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.

After the Asylum? The New Institutional Landscape.

During the last decades services to people with severe mental health problems have gone through important changes. Terms as de-, trans-, reinstitutionalisation and dehospitalisation has been used. The objective of the study was to collected data about the changes in a welfare society about the new institutional landscape after the mental hospital area. Data about interventions from social welfare agencies, psychiatric care, and prisons were collected from local and national register as well as data about cause of death and socio-economic status for 1355 persons treated with a diagnosis of psychosis in a Stockholm area 2004-2008. Psychiatric in-patient care and prisons are marginalized. Different interventions in open care touched a very large number of persons. Social welfare agencies play an increasing role in this context. The total institutions have been replaced by a network of micro-institutions sometimes offering help but also control.

[Services for the early recognition of psychoses and bipolar disorders in Germany: inventory survey study]. / Angebote zur Früherkennung von Psychosen und bipolaren Störungen in Deutschland: Bestandsaufnahme.

BACKGROUND: In order to successfully implement early recognition and intervention services in psychiatry, it is crucial to improve the attention to and recognition of severe mental disorders and to establish low threshold services that are available at short notice for diagnostic and treatment procedures. MATERIAL AND METHODS: For this inventory survey study, questionnaires regarding the presence and type of early recognition services for psychoses and bipolar disorders were sent separately to German psychiatric hospitals by mail in September and October 2012. Additionally, an internet search and telephone inquiries as well as an alignment of responses from the two surveys and with network lists from published and ongoing early recognition studies were performed. RESULTS: Response rates in the psychosis and bipolar disorder surveys were 21 % (51/246) and 36 % (91/255), respectively. Three quarters of participating institutions reported at least an interest in creating an early recognition service for psychoses and one half for bipolar disorders. Overall, 26 institutions were identified that already offer early recognition of psychoses and 18 of bipolar disorders. Of these 16 are low threshold early recognition centres with direct access at short notice for first-episode patients and person from at-risk groups and separate specific public relations work. Of these early recognition centres five have a separate and easy to find homepage available; in an additional 15 institutions the specific websites are part of the institutions homepage. CONCLUSION: Despite widespread interest and the increasingly recognized importance of early recognition and intervention services in psychiatry, there is currently no nationwide coverage with early recognition services for severe mental disorders in Germany. Public relations and information activities are not (yet) sufficiently provided to reach affected persons and their environment. Common standards are (still) missing and interdisciplinary models are sparse. To correct these shortcomings, amongst other factors, acquisition of sufficient funding for such services is required.

[The care of mentally retarded children and adolescents with psychiatric disorders in hospitals for child and adolescent psychiatry and psychotherapy in Germany - results of a questionnaire survey]. / Zur Versorgung von Menschen mit Intelligenzminderung und psychischen Störungen in den Kliniken für Kinder- und Jugendpsychiatrie/Psychotherapie in Deutschland - Ergebnisse einer Fragebogenuntersuchung.

OBJECTIVES: To assess the prevalence of and standards of treatment for young mentally retarded patients in inpatient units and ambulant settings. METHODS: Mail questionnaire survey of all German hospitals for child and adolescent psychiatry (N = 136); 68 closed-ended questions; 54.4% respondents. RESULTS: The average prevalence was 6% of in- and outpatients. Specialised inpatient units for the mentally retarded are available at 8% of the hospitals; 5% only have outpatient services, i.e., most of the clients are managed within mainstream units. The standards of assessment and treatment are as usual. Pharmacotherapy is not more frequent. The quality of services is more or less sufficient. Of the responders, 85% demand specialised in- and outpatient psychiatric services for the mentally retarded in every federal state. CONCLUSIONS: The overall deficit of psychiatric services for mentally retarded children and adolescents in Germany is confirmed. New specialised in- and outpatient services must be created in every federal state. The quality of assessment and treatment seems to be sufficient to establish accurate diagnoses and multidisciplinary therapeutic approaches.

Assessment of mental health services in Slovenia with The European Service Mapping Schedule.

The aim of our study was to examine availability and utilization of mental health services in the 12 Slovenian statistical regions by using the The European Service Mapping Schedule (ESMS) methodology. 251 mental health services were mapped according to their type as presented in schema of ESMS service tree. Marked differences between regions were noticed in patterns of service provision and utilization. In contrast with the scarcity of mental health services in the Zasavska and Notranjsko-kraska region, the Central-Slovenian region offered the most diverse and abundant choice of services of all statistical regions. We lack day and structured activity services offering work or work-related activities. Out-patient and community services are mainly medium intensity non-mobile services that offer continuing care.

Is psychiatric reform a strategy for reducing the mental health budget? The case of Brazil.

OBJECTIVE: To investigate trends in the provision of mental health services and financing in Brazil. METHOD: Data from DATASUS (the Brazilian Unified Health Computerized System) with free access in the web were collected regarding the number of beds, the development of new community centers, the number of mental health professionals, and costs involved from 1995 to 2005. RESULTS: In ten years, the number of psychiatric beds decreased 41% (5.4 to 3.2 per 10,000 inhabitants) while community services have increased nine-fold (0.004 to 0.037 per 10,000 inhabitants). Psychologists and social workers have accounted for three and two-fold, respectively, as much hirings as psychiatrists. Psychiatric admissions accounted for 95.5% of the budget in 1995 and 49% in 2005, and the expenses with community services and medication have increased 15% each. As a whole, the expenses in mental health decreased by 26.7% (2.66 to 1.95 US$ per capita). CONCLUSION: There has been a clear switch from hospital to community psychiatric care in Brazil, where the system can now provide a diversity of treatments and free access to psychotropics. However, the coverage of community services is precarious, and the reform was not accompanied by an increased public investment in mental health. The psychiatric reform is not a strategy for reducing costs; it necessarily implies increasing investments if countries decide to have a better care of those more disadvantaged.

Stressed out.

With mental health services shrinking, emergency departments are deluged by patients they were never designed to handle."The safety net for these poor people is unraveling," says Alicia Boccellari of San Francisco General Hospital. Her hospital and several others are confronting the crisis with little help from the government or private insurers.

Increasing Access to State Psychiatric Hospital Beds: Exploring Supply-Side Solutions.

OBJECTIVE: The objective of this study was to identify supply-side interventions to reduce state psychiatric hospital admission delays. METHODS: Healthcare Enterprise Accounts Receivable Tracking System (HEARTS) data were collected for all patients admitted between July 1, 2010, and July 31, 2012, to one of North Carolina's three state-operated psychiatric hospitals (N=3,156). Additional information on hospital use was collected at nine meetings with hospital administrators and other local stakeholders. A discrete-event simulation model was built to simulate the flow of adult nonforensic patients through the hospital. Hypothetical scenarios were used to evaluate the effects of varying levels of increased capacity on annual number of admissions and average patient wait time prior to admission. RESULTS: In the base case, the model closely approximated actual state hospital utilization, with an average of 1,251±65 annual admissions and a preadmission wait time of 3.3±.1 days across 50 simulations. Results from simulated expansion scenarios highlighted substantial capacity shortfalls in the current system. For example, opening an additional 24-bed unit was projected to decrease average wait time by only 6%. Capacity would need to be increased by 165% (356 beds) to reduce average wait time below 24 hours. CONCLUSIONS: Without more robust community-based hospital and residential capacity, major increases in state psychiatric hospital inpatient capacity are necessary to ensure timely admission of people in crisis.

[Psychiatric and psychosomatic day hospitals in Austria]. / Psychiatrische und psychosomatische Tageskliniken in Österreich.

This paper on psychiatric and psychosomatic day hospitals in Austria first looks at the overall situation of Austrian day clinics then, in a second step, compares psychiatric and psychosomatic day hospitals. For this purpose, a questionnaire was developed and sent to all psychiatric and psychosomatic day hospitals in Austria. The first part consisted of closed questions and was used to gather and evaluate the categories: general conditions for treatment in day hospitals, tasks of day hospitals, therapeutic paradigms, indication and contraindication, diagnostics, day hospital organisation, interdisciplinary cooperation and the offering in day hospitals. The second section consisted of open questions which were used to gather and evaluate active factors, difficulties, specifics and requests for future treatment in day hospitals. The results show that there is a trend towards more day hospitals. Psychosomatic day hospitals are a rather new phenomenon. Furthermore, the distinction between psychiatric and psychosomatic day hospitals is important in order to offer patients distinguishable treatment options in future. The results show that psychiatric and psychosomatic day hospitals both have a strong focus on psychotherapy and both fulfill the active factors for psychotherapy by Grawe.

The phasing out of mental hospitals in the United States.

The authors view the current wave of closing state mental hospitals against the background of trends in mental health services during the past 20 years. Although a small number of hospitals has been totally closed, the overall number of institutions has remained stable due to the opening of new hospitals, and many states will be forced to consider phasing out additional hospitals in the immediate future. The closing of hospitals is a social phenomenon that involves the lives and welfare of patients, personnel, families, and the community and poses a substantial political and logistical challenge. The authors make a few suggestions for those who are contemplating closing hospitals in the future.