[Quality of the location as a principle in psychiatric health care planning].

The goal of reasonable accessibility of specialised care to all those who need it must be kept in mind when planning to establish mental health service in the community. For methodological purposes, an attempt is made to quantify and thus render measurable the accessibility factor, also to be called "quality of location", based on "spatial" as well as "non-spatial" indicators. In many areas of community life involving planning and political decision making, the importance of such an approach cannot be underestimated. On the basis of the 1989 case register in the Austrian State of Tyrol, we investigated the relationship between administrative prevalence and the distance between the patient's home and the nearest hospital providing in-patient care, this distance being measured in terms of the time it takes to get to the hospital by public transportation. Our investigation confirmed the phenomenon described for the first time in 1852 by E. Jarvis, that there is an inverse relationship between the frequency of hospital admission and the geographical distance patients had to travel. This observation was validated, first of all, by excluding the possibility of selective migration influencing the inverse relationship between utilisation of available facilities by patients and the distance from their homes, and, secondly, by making suitable adjustments for the influence of "non-spatial" indicators such as rural/urban differences, socio-demographic variables and economic factors as indicated by the census figures. In the health service region we investigated, comprising of small town/rural areas, it was found that the Jarvis effect was slightly weakened; this observation, however, could not be explained solely in terms of the "non-spatial" indicators. What is new in the present investigation is the use of time as a dimension in the description of quality of location, as well as the approach combining the two sets of indicators, the "spatial" and the "non-spatial", which have hitherto been considered isolated from each other. Using the temporal dimension, it was possible to determine the time limit, i.e. the "sensitivity to distance" which can be looked upon as defining reasonable accessibility to in-patient care. This turned out to be about 30 to 45 minutes of travel by public transportation, this being shorter than the figure given by the German Mental Health Service survey. In summary, our investigation shows that the temporal dimension-the distance between home and hospital measured in terms of the time it takes to get to the hospital-is the most significant determinant of the quality of location; socio-demographic and economic factors play merely a secondary role.