Does community psychiatry treat the severely mentally ill in accordance with social and sociopsychologic criteria?

Abstract

This article is the second in an investigation of the reorganisation of a psychiatric service to a community psychiatric service. 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 aim of this study was to investigate whether the new service was capable of finding and treating as many mentally ill and especially as many severely mentally ill patients as the former service diagnosed on the basis of criteria for poor social network, severe social dysfunction, and severe objective burden/subjective distress on relatives. The new community psychiatric service within the catchment area did accept significantly fewer patients with poor social network, patients with the worst possibilities for social functioning, patients who were the most dissatisfied with their social condition, and patients who caused the most severe objective burden/subjective distress on their relatives. Except for patients with a poor social network, they were rather admitted to the mental hospital. The explanation might be a) a shortage of psychiatrists in the new service, which probably was caused by a general shortage of psychiatrists in rural parts of Denmark, transferral of responsibility for psychiatric services from health to social welfare authorities, and complicated rules for delegation of responsibility and b) the possibility of admitting emergency cases outside normal working hours was abolished in the new service.

Key Words:

• Burden on the relatives
• Community psychiatry
• Severely mentally ill
• Social functioning
• Social network