The Nordic comparative study on sectorized psychiatry: rates of compulsory care and use of compulsory admissions during a 1-year follow-up

BACKGROUND

As part of a Nordic comparative study on contact rates of new patients and use of services in seven catchment areas, rates of compulsory care and use of compulsory admissions were explored and analyzed. The total cohort comprised 2834 patients.

RESULTS

A total of 219 patients, 7.7%, were subject to compulsory care during the follow-up. The proportion of compulsorily admitted patients of all admitted patients ranged from 6% to 58% in the seven psychiatric services, and the rate of compulsory care per 1,000 inhabitants, from 0.14 to 0.99. The diagnostic subgroup most commonly committed to inpatient care was functional psychosis, comprising around 50% of all compulsory admissions. The strongest predictor of being compulsorily admitted was the specific psychiatric service the patient was in contact with, followed by having a psychosis diagnosis. High consumption of care was also associated with compulsory care, while social variables played only a minor role in predicting compulsory care.

CONCLUSIONS

There was a great variation in rates of compulsory care. No consistent rural-urban pattern in rates of commitment was found. It is discussed whether a formal referral procedure to the psychiatric service is associated with higher rates of compulsory care.

Factors associated with referral to psychiatric care by general practitioners compared with self-referrals

BACKGROUND

The gatekeeper function of the general practitioner (GP) in the pathway to specialized psychiatric services was investigated in this study, which is part of the Nordic Comparative Study on Sectorized Psychiatry. The question addressed in this paper is whether different sociodemographic and clinical factors as well as factors related to service utilization are associated with referral from the GP compared with self-referrals (including referrals from relatives).

METHODS

The study comprised a total of 1413 consecutive patients, admitted during 1 year to five psychiatric centres in four Nordic countries. The centres included in this study were those that accepted non-medical referrals. Only new patients (not in contact with the service for at least 18 months) were included.

RESULTS

Increasing age was the only sociodemographic factor significantly associated with referral by the GP. The clinical factors (psychosis, being totally new to psychiatry and being in need of in-patient treatment) and some treatment characteristics (planned out-patient treatment and involuntary in-patient treatment), were all significantly associated with referral by the GP. Some indication was found that self-referred patients have shorter episodes of care.

CONCLUSIONS

The findings were remarkably stable across the different centres indicating a general pattern. This study extends previous work on the role of GPs in the pathway to specialized psychiatric services and indicates that the GP has an important gatekeeper function for the most disabled patients.

The Nordic Comparative Study on Sectorized Psychiatry. Part V. Contact rates, contact patterns and care level at index contact

As part of a Nordic comparative study on sectorized psychiatry in seven Nordic catchment areas, a prospective investigation of contact rates of new patients and pathways to the psychiatric services was performed. The results showed that there was more than a twofold difference between the services in the total contact rates. Regarding diagnostic groups, contact rates for neurosis were predominant in three of the services, while adjustment disorders, dependencies and personality disorders were predominant in other the services. The contact rate of functional psychosis, as well as the ratio of psychotic patients to the total contact rate were highest in two catchment areas serving inner parts of big cities. The most common way of getting into contact with the services was by self-referral, 39.4% of total referrals, followed by primary care referrals, although there were large differences between the services. Psychotic patients made contact with the services to a significantly less extent by self-referral. The majority of patients were treated in outpatient care at entry to the services, with a large variation between the services. It was also found that inpatient care at index contact was predicted by clinical characteristics-a diagnosis of psychosis and a history of former inpatient care-as well as by social characteristics-male, widowed or divorced, sick pension/old age pension.

The Nordic comparative study on sectorized psychiatry. Utilization of psychiatric hospital care related to amount and allocation of resources to psychiatric services

As a part of a Nordic comparative study on sectorized psychiatry, utilization of inpatient care was related to resources and dynamic qualities of psychiatric services in seven catchment areas in four Nordic countries. One-year treated incidence cohorts were used. Each patient was followed for 1 year after first contact with the psychiatric service. Data were collected concerning number of beds and staff, number of long-term patients and turnover rate of patients in inpatient care. Findings gave some support to the earlier reports that the utilization of inpatient care is determined by the supply of available beds. Highly staffed community services did not themselves reduce the use of inpatient services, but availability of day care services seemed to reduce utilization of inpatient care among psychotic patients.

The Nordic comparative study on sectorized psychiatry. Part IV. The influence of patient social characteristics on treated incidence

As part of a Nordic comparative study on sectorized psychiatry, sociodemographic characteristics (gender, age and marital status) were studied in relation to treated incidence in eight diagnostic subgroups. One-year incidence cohorts in seven sectorized psychiatric services were used. Women with a neurosis diagnosis had a significantly higher relative probability of contact with all services. Men with a dependence diagnosis had a significantly higher relative probability of contact with four of the seven services. Older people had a significantly higher relative risk for affective psychosis in six of the seven centres, and younger individuals had a significantly higher relative risk for personality disorders in six of the seven centres. Unmarried people showed a higher relative risk for functional psychosis and personality disorders in five of the seven services.

The Nordic comparative study on sectorized psychiatry. II. Resources of the psychiatric services and treated incidence

As a part of a Nordic comparative study on sectorized psychiatry, treated incidence was related to the resources and dynamic qualities of psychiatric services in 7 catchment areas. One-year treated incidence cohorts were used. Data was collected concerning number of beds and staff, number of long-term patients and turnover rate of patients in the services and availability of specialized services. A positive correlation was found between rates of outpatient staff and treated incidence. No statistically significant correlation was found between the dynamic qualities of the services and treated incidence. Treated incidence of dependence was the highest in a center that had a special service unit for abusers. Special services for young and old people were not clearly reflected in treated incidence in respective patient groups.