Does community psychiatry treat the severely mentally ill in accordance with diagnostic criteria?

Abstract

The reorganisation of a psychiatric service to a community psychiatric service was investigated. Before and after the reorganisation there was a local service situated within the catchment area which changed to community psychiatry and in which the number of staff was increased substantially. A central service at a mental hospital situated about 100 km outside the area remained unchanged. The responsibility for the psychiatric services was transferred from the health authorities to the social welfare authorities. The aim of the study was to investigate whether the new service was able to find and treat as many mentally ill, and especially as many severely mentally ill, in accordance with diagnostic criteria, as the former service. A cross-sectional study showed significant increases of 63.6% in the total number of patients in treatment and of 105.8% in psychotic patients in the local service within the area. An insignificant decrease of 33.3% occurred at the mental hospital. In the service within the area the total number of patients accepted for treatment decreased significantly by 23.9% per year. There were no changes in the number of psychotic patients. The total number of patients at the mental hospital decreased insignificantly by 26%. An interview study by means of the Present State Examination showed a significant decrease in the number of affective disorders by 31.3% in the service within the area, whereas the number of admissions increased by 202.4% at the mental hospital for affective disorders. Changes were insignificant in other diagnostic categories. The conclusion is dependent on the method adopted; the reason for this is discussed in the article.

Key Words:

• Community psychiatry
• Diagnosis
• ICD-8
• ICD-10
• Severely mentally ill