Decentralizing psychiatry in a rural area: Changes in patterns of care

Abstract

Decentralizing psychiatric care in the county of Nordland (Norway) between 1982 and 1990 has led to a mental health structure consisting of a markedly reduced mental hospital and 15 outpatient units—7 for children and 8 for adults. The establishment of outpatient units marks a phase between centralized psychiatry consisting of, mainly, one psychiatric hospital and a structure built on psychiatric centres incorporating these outpatient units. The number of beds for psychiatric patients in Nordland is now about 60% of the national average. The article describes changes in the use of inpatient and outpatient facilities in a period characterized by dehospitalization and the extended use of outpatient treatment. The results show a marked increase in the total number of patients entering the system, an increasing number of patients admitted to inpatient treatment, and a net recruitment of new inpatients. The number of long-stay patients is reduced, and there has been no accumulation of “new long-stay patients”. Marked regional differences in use of both inpatient and outpatient services exist which are difficult to explain on a demographic basis, and there is a preponderance of women (girls) entering all parts of the system. The article points to problems in the administrative structures covering the different mental health organizations in the county, such as absence of a common frame of reference stating objectives, priorities, and strategies for documenting activities and for evaluations. Q Decentralized psychiatry. Community psychiatry, Dehospitalisation.