Clients and patients of mental health services.

To determine how a cohort of patients admitted to a mental health center in a single month used the center's clinical services over a year's time, an index of service utilization for each patient was developed. The weighted score took account of days of inpatient and day hospital care and minutes of outpatient time consumed. It was found that 15% of the cohort (48 patients of 330 admitted) used 70% of the total clinical services delivered to the cohort. Analyses of the data on patient characteristics as related to the index or score included the chi 2 test and multiple regression analysis. Not a single sociodemographic variable predicted high utilization of services. Only such clinical characteristics as severity of psychopathology as reflected in patients' diagnoses, suicidal behavior, and a history of prior inpatient treatment contributed to the prediction. The largest group of entrants had relatively brief encounters with the center, and the bulk of the services were actually delivered to a small, severely disturbed minority.

Criteria for psychiatric hospitalization: experience with a checklist for chart review.

The authors report their experience with a 12-item checklist used to score need for hospitalization. The checklist was filled in and scored by research assistants who reviewed the charts of 100 hospitalized and 50 nonhospitalized patients. A written opinion of a senior clinical consultant was available for hospitalized patients whose charts were rated low in need for hospitalization and for nonhospitalized patients whose charts were rated high. The checklist scores differentiated the two groups of patients. The authors can conclude that the checklist can be a valuable tool in a review process that culminates in review by an experienced clinician.