We examined income source and match between recommended and received care among users of community mental health services. We conducted a secondary analysis of needs-based planning data on adults in Ontario community mental health programs from 2000 to 2002. The outcome was whether clients were severely underserved (yes/no) based on the match between level of care recommended and received. A logistic regression model investigated if income source predicted this outcome. 13% of clients were severely underserved. Over 40% were on public assistance and they had a higher risk of being severely undeserved than the others. Men were at greater risk. One aim of mental health reform is to increase access to care for vulnerable individuals. The finding that among users of community mental health services, individuals with public assistance income support are most vulnerable to being severely underserved should be considered by service planners and providers.
The purpose of this study was to extend previous findings on the relationship of V code conditions to use of psychiatric services and treatment outcome.
The group under study involved 2,542 outpatients from three community mental health centers in Nova Scotia, Canada. From this group, three subgroups of patients were compared: 1) patients with V code conditions, 2) patients with DSM-III-R mental disorders, and 3) patients with both V code conditions and mental disorders.
The majority of patients (61.8%) were diagnosed with V code conditions, and a substantial minority (19.6%) had V code conditions as the sole diagnoses. Patients with V code conditions without mental disorders were similar to patients with mental disorders in consumption of treatment resources and treatment outcome.
Strategies for improving the efficiency of mental health services to patients with V code conditions need to be developed.
The authors have studied the syndromal, nosological, sex and age characteristics of the patients registered at the gerontopsychiatric room of a general somatic district polyclinic as compared with the same parameters in mental outpatients of late age. It has been demonstrated that a new organizational form of specialized help (gerontopsychiatric consultations at the primary level of health care) makes it possible to ascertain mental disturbances of a borderline nature in old people and to expand the provision of therapeutic and rehabilitative measures to people not registered at outpatient psychiatric institutions.
We examined hospital utilization and use of community facilities for the treatment of alcohol problems in Ontario using Statistics Canada, Hospital Medical Records Institute records, and other administrative records. Between 1974 and 1986 there was a large drop in utilization of hospital services for treatment of alcohol problems. Rates of alcohol inpatient cases in general hospitals dropped by 47% and in mental hospitals by 33%. At the same time, there was an increase in overall availability of hospital beds and bed-days of care for all medical conditions, and no change in the total number of hospital discharges (1.3 million) and occupancy rates (80-85%). Also at the same time, the number of community-based programs for the treatment of alcohol problems increased, as did the number of persons or cases treated by them. This was associated with a drop of inpatient cases treated for alcohol problems in 38 out of 48 counties in Ontario (P
National trends in minority utilization of mental health services are reviewed, and recommendations are made for needed research. In relation to their representation in the population, blacks use services more than expected, and Asian American/Pacific Islanders use services less; Hispanics and Native American/Alaska Islander use varies according to type of service. Hospitalization accounts for part of the increase in minority utilization; this trend is problematic. Disruptions in service continue to plaque minority clients, possibly stemming from inadequacies in the organization and financing of care, and from cultural incongruity. Much more must be learned about these problems in utilization, as well as about other key issues.
An examination of two samples of children seen one year apart at a community mental health service indicated that a significant proportion had also been involved with the child welfare system (44% of the 119-member older sample and 32% of the 160 individuals from the current sample). A reanalysis of the latter sample one year later showed that the caseload overlap had increased to 39%.
Rapid deinstitutionalization occurred in Finland in the 1990s, a decade later than in many other Western countries. A four-year follow-up study in northern Finland examined community placements of 253 long-stay psychiatric inpatients after deinstitutionalization in 1992 and at follow-up at the end of 1995. About 70 percent of the patients were discharged. Only 15 percent were able to live outside the hospital without continuous support. No patient was homeless at follow-up. Being unmarried, living in the city of Oulu, and having greater severity of illness were associated with hospitalization at follow-up. The results showed that long-stay patients are dependent on considerable support. Alternative residential facilities have made deinstitutionalization possible.
This paper describes the first three years of a community outreach service for psychogeriatric assessment and treatment, provided by a multidisciplinary team in an urban area. As one component of a comprehensive geriatric psychiatry service within a general hospital, this program provides a long-term link between patient, family, community agencies and hospital. The paper describes the functioning of the team, including its relationships with other hospital and community services. An overview is given of patient characteristics, referral sources, services provided, and outcomes at discharge from the program. Educational opportunities for students and staff in various health professions and settings are discussed.
To document the number and pattern of psychiatric and psychosocial referrals to community resources by family physicians (FPs) and to determine whether referral practices correlate with physician variables.
Cross-sectional survey of referrals by FPs to 34 key psychiatric and psychosocial community resources identified by a panel of FPs, psychiatric social workers, psychiatric nurses, public health nurses, and the local community information service.
Regional municipality of 434,000 persons in Ontario.
Twenty-seven of 34 (79%) community agencies identified 261 FPs who made 4487 referrals to participating agencies (range 0 to 65, median 15, mean 17.19 +/- 13.42).
Number of referrals to all agencies; variables, such as physician sex, school of graduation, year of graduation, and certificate status in the College of Family Physicians of Canada, related to referral patterns.
Referrals to outpatient psychiatric clinics, support services, and general counseling services accounted for 96% of all referrals. Physicians' average annual referral profile was as follows: 8.6 patients to a support service, 6.3 to an outpatient psychiatric service, 1.6 to a counseling service, and 0.46 to a substance abuse service. Referral profiles of individual physicians varied greatly. Female FPs made fewer referrals than male FPs to support services, but both made similar numbers of referrals to psychiatric, counseling, and substance abuse services. The more recent the year of graduation, the greater the number of referrals to psychiatric (r = 0.158, P = 0.0107) and counseling services (r = 0.137, P = 0.0272) and the higher the fraction of referrals to psychiatric services (r = 0.286, P = 0.0001).
Family physicians in Hamilton-Wentworth made few referrals to psychiatric and psychosocial services. Only physician sex and year of graduation correlated significantly with numbers of referrals made. Recent graduates of both sexes made significantly more referrals to psychiatric clinics and counseling services than their older colleagues.
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This study examines whether community treatment orders (CTOs) reduce psychiatric admission rates or bed-days for patients from Western Australia compared to control patients from a jurisdiction without this legislation (Nova Scotia).
A population-based record linkage analysis of an inception cohort using a two-stage design of matching and multivariate analyses to control for sociodemographics, clinical features and psychiatric history. All discharges from in-patient psychiatric services in Western Australia and Nova Scotia were included covering a population of 2.6 million people. Patients on CTOs in the first year of implementation in Western Australia were compared with controls from Nova Scotia matched on date of discharge from in-patient care, demographics, diagnosis and past in-patient psychiatric history. We analysed time to admission using Cox regression analyses and number of bed-days using logistic regression.
We matched 196 CTO cases with an equal number of controls. On survival analyses, CTO cases had a significantly greater readmission rate. Co-morbid personality disorder and previous psychiatric history were also associated with readmission. However, on logistic regression, patients on CTOs spent less time in hospital in the following year, with reduced in-patient stays of over 100 days.
Although compulsory community treatment does not reduce hospital admission rates, increased surveillance of patients on CTOs may lead to earlier intervention such as admission, so reducing length of hospital stay. However, we do not know if it is the intensity of treatment, or its compulsory nature, that effects outcome.