Hostname: page-component-55f67697df-2mk96 Total loading time: 0 Render date: 2025-05-09T13:41:56.876Z Has data issue: false hasContentIssue false
  • English
  • Français

The impact of an expanding community mental health service on patterns of bed usage: evaluation of a four-year period of implementation

Published online by Cambridge University Press:  09 July 2009

H. Häfner  and
J. Klug
H. Häfner*
Affiliation:
Zentralinstitut für Seelische Gesundheit, Mannheim, West Germany
J. Klug
Affiliation:
Zentralinstitut für Seelische Gesundheit, Mannheim, West Germany
*
1Address for correspondence: Prof. Dr H. Häfner, Zentralinstitut für Seelische Gesundheit, 6800 Mannheim 1, J5, Postfach 5970, West Germany.
Get access Rights & Permissions [Opens in a new window]

Synopsis

In the city of Mannheim the introduction of an extensive community mental health service has been shown, by means of case-register data over 4½ years, to have led to a considerable increase in utilization, mainly at the out-patient level of care. The rates of admission to hospital increased very little. Due to the simultaneous decline in long-term bed occupancy, the overall need for psychiatric beds remained stable at a rate of about 1·2/1000, a rate which is very low by international standards.

The sharp decline in the ‘old’ long-stay population was followed by a smaller increase in ‘new’ long-stay patients which it has not been possible to prevent. These patients are, however, admitted for a long-term stay significantly later than formerly, and their diagnostic composition has changed significantly.

The increase in the bed requirements for short- and medium-term stay patients resulted from different sources: an increasing morbidity in some groups of disorders, the rising utilization in case of emergencies and severe crises, and the transfer of long-stay patients to alternative care services. The level of these needs was very similar in Mannheim, Salford, Samsø and Camberwell, whereas the rates for long-term beds still show clear national differences.

Type
Research Article
Information
Psychological Medicine , Volume 12 , Issue 1 , February 1982 , pp. 177 - 190
Copyright
Copyright © Cambridge University Press 1982

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

REFERENCES

Babigian, H. M. (1977). The impact of community mental health centers on the utilization of services. Archives of General Psychiatry 34, 385–394.CrossRefGoogle ScholarPubMed
Bericht über die Lage der Psychiatrie in der Bundesrepublik Deutschland (1975). Zur psychiatrischen und psychotherapeutisch/psychosomatischen versorgung der Bevölkerung. Deutscher Bundestag, Drs. 7/4200, 7/4201: Bonn.Google Scholar
Brown, G. W. (1960). Length of hospital stay and schizophrenia. A review of statistical studies. Acta psychiatrica et neurologica scandinavica 35, 414–430.CrossRefGoogle Scholar
Department of Health and Social Security (1980). In-patient Statistics from the Mental Health Enquiry for England 1977. Statistical and Research Report Series No. 23. HMSO: London.Google Scholar
Dupont, A. (1979). Psychiatric case registers. In Estimating Needs for Mental Health Care (ed. Häfner, H.), pp. 43–51. Springer: Berlin.CrossRefGoogle Scholar
Fryers, T. (1974). Psychiatric in-patients in 1982 – how many beds? Psychological Medicine 4, 196–211.CrossRefGoogle Scholar
Fryers, T. (1979). Estimation of need on the basis of case register studies: British case register data. In Estimating Needs for Mental Health Care (ed. Häfner, H.), pp. 52–63. Springer: Berlin.CrossRefGoogle Scholar
Godber, C. (1972). Reasons for the increase in admissions. In Evaluating a Community Psychiatric Service: The Camberwell Register, 1964–1971 (ed. Wing, J. K. and Hailey, A. M.), pp. 189–197. Oxford University Press: London.Google Scholar
Häfner, H. (1980). Planung und Aufbau psychiatrischer Abteilungen und gemeinernaher Fachkrankenhäuser seit der Enquête-Ehrebung (30.5.1973). In Psychiatrie fünf Jahre nach der Enquête (ed. Häfner, H. and Picard, W.), pp. 17–21. Rheinland-Verlag: Cologne.Google Scholar
Häfner, H. & Klug, J. (1981). Wissenschaftliche Begleitung der Entwicklung einer gemeindenahen psychiatrischen Versorgung in Mannheim. In Bürgernahe Psychiatrie im Wirkungsberiech des psychiatrischen Krankenhauses (ed. Haase, H. J.), pp. 23–58. Perimed Fachbuch-verlagsgesellschaft: Erlangen.Google Scholar
Hailey, A. M. (1974). The new chronic psychiatric population. British Journal of Preventive and Social Medicine 28, 180–186.Google ScholarPubMed
Kastrup, M. (1980). A nation-wide census of psychiatric out-patients in Denmark. Acta psychiatrica scandinavica 61, 245–255.Google Scholar
Kelleher, M. J. & Benner, C. (1981). Die Lebenssituation der Bewohner in Alteneinrichtungen: ihre Bedürfnisse und ihre Versorgung. In Gerontopsychiatrie. Aktuelle Psychiatrie vol. 3 (ed. Häfner, H. & Heimann, H.), pp. 21–38. Gustav Fischer Verlag: Stuttgart.Google Scholar
Klug, J., an der Heiden, W., Scheel, R. & Kistner, K. H. (1981). Inanspruchnahme psychosozialer Einrichtungen durch schizo-phrene Patienten im Langzeitverlauf. In Forschritte der Biologischen Psychiatrie (ed. Beckmann, H.), pp. 80–85. Huber: Bern.Google Scholar
Krauth, J. & Lienert, G. A. (1973). Die Konfigurationsfrequenzanalyse und ihre Anwendung in Psychologie und Medizin. Karl Alber: Freiburg.Google Scholar
Magnus, R. V. (1967). The new chronics. British Journal of Psychiatry 113, 555–556.Google Scholar
Mann, S. & Cree, W. (1975). The new ‘long-stay’ in mental hospitals. British Journal of Hospital Medicine 9, 55–63.Google Scholar
Martini, H. (1979). Altenheime in Mannheim. Stadt Mannheim, 05 1979.Google Scholar
May, A. R. (1976). Mental Health Services in Europe. A Review of Data Collected in Response to a WHO Questionnaire. WHO: Geneva.Google Scholar
National Institute of Mental Health (1977). Psychiatric Services and the Changing Institutional Science, 1950–1975. DHEW Publication No. (ADM) 77–433, Superintendent of Documents, 20402, US Government Printing Office: Washington, D.C.Google Scholar
Nielsen, J. & Nielsen, J. A. (1977). A census study of mental illness in Samsø. Psychological Medicine 7, 491–503.CrossRefGoogle ScholarPubMed
Nielsen, J. & Nielsen, J. A. (1979). Incidence of first contacts and need of staff and beds in a community psychiatric service. In Estimating Needs for Mental Health Care (ed. Häfner, H.), pp. 125–130. Springer: Berlin.CrossRefGoogle Scholar
Nielsen, J. A., Biørn-Henriksen, T. & Nielsen, J. (1980). Psychiatric illness and use of psychotropic drugs in a geographically delimited population. Acta psychiatrica scandinavica Suppl. 285, 62, 96–102.CrossRefGoogle Scholar
Rey, E.-R., Klug, J. & Welz, R. (1978). The application of Lienert's configuration frequency analysis in psychiatric epidemiology. Social Psychiatry 13, 53–60.CrossRefGoogle Scholar
Strömgren, E. (1980). Who takes care how and where and why? In Epidemiological Research as a Basis for the Organization of Extramural Psychiatry. Acta psychiatrica scandinavica Suppl. 285, 62, 9–14.Google Scholar
Strömgren, E., Kyst, E., Ryberg, I. & Weeke, A. (1979). Estimation of need on the basis of field survey findings. In Estimating Needs for Mental Health Care (ed. Häfner, H.), pp. 37–42. Springer: Berlin.CrossRefGoogle Scholar
Weeke, A. & Strömgren, E. (1978). Fifteen years later. A comparison of patients in Danish psychiatric institutions in 1957, 1962, 1967, and 1972. Acta psychiatrica scandinavica 57, 129–144.Google Scholar
Welz, R. (1979). Selbstmordversuche in städtischen Lebensumwelten. Eine epidemiologische, ökologische und mehrebenenanalytische Untersuchung über Häufigkeit und regionale Verteilung von Selbstmordversuchen in Mannheim. Beltz-Verlag: Weinheim.Google Scholar
Welz, R. (1981). Drogenabhängigkeit in der BRD – Häufigkeit Verbreitung und weitere Entwicklung. In Drogenabhängigkeit und Alkoholismus- Eine Bestandsaufnahme über den Stand der Forschung, Therapie und Rehabilitation (ed. Häfner, H. and Welz, R.). Rheinland-Verlag: Cologne.Google Scholar
Wing, J. K. (1979). Trends in the care of the chronically mentally disabled. In Community Care for the Mentally Disabled (ed. Wing, J. K. and Olsen, R.), pp 1–13. Oxford University Press: Oxford.Google Scholar
Wing, J. K. & Fryers, T. (eds.) (1976). Psychiatric Services in Camberwell and Salford. Statistics from the Camberwell and Salford Psychiatric Registers, 1964–1974. MRC Social Psychiatry Unit: London; and Department of Community Medicine: University of Manchester.Google Scholar
Wing, J. K. & Hailey, A. M. (eds.) (1972). Evaluating a Community Psychiatric Service: The Camberwell Register, 1964–1971. Oxford University Press: London.Google Scholar