Admission and prevalence rates for psychiatric facilites in four register areas.

Abstract

A PSYCHIATRIC case register is a relatively new tool for obtaining more precise information on the number and characteristics of residents of a geographic area who receive care in a defined set of inpatient and outpatient psychiatric facilities. Linkage of reports for persons who receive more than one episode of service yields unduplicated patient counts for psychiatric admission and prevalence rates, and longitudinal psychiatric data. A limitation of the psychiatric register is that it includes only those mentally ill persons who receive psychiatric services. The latter is affected by a number of selective factors such as availability of facilities, cultural attitudes toward mental illness, and receptivity to psychiatric services. Our objective in this first cooperative psychiatric register research is to review the use of psychiatric services in four register areas the states of Maryland and Hawaii and the communities of Monroe County, New York, and a tricounty area (Durham, Orange, and Wake Counties) in North Carolina. We hope to find the baseline similarities and differences in services before the advent of the new community mental health programs. For example, is the general magnitude of the rates similar? Are there common service patterns by urban-rural and other demographic subgroups? Can differences be explained by variation in the availability of facilities, programs or policies, or urbanization? What clues are there to further research with respect to population needs? The four register areas differ markedly in ethnic and urban composition (Table 1), psychiatric and other resources (Table 2), and reporting facilities. Therefore data were examined by central city versus other areas, by age, sex, and race, and by class of psychiatric facility or combinations of classes. Total rates will be presented first for one day prevalence, one year admissions and one year prevalence, followed by comparisons of rates by demographic variables and by diagnostic classification. Some methodological problems were: (1) nonreporting facilities (estimates were made for these in total rates) ; (2) availability of only one day prevalence data for Tricounty, North Carolina, register, due to its recent establishment (July 1, 1964); (3) lack of separate