Transferring psychiatric specialist services to local authorities—Characteristics of the patients involved

Abstract

Background: To obtain more co-ordinated services, better co-operation between the services and more efficient use of resources, a pilot project for transferring some district psychiatric centres (DPCs) to large municipalities is planned by the Norwegian government. Systematic knowledge about the patients involved is needed when clinical needs and standards, funding, and political agendas are discussed. This study identifies the clinical, socio-demographic, and behavioural characteristics of patients who need services from both the municipality and the DPC.

Method: A national mapping of patients in specialist mental health services was conducted in 2012/2013, including 65% of all inpatients (n = 2358) and 60% of all outpatients (n = 23 124). The need for services was assessed by each patient’s clinician.

Results: It was found that 74% of inpatients and 43% of outpatients needed one or more services from the municipality, usually involving housing, mental health treatment/therapy, or economic support according to their clinicians. These were typically patients with severe mental illness, young inpatients, older outpatients and persons with low education and weak social networks. Only small differences in the need for municipal services were found between patients in hospitals and DPCs.

Conclusions: Many of the patients in specialist mental health services, especially the inpatients, needed services from municipal social and health services. Because these patients had the most severe mental illnesses and were the most socially deprived, a stronger integration of service levels would potentially benefit these patients most. The pilot project should be evaluated to identify the consequences for patients, staff, quality of services, and costs of transferring services to a lower system level.

Keywords:

• Mental health services
• needs
• patient characteristics
• service levels

Acknowledgements

We are grateful to the Norwegian Directorate of Health for funding the mapping. We also thank the national reference group of clinicians (Ulrica Grannas Bore, Tone Tveit, Egil Jonsbu, Anne Karin Steffensen, Ola Marstein, Anne Solberg, Solfrid Lilleeng, and one patient representative) for participating in the development of the mapping forms and in the discussion of the main results. We also thank Torleif Ruud, who was responsible for the quality assurance of the reports from the project.

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.