scholarly journals Organization of Community Psychiatric Services in Finland

10.17816/cp64 ◽  
2021 ◽  
Vol 2 (1) ◽  
pp. 55-64
Author(s):  
Jyrki Korkeila
Keyword(s):  
Psychiatric Treatment ◽  
Psychiatric Patients ◽  
Economic Recession ◽  
Psychiatric Services ◽  
Severe Mental Disorders ◽  
Community Based ◽  
Institutional Settings ◽  
Primary Organization ◽  
Methods Of Treatment ◽  
Rapid Transformation

Background. The Finnish psychiatric treatment system has undergone a rapid transformation from operating in institutional settings to a adopting a community-based approach, through implementation of national plans; this process was carried out quickly, due to a severe economic recession in the early 1990s. Methods. This paper is a narrative review, based on relevant documents by national authorities, academic dissertations and published scientific literature, between 1984 and 2018, as well as the interviews of key experts in 2019. Results. The municipality is currently the primary organization, responsible for all health services. Municipalities may also work together in organizing the services, either through unions of municipalities or hospital districts. Services are to a great extent outpatient-oriented. The number of beds is one fifth of the previous number, around four decades ago, despite the increase in population. In 2017, 191,895 patients in total (4% of Finns) had used outpatient psychiatric services, and the number of visits totalled 2.25 million. Psychotherapy is mainly carried out in the private sector by licensed psychotherapists. Homelessness in relation to discharged psychiatric patients has not been in evidence in Finland and deinstitutionalization has not caused an increase in the mortality rate among individuals with severe mental disorders. Conclusion. Psychiatric patients have, in general, benefitted greatly from the shift from institutions to the community. This does not preclude the fact that there are also shortcomings. The development of community care has, to date, focused too heavily on resource allocation, at the expense of strategic planning, and too little on methods of treatment.

scholarly journals Psychiatric Services in Saskatchewan under Medicare*

1970 ◽  
Vol 15 (1) ◽  
pp. 63-72 ◽  
Author(s):  
Wilfred A. Cassell ◽  
Colin M. Smith ◽  
Maggie Grandy Rankin
Keyword(s):  
Private Practice ◽  
Urban Areas ◽  
Psychiatric Care ◽  
Psychiatric Treatment ◽  
Psychiatric Patients ◽  
Treatment Session ◽  
Psychiatric Services ◽  
Treatment Services ◽  
Hospital Visits ◽  
To Receive

This study has examined the nature and extent of services provided to psychiatric patients under ‘Medicare’. An analysis of the records of 864,128 residents of Saskatchewan revealed that in 1965, 13,950 males and 27,009 females received a psychiatric diagnosis from physicians in private practice. Psychoneurotic conditions were frequent. General practitioners provided the majority of treatment services for this group. Physicians practising in urban areas were found to complete more psychiatric treatment than their rural counterparts. Female patients were found to receive relatively more psychiatric care than males. The latter obtained more consultations, hospital visits and somatic investigations. Lastly, the rate of service was infrequent, averaging less than one treatment session per patient.

Attitudes of general practitioners to the psychiatric services

1994 ◽  
Vol 11 (1) ◽  
pp. 44-46 ◽  
Author(s):  
Liam Watters ◽  
Miriam Gannon ◽  
Denis Murphy
Keyword(s):  
General Practitioners ◽  
Catchment Area ◽  
Psychiatric Treatment ◽  
Psychiatric Patients ◽  
Psychiatric Service ◽  
Psychiatric Morbidity ◽  
Psychiatric Hospitals ◽  
Psychiatric Services ◽  
Community Psychiatric ◽  
High Level

Structural AbstractObjective: General practitioners play a crucial role in the delivery of psychiatric treatment to patients who have many similarities to those attending the general psychiatric services. The purpose of this study was to elicit attitudes of general practitioners to an existing local service. Methods: We used an anonymous questionaire hand delivered to 54 general practitioners with practices in the catchment area of one of Dublin's psychiatric hospitals. Results: We received responses from 40 of the GP's indicating a high level of psychiatric morbidity in the primary care setting, a moderate level of satisfaction with psychiatric service, a low level of knowledge of the catchment area system, limited interest in taking on an increased role in the care of psychiatric patients and a high popularity rating for the community psychiatric nurse. Conclusions: This study confirms previous estimates of psychiatric morbidity in general practice, a need for improved communication between psychiatrists and general practitioners to identify more realistic expectations on both sides of the equation, and a huge potential for the expanding community psychiatric services to improve liaison between general practitioners and psychiatrists and yield considerable patient and doctor gains.

Sudden death in psychiatric patients

1998 ◽  
Vol 172 (4) ◽  
pp. 331-336 ◽  
Author(s):  
David Ruschena ◽  
Paul E. Mullen ◽  
Philip Burgess ◽  
Stephen Cordner ◽  
Justin Barry-Walsh ◽  
...  
Keyword(s):  
Sudden Death ◽  
Affective Disorders ◽  
Suicide Risk ◽  
Excess Mortality ◽  
Substance Misuse ◽  
Psychiatric Treatment ◽  
Psychiatric Patients ◽  
Community Based ◽  
Case Register ◽  
Community Based Services

BackgroundThe present study investigated histories of prior psychiatric treatment in cases of sudden death reported to the coroner.MethodsA matching survey linked the register of deaths reported to the coroner with a comprehensive statewide psychiatric case register covering both inpatient and community-based services.ResultsSudden death was five times higher in people with histories of psychiatric contact. Suicide accounted for part of this excess mortality but deaths from natural causes and accidents were also elevated. Schizophrenic and affective disorders had similar suicide rates. Comorbid substance misuse doubled the risk of sudden death in affective and schizophrenic disorders.ConclusionsThe rates of sudden death are sufficiently elevated to raise questions about current priorities in mental health care. There is a need both for greater attention to suicide risk, most notably among young people with schizophrenia, to the early detection of cardiovascular disorders and to the vigorous management of comorbid substance misuse.

scholarly journals Mortality among people with mental disorders

2010 ◽  
Vol 19 (1) ◽  
pp. 1-3 ◽  
Author(s):  
Francesco Amaddeo ◽  
Michele Tansella
Keyword(s):  
General Population ◽  
Mental Disorders ◽  
Systems Of Care ◽  
Psychiatric Patients ◽  
Psychiatric Hospitals ◽  
Psychiatric Services ◽  
Community Based

Mortality among psychiatric patients has been found to be higher than the general population, not only in those long-term residents in old-fashioned psychiatric hospitals or attending hospital-based psychiatric services (Harris & Barraclough, 1998) but also in those treated in modern community-based systems of care (Amaddeo et al., 1995; Grigoletti et al., 2009).

Utilization of Emergency Departments for Psychiatric Treatment

1978 ◽  
Vol 23 (3) ◽  
pp. 143-148 ◽  
Author(s):  
G.D. Watson
Keyword(s):  
Emergency Department ◽  
Emergency Services ◽  
Suicide Attempts ◽  
Psychiatric Treatment ◽  
Psychiatric Patients ◽  
Relevant Literature ◽  
Emergency Department Utilization ◽  
Annual Number ◽  
Personal Distress ◽  
Clinical Records

A survey of four Edmonton hospital emergency department records for a one month period was carried out to determine the frequency of utilization by patients suffering from psychiatric disorders. Male attenders outnumbered females and the majority of patients fell into the 21 — 50 year age range. Alcohol-related illness was almost three times more frequent in males than females, whereas females were more frequently categorized as suffering “personal distress” or presented as suicide attempts. Overall, seventy-three percent of the patients were discharged; of those admitted, females outnumbered males. The changing pattern of emergency department utilization was compared by examining data from one hospital for the years 1972, 1974 and 1976. During this four-year period the annual number of visits by psychiatric patients increased by almost eighty percent, largely due to dramatic increases in alcohol related problems in males and those described as “personal distress” in females. The establishment of intoxication recovery centres in 1973 paralleled a drop in the proportion of patients admitted to inpatient wards for alcohol-related, street drugs and overdose problems. The results of the present survey are compared to those reported in the relevant literature, and the methodological problems encountered in carrying out a retrospective study of emergency services from clinical records are described.

Mortality among Psychiatric Patients

1970 ◽  
Vol 15 (4) ◽  
pp. 143-148 ◽  
Author(s):  
G. Innes ◽  
W. M. Millar
Keyword(s):  
Causes Of Death ◽  
Psychiatric Patients ◽  
Psychiatric Services ◽  
Social Classes ◽  
First Year ◽  
Organic Psychosis ◽  
Physical Symptomatology ◽  
Regional Board ◽  
Excessive Number

A 5-year follow-up study was carried out of all referrals to the psychiatric services in a Regional Board area. The death registers of the Registrar General for Scotland were searched for all patients who were not known to be alive at the end of the study. Of the 2103 patients included in the original study, 343 were found to have died. This represents 15.9 per cent of males and 16.7 per cent of females referred. Most of the deaths (41%) occurred in the first year of follow-up, 20 per cent in the first 3 months. The overall death rate was approximately twice the expectation based on death rates in the general population of the area. The excess was greatest in those aged under 55 years. All areas of residence, occupations and social classes had increased mortality. Those patients diagnosed as organic psychosis had highest mortality (70%) but all diagnoses had an excessive number of deaths when standardised for age. Of the initial referrals, 1.4 per cent committed suicide during the follow-up period. Apart from neoplasms where deaths were close to expectation, all other broad categories of causes of death were equally involved in the increase. This survey of a total psychiatric referral group (in-patients, out-patients and domiciliary visits and private patients) supports previously reported studies, mainly of in-patients, in their finding of an association between high mortality rates and psychiatric illness. It is possible that this association may result from selective referral to the psychiatric services of those psychiatrically ill patients who exhibit physical symptomatology.

scholarly journals Managing criminal acts on the psychiatric ward: understanding the police view

2003 ◽  
Vol 9 (5) ◽  
pp. 359-367 ◽  
Author(s):  
Richard Bayney ◽  
George Ikkos
Keyword(s):  
Mental Health ◽  
Criminal Justice ◽  
Justice System ◽  
Psychiatric Patients ◽  
Psychiatric Services ◽  
Case Vignette ◽  
Psychiatric Ward ◽  
Police Services ◽  
Local Police ◽  
Legal Remedies

Success in preventing and responding to criminal behaviours on psychiatric wards may sometimes require cooperation between mental health services and local police services. This is especially so when seeking legal remedies through the criminal justice system. This article describes police perceptions of psychiatric services and psychiatric patients. It also reviews police procedures and factors that influence their response when the police are requested to intervene following an alleged criminal act by an in-patient. A case vignette is used to highlight the causes of tensions and guide the reader through the steps that might be considered when the issue of prosecution arises.

Severe Personality Disorder

1996 ◽  
Vol 168 (6) ◽  
pp. 723-731 ◽  
Author(s):  
Kingsley Norton ◽  
R. D. Hinshelwood
Keyword(s):  
Personality Disorder ◽  
Psychiatric Treatment ◽  
Psychiatric Patients ◽  
Relevant Literature ◽  
Term Treatment ◽  
Successful Outcome ◽  
Post Discharge ◽  
Long Term Treatment ◽  
Severe Personality Disorder

BackgroundSevere personality disorder (SPD) is an imprecise but useful term referring to some notoriously difficult to treat psychiatric patients. Their long-term psychiatric treatment is often unsuccessful, in spite of hospitalisation. The specialist expertise of in-patient psychotherapy units (IPUs) can successfully meet some of SPD patients' needs.MethodRelevant literature on the subject is summarised and integrated with the authors' specialist clinical experience.ResultsMany clinical problems with SPD patients are interpersonal and prevent any effective therapeutic alliance, which is necessary for successful treatment. With in-patients, inconsistencies in treatment delivery and issues surrounding compulsory treatment reinforce patients' mistrust of professionals, compromising accurate diagnosis and an assessment of the need for specialist IPU referral.ConclusionsGeneral psychiatric teams are well-placed to plan long-term treatment for SPD patients which may include IPU treatment. Timely referral of selected SPD patients to an IPU maximises a successful outcome, especially if there is appropriate post-discharge collaboration with general psychiatric teams to consolidate gains made.

Proposal for a new funding system for mental health departments. Results from an evaluative multicentre Italian study (I-psycost)

2006 ◽  
Vol 15 (4) ◽  
pp. 295-306 ◽  
Author(s):  
Laura Grigoletti ◽  
Francesco Amaddeo ◽  
Aldrigo Grassi ◽  
Massimo Boldrini ◽  
Marco Chiappelli ◽  
...  
Keyword(s):  
Mental Health ◽  
Psychiatric Services ◽  
Community Based ◽  
Multinomial Logistic Model ◽  
Funding System ◽  
Predictive Variables ◽  
Use Of Resources ◽  
Mental Health Funding ◽  
The Right ◽  
Italian Community

SummaryAims – To obtain a new, well-balanced mental health funding system, through the creation of i) a list of psychiatric interventions provided by Italian Community-based Psychiatric Services (CPS), and associated costs; ii) a new prospective funding system for patients with a high use of resources, based on packages of care. Methods – Five Italian Community-based Psychiatric Services collected data from 1250 patients during October 2002. Socio-demographical and clinical characteristics and GAF scores were collected at baseline. All psychiatric contacts during the following six months were registered and categorised into 24 service contact types. Using elasticity equation and contact characteristics, we estimate the costs of care. Cluster analysis techniques identified packages of care. Logistic regression defined predictive variables of high use patients. Multinomial Logistic Model assigned each patient to a package of care. Results – The sample's socio-demographic characteristics are similar, but variations exist between the different CPS. Patients were then divided into two groups, and the group with the highest use of resources was divided into three smaller groups, based on number and type of services provided. Conclusions – Our findings show how is possible to develop a cost predictive model to assign patients with a high use of resources to a group that can provide the right level of care. For these patients it might be possible to apply a prospective per-capita funding system based on packages of care.Declaration of Interest: None

Mortality Among Patients with Psychiatric Illness a Ten-Year Case Register Study in an Area with a Community-based System of Care

1995 ◽  
Vol 166 (6) ◽  
pp. 783-788 ◽  
Author(s):  
Francesco Amaddeo ◽  
Giulia Bisoffi ◽  
Paola Bonizzato ◽  
Rocco Micciolo ◽  
Michele Tansella
Keyword(s):  
Poisson Regression ◽  
Psychiatric Patients ◽  
Age Groups ◽  
System Of Care ◽  
Register Study ◽  
First Year ◽  
Community Based ◽  
Pattern Of Care ◽  
Case Register ◽  
Specialist Services

BackgroundMost studies which showed an excess mortality in psychiatric patients have been conducted on hospitalised samples.MethodThis was a case register study. All South Verona patients with an ICD diagnosis who had psychiatric contacts with specialist services in 1982–1991 were included. Mortality was studied in relation to sex, age, diagnosis, pattern of care and interval from registration. Standardised Mortality Rates (SMRs) and Poisson regression analysis were calculated.ResultsThe overall SMR was 1.63 (95% CI = 1.5–1.8), which is the lowest value reported so far. Mortality was higher among men (SMR = 2.24; 95% CI = 1.9–2.6), among patients who were admitted to hospital (SMR = 2.23; 95% CI = 1.9–2.6), among younger age groups (SMR = 8.82; 95% CI = 4.9–14.6) and in the first year after registration (SMR = 2.32; 95% CI = 1.8–2.9). Higher mortality was found in patients with a diagnosis of alcohol and drug dependence (SMR = 3.87; 95% CI = 3.0–4.9). The SMR for suicide was 17.41. Using a Poisson regression model, diagnosis, pattern of care and interval from registration were all found to be significantly associated with mortality. When all these variables were entered together in the model, each maintained its predictive role.ConclusionsThe overall mortality of psychiatric patients treated in a community-based system of care was higher than expected, but lower than the mortality reported in other psychiatric settings. The highest mortality risk was found in the first year after registration.

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