Does primary care mental health resourcing affect the use and costs of secondary psychiatric services?

Minna Sadeniemi,Taina Ala-Nikkola,Kristian Wahlbeck,Raija Kontio,Maili Malin,Sami Pirkola,Maiju Pankakoski,Grigori Joffe

doi:10.3390/ijerph110908743

Minna Sadeniemi, Taina Ala-Nikkola + Show 6 more

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https://doi.org/10.3390/ijerph110908743

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Collaborative care models for treatment of depression and anxiety disorders in primary care have been shown to be effective. The aim of this study was to investigate at the municipal level to what extent investment in mental health personnel at primary care health centres in the study area is reflected in the costs and use of secondary psychiatric services. Furthermore, we analysed whether the service provision and use of secondary psychiatric care correlates with the socioeconomic indicators of need. We found significant variation in the amount of mental health personnel provided at the health centres, uncorrelated with the indicators of need nor with the costs of secondary psychiatric care. The amount of mental health nurses at the health centres correlated inversely with the number of secondary psychiatric outpatient visits, whereas its relation to inpatient days and admission was positive. The costs of secondary psychiatric care correlated with level of psychiatric morbidity and socioeconomic indicators of need. The results suggest that when aiming at equal access of care and cost-efficiency, the primary and secondary care should be organized and planned with integrative collaboration.

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Mental health services have been transformed from hospital-centred to a balanced model of integrated community-based services supported by psychiatric hospital care in most developed countries [1].Since 1970, the number of psychiatric hospital beds in Finland has decreased by 80% [2]
The aim of this study was to: (1) investigate the association of the amount of mental health personnel provided at health centres with the use and costs of secondary psychiatric services in the study area and (2) investigate whether the investment in psychosocial resources at primary care level, and the use and costs of secondary psychiatric care reflect the needs of the population as measured by socioeconomic indicators
We looked at the total amount of personnel, the mental health nurses were the most relevant and prevalent occupational group

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Introduction

Mental health services have been transformed from hospital-centred to a balanced model of integrated community-based services supported by psychiatric hospital care in most developed countries [1]. Since 1970, the number of psychiatric hospital beds in Finland has decreased by 80% [2]. Deinstitutionalization has not resulted in poorer outcomes [4], on the contrary, well developed community mental health services are associated with lower suicide rates than services oriented towards inpatient treatment provision [5,6]. Most of the patients with anxiety, mood and substance use disorders are diagnosed and treated in primary care [8,9]. In an earlier Finnish study, specialized mental health services accounted for two-thirds of the services that were used by people suffering from major depression and anxiety disorders [7]

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