André I Wierdsma1, Hilde D Poodt, Cornelis L Mulder. 1. O3 Research Centre, Mental Health Care Rijnmond, Erasmus MC, University Medical Centre, Rotterdam, Department of Psychiatry 0452, PO Box 2040, 3000 CA Rotterdam, The Netherlands. a.wierdsma@erasmusmc.nl
Abstract
BACKGROUND: Community-care networks are a partnership between the local police force, housing corporations, general social services, specialised home care and mental healthcare services. The networks were set up to improve the healthcare for patients with (chronic) psychiatric problems through local cooperation between different agencies operating in underprivileged areas. OBJECTIVE: To evaluate the effects of community-care networks on psychiatric emergency contacts, hospitalisation and involuntary admission. DESIGN: An ecological intervention design was used, comparing neighbourhoods with and without a community-care network. Mean numbers and standardised ratios of psychiatric emergency contacts, hospitalisation rates and involuntary admissions were assessed over a 10-year period, covering the early stages and the years in which community-care networks were fully operational. SETTING: Underprivileged neighbourhoods in the city of Rotterdam, The Netherlands. PATIENTS: Inhabitants aged 20-64 years living in these neighbourhoods. RESULTS: Standardised ratios for contact with psychiatric emergency services were higher in the neighbourhoods where community-care networks were set up (standardised ratios = 137, 95% CI 121 to 145 in the network neighbourhoods vs standardised ratios = 107, 95% CI 96 to 119 in the control neighbourhoods). Number of admissions and standardised ratios for involuntary admissions were lower in the community-care network neighbourhoods than in the control neighbourhoods (standardised ratios = 123, 95% CI 95 to 157 vs standardised ratios = 152, 95% CI 120 to 191). CONCLUSIONS: Community-care networks have a significant impact on the use of mental healthcare services. These networks may be an important tool in the prevention of involuntary admissions.
BACKGROUND: Community-care networks are a partnership between the local police force, housing corporations, general social services, specialised home care and mental healthcare services. The networks were set up to improve the healthcare for patients with (chronic) psychiatric problems through local cooperation between different agencies operating in underprivileged areas. OBJECTIVE: To evaluate the effects of community-care networks on psychiatric emergency contacts, hospitalisation and involuntary admission. DESIGN: An ecological intervention design was used, comparing neighbourhoods with and without a community-care network. Mean numbers and standardised ratios of psychiatric emergency contacts, hospitalisation rates and involuntary admissions were assessed over a 10-year period, covering the early stages and the years in which community-care networks were fully operational. SETTING: Underprivileged neighbourhoods in the city of Rotterdam, The Netherlands. PATIENTS: Inhabitants aged 20-64 years living in these neighbourhoods. RESULTS: Standardised ratios for contact with psychiatric emergency services were higher in the neighbourhoods where community-care networks were set up (standardised ratios = 137, 95% CI 121 to 145 in the network neighbourhoods vs standardised ratios = 107, 95% CI 96 to 119 in the control neighbourhoods). Number of admissions and standardised ratios for involuntary admissions were lower in the community-care network neighbourhoods than in the control neighbourhoods (standardised ratios = 123, 95% CI 95 to 157 vs standardised ratios = 152, 95% CI 120 to 191). CONCLUSIONS: Community-care networks have a significant impact on the use of mental healthcare services. These networks may be an important tool in the prevention of involuntary admissions.
Authors: Howard H Goldman; Joseph P Morrissey; Robert A Rosenheck; Joseph Cocozza; Margaret Blasinsky; Frances Randolph Journal: Psychiatr Serv Date: 2002-08 Impact factor: 3.084