Mental health service areas in Switzerland.

OBJECTIVES: Small area analysis is a health services research technique that facilitates geographical comparison of services supply and utilization rates between health service areas (HSAs). HSAs are functionally relevant regions around medical facilities within which most residents undergo treatment. We aimed to identify HSAs for psychiatric outpatient care (HSA-PSY) in Switzerland. METHODS: We used HSAr, a new and automated methodological approach, and comprehensive psychiatric service use data from insurances to identify HSA-PSY based on travel patterns between patients' residences and service sites. Resulting HSA-PSY were compared geographically, demographically and regarding the use of inpatient and outpatient psychiatric services. RESULTS: We identified 68 HSA-PSY, which were reviewed and validated by local mental health services experts. The population-based rate of inpatient and outpatient service utilization varied considerably between HSA-PSY. Utilization of inpatient and outpatient services tended to be positively associated across HSA-PSY. CONCLUSIONS: Wide variation of service use between HSA-PSY can hardly be fully explained by underlying differences in the prevalence or incidence of disorders. Whether other factors such as the amount of services supply did add to the high variation should be addressed in further studies, for which our functional mapping on a small-scale regional level provides a good analytical framework.

[Moving into the community: evaluation of the effects of a structural factor on community based psychiatry and low-threshold psychiatry]. / Stadt statt land: Evaluation der Auswirkungen eines strukturellen Faktors auf die Gemeindenähe und Niederschwelligkeit der Akutpsychiatrie.

OBJECTIVE: In 2005 the ipw acute care units were relocated from the rural area of Rheinau into the outskirts of Winterthur, the second largest city in the canton Zurich. The objective of the present study is to answer the question whether relocation has made a verifiable contribution to community based psychiatry and low-threshold psychiatry. METHODS: The analysed data were taken from selected items of the cantonal psychiatric basis documentation and the ZÜPAZ questionary of patient contentment. For each location, Rheinau and Winterthur, a sample was taken containing data of 12 months. The corresponding data was analysed retrospectively with Chi-Square statistics and paired T-Tests. RESULTS: The distance between patients' residence and the psychiatric institution was reduced significantly by 73 %. Compulsory admission decreased overall by 10 %, with affective disorders showing the most explicit reduction (28 %). Regarding patient's contentment with the clinical treatment, there was a considerable increase. The degree of illness severity at the patient's admission was higher in Winterthur than in Rheinau. CONCLUSIONS: The results indicate that relocation of the acute care units from a rural to an urban area has enhanced community based psychiatry (shorter distance) as well as low-threshold psychiatry (lower rate of compulsory admission, increase in patient's contentment). Nevertheless, there is a major limitation regarding the present study: the two concepts community based psychiatry and low-threshold psychiatry have been operationalised retrospectively. Further prospective empirical evaluations are needed to disclose the relation between community based psychiatry and low-threshold psychiatry.