Utilization Of Psychiatric Services Research Articles

Monitoring service utilization of persons with mental disorders – a case for mapping pathways of care

Routinely collected and reported indicators for health service utilization have traditionally been event/episode related and hospital centered. This is also the case for service utilization by persons with mental disorders, for whom national and international databases usually report rates of hospital discharges, mean length of stay for hospital episode and the like. Such event/episode-related indicators are of limited use for planning and improving services for persons with mental disorders. It is argued that new reporting systems are needed that allow the monitoring of the pathways of persons with mental disorders through the service system. It is shown how--owing to recent developments in techniques of 'pseudonymization' and the ever-increasing computer power for dealing with large volumes of patient data--such a system can be established and how it can contribute to analyzing empirically such mental health-care issues as 'heavy utilizers', 'revolving door psychiatry', 'continuity of care', 'de-institutionalization' and the like. Results of a record linkage study for the total population of a federal state of Austria monitoring both psychiatric and non-psychiatric health service utilization are reported. Some unexpected findings include the high utilization of non-psychiatric services by patients discharged from a psychiatric hospital bed, results which could not have been found by psychiatric case registers which usually only monitor utilization of psychiatric services.

Psychiatric disorders and health service utilization in unemployed youth

Youth unemployment is associated with increased levels of anxiety, depression, alcohol abuse, reduced self-esteem and satisfaction with life. Up to date data based on standardized psychiatric diagnostic assessments in adolescent or young adult unemployment is very scarce. To our knowledge, this study has, for the first time, assessed both Axis-I (non-personality) and Axis-II (personality) psychiatric disorders and related constructs in a preselected sample of unemployed individuals. Subjects were aged 16–24 and lived in the large urban region of Essen, Germany. They were referred by case managers of the vocational services centre to the on-site psychiatric out-patient unit. SCID-I and II were administered to assess DSM-IV diagnoses. Symptom Checklist 90 R, Beck Depression Inventory and Client Sociodemographic Service Receipt Inventory were used to measure severity of psychopathology and health service utilization. In all, 98% of the unemployed young adults suffered from mental disorders. Mood and anxiety disorders were the most common Axis-I disorders (47.9 and 33.4%). Altogether, 58.2% of probands met diagnostic criteria for a personality disorder; a borderline personality disorder accounted for one half of these disorders. Despite a 49% rate of Axis-I and II comorbidity and severe psychopathology, the majority of subjects were untreated and mental health service utilization in general was low. The diagnosis of a personality disorder was related to a 2.7-fold risk of dropping out of job reintegration programmes. Unemployed young adults referred for a psychiatric assessment have a high rate of both Axis-I and II disorders, which need to be considered upon planning individual-based vocational rehabilitation programs.

Medicaid medication access problems and increased psychiatric hospital and emergency care

Objectives To quantify the extent to which Medicaid programs may incur increased psychiatric emergency department and hospital use associated with clinically unintended medication discontinuations, gaps, switches and other access problems attributed to prescription drug coverage and management. Method This study uses clinically detailed, physician-reported data. A total of 4866 psychiatrists in 10 states were randomly selected from the AMA Masterfile; 62% responded and 32% treated Medicaid patients and reported on 1625 systematically selected Medicaid patients. Propensity score multivariate models assessed predicted probabilities and mean number of emergency department visits and hospital days. Results Many patients (46.0%, S.E.=1.3%) had medication access problems reported during the past year, including discontinuing or switching medications or inability to obtain clinically indicated prescriptions because of drug coverage or management. The expected number of emergency department visits was estimated to be 73.8% higher among patients with medication access problems reported compared to matched patients without access problems reported. Among acute stay inpatients, the expected number of hospital days was 71.7% higher for patients with medication access problems reported. Conclusions Medication access problems may have significant implications for Medicaid programs. The potential indirect costs of these policies in psychiatric and social services utilization should be considered in addition to direct pharmacy costs.

Service utilization in a tertiary psychiatric care setting in South India

Objective To carry out an audit reviewing the utilization of psychiatric services and types of disorders presenting to a tertiary care psychiatry hospital in a developing Asian country. Method Consecutive adult patients who came for detailed consultation in 1 year were included in this study. A senior consultant psychiatrist reconfirmed the diagnosis in each patient who underwent detailed psychiatric evaluation. Psychiatric evaluation consists of clinical history from the patients and the relatives and a mental state examination. Data was obtained from the detailed work up evaluation psychiatry records of these patients. Results Mood disorder was the most common diagnosis followed by substance use disorders and psychotic disorders (ICD 10). There is a substantial delay of more than 2–5 years for seeking treatment in most disorders including schizophrenia. More than 80% of the population directly seeks treatment at this tertiary hospital. Sixty-four percent of the patients came for at least one follow up. Conclusion The result suggests the urgent need for strengthening community care in India and similar low and middle-income countries for early and optimal treatment.

Patienten mit Migrationshintergrund in Psychiatrischen Institutsambulanzen – ein Vergleich zwischen Patienten mit türkischer und osteuropäischer Herkunft sowie Patienten ohne Migrationshintergrund

Nationwide representative survey of the use of psychiatric outpatient services in Germany. Every fifth patient of several psychiatric outpatient services was surveyed on one index day (27 (th) of May 2008) with respect to sociodemographic characteristics, ICD-10 diagnoses, difficulties in communication, treatment duration, and number of sickness certificates. Patients with immigrant background comprised 32.5 % of all patients. Compared to German patients, patients with immigrant background received significantly more neurotic, stress-related and somatoform disorders (F4). Turkish patients received significantly more mood (affective) disorders diagnoses (F3), compared to German and Eastern Europe patients. Immigrants had shorter treatment duration and a higher number of sickness certificates. Eastern European patients had a significantly higher education, compared to patients with Turkish background. Patients with immigrant background were younger compared to German patients and had significantly more children. The utilization of outpatient psychiatric services by patients with a migratory background is high. This suggests that immigrants benefit from the multiprofessional team and the low-treshold service offered by outpatient units.

Suicide with psychiatric diagnosis and without utilization of psychiatric service

BackgroundConsiderable attention has been focused on the study of suicides among those who have received help from healthcare providers. However, little is known about the profiles of suicide deceased who had psychiatric illnesses but made no contact with psychiatric services prior to their death. Behavioural model of health service use is applied to identify factors associated with the utilization of psychiatric service among the suicide deceased.MethodsWith respect to completed suicide cases, who were diagnosed with a mental disorder, a comparison study was made between those who had (contact group; n = 52; 43.7%) and those who had not made any contact (non-contact group; n = 67; 56.3%) with a psychiatrist during the final six months prior to death. A sample of 119 deceased cases aged between 15 and 59 with at least one psychiatric diagnosis assessed by the Structured Clinical Interview for DSM-IV-TR (SCID I) were selected from a psychological autopsy study in Hong Kong.ResultsThe contact and non-contact group could be well distinguished from each other by "predisposing" variables: age group & gender, and most of the "enabling", and "need" variables tested in this study. Multiple logistic regression analysis has found four factors are statistically significantly associated with non-contact suicide deceased: (i) having non-psychotic disorders (OR = 13.5, 95% CI:2.9-62.9), (ii) unmanageable debts (OR = 10.5, CI:2.4-45.3), (iii) being full/partially/self employed at the time of death (OR = 10.0, CI:1.6-64.1) and (iv) having higher levels of social problem-solving ability (SPSI) (OR = 2.0, CI:1.1-3.6).ConclusionThe non-contact group was clearly different from the contact group and actually comprised a larger proportion of the suicide population that they could hardly be reached by usual individual-based suicide prevention efforts. For this reason, both universal and strategic suicide prevention measures need to be developed specifically in non-medical settings to reach out to this non-contact group in order to achieve better suicide prevention results.

Utilization of Psychiatric Services by Female Military Personnel Changes Since Admission of Women to All German Armed Forces Military Careers

In 2001, women were admitted to all military careers in the German Armed Forces. This study examines whether the utilization of psychiatric services of female military personnel has changed since then. The central medical database of German military personnel for the years 2000 and 2006 was analyzed. Between 2000 and 2006, the percentage (based on the average totals of male and female military personnel) of consultations of primary care unit surgeons for psychiatric problems increased significantly for both male and female military personnel, this increase being more apparent for women than for men. Stress-related disorders showed the greatest rise. In 2006, as opposed to 2000, the total proportion of both outpatient and inpatient mental health treatment provided to female military personnel was significantly higher than for males, particularly regarding stress-related, affective and personality disorders. Gender-specific aspects should be considered more intensely in preventive and therapeutic psychiatric supply in the German Armed Forces.

How are caseload and service utilisation of psychiatric services influenced by distance? A geographical approach to the study of community-based mental health services

The aim of this study was to assess how the caseload and the utilisation of community-based mental health services is influenced by distance and to socioeconomic characteristics. Spatial and statistical analyses were conducted with a sample of 12,347 patients, with ICD-10 psychiatric diagnosis, who had at least one contact with psychiatric services in Verona, Italy, between 2000 and 2006. Three types of mental health facility were considered: acute inpatient wards, outpatient clinics, and community mental health centres (CMHC). To measure distance and accessibility, the locations of static mental health facilities and patients' homes were geocoded. Data were organised in a spatial database, which included census blocks, catchment areas locations, road network graphs, patients' and facilities' locations. In order to calculate travel distances, patients' and facilities' locations were connected to the road network. Accessibility was modelled by using the Network Analyst Service Area Function and 13 Service Areas were created around all facility locations, by measuring distances along the street network. For the epidemiological analyses, patients and census block centroids were linked to the service areas by using spatial join techniques. Epidemiological and utilisation analyses were performed for each type of setting. The facilities were not equally located in the catchment areas. Of particular significance, rural areas appear to be poorly served by mental health services. The distance decay effect exists, with different trends for the three types of facility. The caseload (number of patients using services) decreased with increasing distance; at a distance of 10km, there was a decrease of 80, 60 and 85%, respectively, for CMHCs, inpatients wards and outpatients clinics. From the Poisson regression models, distance was significantly correlated (p value<0.0001) with service use. Also univariate analyses showed a statistically significant association between distance and caseload for each type of setting (p value<0.05), with a decrease in service use for each service area increase in distance (1.5% for acute inpatient wards, 2.0% for CMHC, and 2.1% outpatient clinics). By adding other predictors in the Poisson regression models, these percentages increased. Further studies are needed to evaluate the influence of other factors, such as environmental variables, that may influence the use of mental health services.

Outcomes of Integrated Assertive Community Treatment for Homeless Consumers With Co-occurring Disorders

The objective of this research was to evaluate the impact of Integrated Assertive Community Treatment (I-ACT) on psychiatric symptoms, drug use, housing status, and service utilization. A single-group repeated measures evaluation of outcome indicators at intake, 6 months, and 12 months examined changes over time with 555 respondents receiving outpatient treatment. While 555 received baseline interviews, figures vary on follow-up sample sizes and are listed as they are discussed in the paper. The study was implemented by a community treatment provider. The primary analyses used in this study were repeated measures ANOVA and the Friedman's two-way analysis test. Significant reductions in substance use (F(1.69, 553.02) = 94.30, p < .01) and psychiatric symptoms (F(1.98, 299.19) = 43.73, p = .0001) were found from baseline to 6 months and changes were sustained from the 6- to 12-month follow-up points. Similar results were found in housing status with the number of participants in stable housing rising significantly. Utilization of substance use and psychiatric treatment declined significantly across all three follow-up points, and physical health service use remained unchanged. I-ACT has demonstrated efficacy through controlled research studies, and this evaluation extends on these findings to demonstrate that I-ACT is effective in community service provision settings in reducing substance use and psychiatric symptoms. Further, the reduction in service use found across follow-up points indicates cost containment.

Entlassungsplanung bei Menschen mit hoher Inanspruchnahme psychiatrischer Versorgung in einer randomisierten kontrollierten Multizenterstudie

A simple, systematic and targeted manualised intervention was developed and applied in the German multicentre randomised controlled trial "Effectiveness and Cost-Effectiveness of Needs-Oriented Discharge Planning and Monitoring for High Utilisers of Psychiatric Services" (NODPAM). Rational of the intervention is outlined. Similarities and differences in comparison with other approaches (Care Programme Approach, "Integrierter Behandlungs- und Rehabilitations plan", Critical Time Intervention) are delineated. The intervention consists of two sessions led by an intervention worker with patient, keyworkers (at inpatient and outpatient services), and - optionally - carer(s) participating. During each intervention session needs identified by the patient are discussed, a treatment plan is developed and subsequently circulated to all participants. Strengths (high structure, simplicity, compatibility with routine care) and disadvantages (e. g. shortness, insufficient dispersion of time, lack of integration with clinical process) of the intervention are discussed.

The cost of relapse and the predictors of relapse in the treatment of schizophrenia

BackgroundTo assess the direct cost of relapse and the predictors of relapse during the treatment of patients with schizophrenia in the United States.MethodsData were drawn from a prospective, observational, noninterventional study of schizophrenia in the United States (US-SCAP) conducted between 7/1997 and 9/2003. Patients with and without relapse in the prior 6 months were compared on total direct mental health costs and cost components in the following year using propensity score matching method. Baseline predictors of subsequent relapse were also assessed.ResultsOf 1,557 participants with eligible data, 310 (20%) relapsed during the 6 months prior to the 1-year study period. Costs for patients with prior relapse were about 3 times the costs for patients without prior relapse. Relapse was associated with higher costs for inpatient services as well as for outpatient services and medication. Patients with prior relapse were younger and had onset of illness at earlier ages, poorer medication adherence, more severe symptoms, a higher prevalence of substance use disorder, and worse functional status. Inpatient costs for patients with a relapse during both the prior 6 months and the follow-up year were 5 times the costs for patients with relapse during the follow-up year only. Prior relapse was a robust predictor of subsequent relapse, above and beyond information about patients' functioning and symptom levels.ConclusionsDespite the historical decline in utilization of psychiatric inpatient services, relapse remains an important predictor of subsequent relapse and treatment costs for persons with schizophrenia.

Investigation of racial and ethnic disparities in service utilization among homeless adults with severe mental illnesses.

This study examined whether there are service disparities among homeless adults with severe mental illnesses, a vulnerable population with a high level of unmet need. Data were collected at baseline for 6,829 black, Latino, and non-Latino white participants in the Access to Community Care and Effective Services and Support study. Outcome variables were measures of utilization of psychiatric outpatient, housing, and case management services in the previous 60 days. The sample was divided into white-black and white-Latino cohorts. Within each cohort, participants were stratified into comparable groups by propensity scores that estimated log-odds of being black or Latino as a function of several confounding variables. White-black and white-Latino differences in mean number of visits (a measure of intensity) and in the mean probability of at least one visit (a measure of access) were subsequently estimated for each of the three services. The composition of the sample was 50% black, 6% Latino, and 44% white. Service utilization was low for the three services regardless of race-ethnicity. On multivariate analyses of service utilization in the previous 60 days, blacks made fewer psychiatric outpatient visits than whites (mean difference=.46, 95% confidence interval [CI]=.10 to .81]), yet Latinos had more case management visits than whites (mean difference=-.51, CI=-1.03 to -.05]). Analyses of access did not reveal racial-ethnic disparities. Whereas blacks used psychiatric outpatient services less frequently than whites, hence experiencing a service disparity, Latinos used case management services more than whites did. Possible contributors and clinical and methodological implications of these results are discussed.

Investigation of Racial and Ethnic Disparities in Service Utilization Among Homeless Adults With Severe Mental Illnesses

This study examined whether there are service disparities among homeless adults with severe mental illnesses, a vulnerable population with a high level of unmet need. Data were collected at baseline for 6,829 black, Latino, and non-Latino white participants in the Access to Community Care and Effective Services and Support study. Outcome variables were measures of utilization of psychiatric outpatient, housing, and case management services in the previous 60 days. The sample was divided into white-black and white-Latino cohorts. Within each cohort, participants were stratified into comparable groups by propensity scores that estimated log-odds of being black or Latino as a function of several confounding variables. White-black and white-Latino differences in mean number of visits (a measure of intensity) and in the mean probability of at least one visit (a measure of access) were subsequently estimated for each of the three services. The composition of the sample was 50% black, 6% Latino, and 44% white. Service utilization was low for the three services regardless of race-ethnicity. On multivariate analyses of service utilization in the previous 60 days, blacks made fewer psychiatric outpatient visits than whites (mean difference=.46, 95% confidence interval [CI]=.10 to .81]), yet Latinos had more case management visits than whites (mean difference=-.51, CI=-1.03 to -.05]). Analyses of access did not reveal racial-ethnic disparities. Whereas blacks used psychiatric outpatient services less frequently than whites, hence experiencing a service disparity, Latinos used case management services more than whites did. Possible contributors and clinical and methodological implications of these results are discussed.

Population-Attributable Risk of Suicide Conferred by Axis I Psychiatric Diagnoses in a Hong Kong Chinese Population

Population-Attributable Risk of Suicide Conferred by Axis I Psychiatric Diagnoses in a Hong Kong Chinese Population

Population-Attributable Risk of Suicide Conferred by Axis I Psychiatric Diagnoses in a Hong Kong Chinese Population

This study was conducted to determine the population-attributable risk (PAR) of completed suicide among Hong Kong Chinese with axis I psychiatric diagnoses. With a case-control psychological autopsy method, 150 suicide decedents aged 15-59 were compared for axis I psychiatric diagnoses and psychosocial variables with 150 randomly selected age- and gender-matched persons living in the community. In the presence of other, non-disease-related social risk factors (unemployment and unmanageable debt), past suicide attempt independently accounted for 44% of the PAR of suicide, followed by current major depressive disorder (27%), schizophrenia spectrum disorders (22%), and substance use disorder or pathological gambling (16%). Other diagnoses (such as anxiety and phobic disorders, dysthymia, adjustment disorders, and past major depressive episode) accounted for 24% of PAR. Psychiatric morbidity remains the major risk factor for suicide in Hong Kong despite well-developed psychiatric services. Mental health policy should be refined to target clinical groups at high risk of suicide.

Ambulante Versorgung kinder- und jugendpsychiatrischer Störungen - Daten einer versichertenbezogenen epidemologischen Studie

The aim of the study was to examine the extent to which psychiatric disorders are documented as a diagnosis requiring treatment in children and adolescents as well as to investigate the frequency with which non-medicinal interventions are utilized. The database comprised an 18.75% random sample of insurees from the AOK statutory health insurance fund Hessen. The data allowed an examination of the care-seeking behaviour of 55,545 children and adolescents aged 0 to 18 years in the year 2006. With respect to all psychiatric diagnostic categories, a psychiatric diagnosis was documented for 19.3% of children and adolescents in 2006. 27% of children and adolescents had received more than one psychiatric diagnosis. Up to the age of 14 years, psychiatric diagnoses were more frequently documented for boys than for girls, while this pattern was reversed from the age of 15 years upwards. Typical differences in the spectrum of services received were evident depending on the psychiatric diagnosis made. Younger age groups predominantly received logopedic treatment, occupational therapy, and physiotherapy/therapeutic exercise. With increasing age, the utilization of psychiatric and psychotherapeutic services expanded. Outpatient care is primarily provided by pediatricians and general physicians followed by practice-based child and adolescent psychiatrists as well as outpatient child and adolescent psychiatric clinics. While not all diagnoses necessitate psychiatric or psychotherapeutic interventions, it may be assumed that the predominant seeking of care from pediatricians and general physicians is reflective of continued inadequate access to child and adolescent psychiatrists or other specialized facilities and professional groups.

Datapoints: Rates and Patterns of Treatment Seeking by Individuals With Mood and Anxiety Disorders

Back to table of contents Previous article Next article ColumnFull AccessDatapoints: Rates and Patterns of Treatment Seeking by Individuals With Mood and Anxiety DisordersPeter Giacobbe M.D., F.R.C.P.C.Roger S. McIntyre M.D., F.R.C.P.C.Benjamin I. Goldstein M.D., Ph.D.Sidney H. Kennedy M.D., F.R.C.P.C.Alastair J. Flint M.D., F.R.C.P.C.Peter Giacobbe M.D., F.R.C.P.C.Search for more papers by this authorRoger S. McIntyre M.D., F.R.C.P.C.Search for more papers by this authorBenjamin I. Goldstein M.D., Ph.D.Search for more papers by this authorSidney H. Kennedy M.D., F.R.C.P.C.Search for more papers by this authorAlastair J. Flint M.D., F.R.C.P.C.Search for more papers by this authorPublished Online:13 Jan 2015AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail Although epidemiological studies have suggested that only a minority of people with a diagnosable mental illness utilize mental health treatments ( 1 ), the type and venue of treatment received by individuals with a mood or anxiety disorder have received little investigation. The goal of this study was to compare the rates of use of medical services among community-dwelling individuals who met criteria for a lifetime diagnosis of social phobia, generalized anxiety disorder, panic disorder with or without agoraphobia, major depressive disorder, and bipolar disorder type I. Specifically, we evaluated rates of contact with a therapist or physician, medication usage for a diagnosed mood or anxiety disorder, and use of emergency services. Data on lifetime psychiatric diagnoses and health service utilization were derived from the 2001–2002 National Epidemiologic Survey on Alcohol and Related Conditions, an epidemiological survey of 43,093 community-dwelling Americans age 18 and older conducted by the National Institute on Alcohol Abuse and Alcoholism (NIAAA). The NIAAA Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV Edition (AUDADIS-IV) was used to generate psychiatric diagnoses. Individuals who met criteria for a lifetime psychiatric diagnosis based on AUDADIS-IV were then asked whether they ever went to a counselor, therapist, or physician; went to the emergency room; and were prescribed medications for the diagnosis in question. Most people in the community with a lifetime diagnosis of a mood or anxiety disorder did not receive treatment from a physician, therapist, or counselor ( Figure 1 ). Although slightly more than half of those who met criteria for major depressive disorder saw a professional for their mood disorder, only a third of those with bipolar disorder type I received treatment. As a group, lower rates of treatment were reported by individuals with anxiety disorders, compared with those with mood disorders. Of individuals who were seen by a health professional, most reported receiving medication at some point for their condition. A significant minority (22%) of individuals with panic disorder reported seeking emergency services for their condition, double the rate of those with a mood disorder. Figure 1 Lifetime health service use for mood and anxiety disordersIn an era of multiple evidence-based psychological and pharmacological treatments for mood and anxiety disorders, most individuals do not receive treatment, with higher rates of nontreatment for anxiety disorders and bipolar disorder type I, compared with major depressive disorder.Acknowledgments and disclosuresThe authors report no competing interests.All the authors except for Dr. Goldstein are affiliated with the Department of Psychiatry, University of Toronto. Dr. Goldstein is with the Department of Psychiatry, University of Pittsburgh. Send correspondence to Dr. Giacobbe at the Department of Psychiatry, Toronto General Hospital, 200 Elizabeth St., Toronto, Ontario, Canada M5G 2C4 (e-mail: [email protected]). Amy M. Kilbourne, Ph.D., M.P.H., and Tami L. Mark, Ph.D., are editors of this column.Reference1. Wang PS, Lane M, Olfson M, et al: Twelve-month use of mental health services in the United States: results from the National Comorbidity Survey Replication. Archives of General Psychiatry 62:629–640, 2005Google Scholar FiguresReferencesCited byDetailsCited ByDiagnosis and Management of Anxiety DisordersCONTINUUM: Lifelong Learning in Neurology, Vol. 24, No. 3 Volume 59Issue 10 October, 2008Pages 1099-1099PSYCHIATRIC SERVICES October 2008 Volume 59 Number 10 Metrics PDF download History Published online 13 January 2015 Published in print 1 October 2008

Datapoints: Rates and Patterns of Treatment Seeking by Individuals With Mood and Anxiety Disorders

1099 A epidemiological studies have suggested that only a minority of people with a diagnosable mental illness utilize mental health treatments (1), the type and venue of treatment received by individuals with a mood or anxiety disorder have received little investigation. The goal of this study was to compare the rates of use of medical services among community-dwelling individuals who met criteria for a lifetime diagnosis of social phobia, generalized anxiety disorder, panic disorder with or without agoraphobia, major depressive disorder, and bipolar disorder type I. Specifically, we evaluated rates of contact with a therapist or physician, medication usage for a diagnosed mood or anxiety disorder, and use of emergency services. Data on lifetime psychiatric diagnoses and health service utilization were derived from the 2001–2002 National Epidemiologic Survey on Alcohol and Related Conditions, an epidemiological survey of 43,093 community-dwelling Americans age 18 and older conducted by the National Institute on Alcohol Abuse and Alcoholism (NIAAA). The NIAAA Alcohol Use Disorder and Associated Disabilities Interview Schedule–DSM-IV Edition (AUDADIS-IV) was used to generate psychiatric diagnoses. Individuals who met criteria for a lifetime psychiatric diagnosis based on AUDADIS-IV were then asked whether they ever went to a counselor, therapist, or physician; went to the emergency room; and were prescribed medications for the diagnosis in question. Most people in the community with a lifetime diagnosis of a mood or anxiety disorder did not receive treatment from a physician, therapist, or counselor (Figure 1). Although slightly more than half of those who met criteria for major depressive disorder saw a professional for their mood disorder, only a third of those with bipolar disorder type I received treatment. As a group, lower rates of treatment were reported by individuals with anxiety disorders, compared with those with mood disorders. Of individuals who were seen by a health Rates and Patterns of Treatment Seeking by Individuals With Mood and Anxiety Disorders

Needs-oriented discharge planning and monitoring for high utilisers of psychiatric services (NODPAM): Design and methods

BackgroundAttempts to reduce high utilisation of psychiatric inpatient care by targeting the critical time of hospital discharge have been rare.MethodsThis paper presents design and methods of the study "Effectiveness and Cost-Effectiveness of Needs-Oriented Discharge Planning and Monitoring for High Utilisers of Psychiatric Services" (NODPAM), a multicentre RCT conducted in five psychiatric hospitals in Germany. Inclusion criteria are receipt of inpatient psychiatric care, adult age, diagnosis of schizophrenia or affective disorder, defined high utilisation of psychiatric care during two years prior to the current admission, and given informed consent. Consecutive recruitment started in April 2006. Since then, during a period of 18 months, comprehensive outcome data of 490 participants is being collected at baseline and during three follow-up measurement points.The manualised intervention applies principles of needs-led care and focuses on the inpatient-outpatient transition. A trained intervention worker provides two intervention sessions: (a) Discharge planning: Just before discharge with the patient and responsible clinician at the inpatient service; (b) Monitoring: Three months after discharge with the patient and outpatient clinician. A written treatment plan is signed by all participants after each session.Primary endpoints are whether participants in the intervention group will show fewer hospital days and readmissions to hospital. Secondary endpoints are better compliance with aftercare, better clinical outcome and quality of life, as well as cost-effectiveness and cost-utility.DiscussionIf a needs-oriented discharge planning and monitoring proves to be successful in this RCT, a tool will be at hand to improve patient outcome and reduce costs via harmonising fragmented mental health service provision.Trial RegistrationISRCTN59603527

Worsening of Symptoms Prevented by Early Detection

Worsening of Symptoms Prevented by Early Detection