Spatial distribution of in-patient service use of psychiatric patients: somatic departments versus psychiatric units.

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It has long been recognized that a high proportion of psychiatric patients are admitted to emergency, medical and surgical wards. However, until now no assessment has been made of which urban general hospitals would be most appropriate for the establishment of specific psychiatric facilities. Our study concerned Germany's second largest city, Hamburg (population 1.7 million), and involved an evaluation of psychiatric principal diagnoses in general and psychiatric hospitals. The research was based on data collected between 1988 and 1994 embracing approximately 77% of all psychiatric patients (n = 64,000) in 41 hospitals. The evaluation was carried out using the statistics programs SPSS and DismapWin. We established that the proportion of male patients discharged from somatic wards, mainly internal medicine, with alcohol and drug abuse as well as with neuroses and personality disorders or illegal drug abuse was surprisingly high (70%, 34% and 24% respectively). For female patients the figures were 67%, 40% and 35% respectively. A geographical analysis of spatial heterogeneity of hospitalization risks showed that general hospitals admit a disproportionately high number of patients from areas of lower social status - both male and female from the above-mentioned diagnostic categories. A rank correlation between the classification of areas based on the heterogeneity model and the social status of the areas supports this hypothesis, at least for males. Our findings lead us to the conclusion that the establishment of new psychiatric services should focus on internal wards in hospitals located in areas of low social status.