case management, there is only limited scientific evidence to support this assumption. In the case control study presented we compared a group of 97 schizophrenic patients in the aftercare of case management services with a group of patients who received no outpatient care by case management services after discharge from hospital. Each patient in the case-managed group was exactly matched with a control patient with regard to diagnosis and known risk factors for rehospitalization. Additionally, we considered influencing factors that result from general health system conditions such as regional differences and different types of hospital care. Our analyses demonstrate that, during an observation period of 2.5 years, case management had neither a significant effect on the risk of rehospitalization nor on the length of time in hospital in the event of rehospitalization.

Community care in child psychiatry. An empirical approach using the concept of travel time

Community care is a crucial element in the organization and development of psychiatric services. The basic idea of community care is that it guarantees equal access to services for all people in need. In this study an empirical approach to community care is undertaken using the concept of travel time. The importance of distance to the use or nonuse of mental health services has been documented for a long time. But if distance is measured by travel time, additional elements, as for example the available transport system are considered relevant for the accessibility of services. It can be shown that most patients of two child psychiatric outpatient services do not accept a travel time exceeding half an hour. Outreach activities of services located in rural areas can partly compensate for the geographic disadvantage of those patients living at long distance to the service.

Mental health workers' ratings of the importance of the goals of a cooperative CMHC-state hospital screening-aftercare program

Ratings of the importance of the goals of a pilot community mental health center (CMHC)-state psychiatric hospital cooperative program aimed at providing screening and aftercare were obtained from 214 mental health professionals. Respondents were employed at state hospitals, at CMHCs that were participating in the program, and at CMHCs that were not participating in the pilot cooperative program. Ratings of importance were found to differ across goals, between mental health workers of state hospitals and CMHCs, between participating and nonparticipating CMHCs, between professions, and as a function of distance between CMHCs and state hospitals. Implications of the findings for the evaluation of the success of a cooperative screening-aftercare pilot program are discussed.