Abstract
Over recent years, the number of compulsory admissions in many countries has increased, probably as a result of the shift from inpatient to outpatient mental health care. This might be mitigated by formal or collaborative relationships between services. In a retrospective record linkage study, we compared two neighboring districts, varying in level of service integration. Two periods were combined: 1991-1993 and 2001-2003. We included patients aged 18-60, who had a first emergency compulsory admission (n=830). Their psychiatric history was assessed, and service-use after admission was monitored over a 12-month follow-up. Over a 10-year period, compulsory admission rates increased by 47%. Difference in relative increase between the integrated and non-integrated services was 14%. Patient characteristics showed different profiles in the two districts. Length of stay was >10 days shorter in the integrated district, where the proportion of involuntary readmissions decreased more, and where aftercare was swift and provided to about 10% more patients than in the non-integrated district. Services outcomes showed better results where mental healthcare was more integrated. However, limited effects were found and other factors than integration of services may be more important in preventing compulsory admissions.
Highlights
IntroductionThe configuration of mental health services in many Western countries has changed fundamentally
Over recent decades, the configuration of mental health services in many Western countries has changed fundamentally
We found no main effect of service integration on changes in case-mix, there were some time and district interaction effects
Summary
The configuration of mental health services in many Western countries has changed fundamentally. Salize and Dressing [8] contradicted suggestions that there was an overall upward trend in the numbers of compulsory admission of mentally ill patients. They suggested that time series of percentages of involuntary admissions on all admissions, show that involuntary quotas in most member states were more or less stable. The number of compulsory admissions in many countries has increased, probably as a result of the shift from inpatient to outpatient mental health care. This might be mitigated by formal or collaborative relationships between services. Limited effects were found and other factors than integration of services may be more important in preventing compulsory admissions
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