Compulsory psychiatric care in Sweden 1979-1993. Prevalence of committed patients, discharge rates and area variation.

The prevalence of committed patients in mental health care from seven different inventories between 1979 and 1993 and rates of discharge from compulsory psychiatric care during 1984, 1988 and between 1 July 1992 and 30 June 1993 were studied by using statistics from the Swedish National Board of Health and Welfare. Changes over time and area variation in prevalence and discharge rates were analysed in relation to mental commitment law reform, urbanization, number of psychiatric beds and locus of short-term psychiatric care. The prevalence of committed patients in psychiatric in-patient care and the discharge rates from compulsory psychiatric care rapidly decreased during the periods studied. Legal reforms in 1983 and 1992, which led to a strengthened legal influence on compulsory care procedures, were followed by further reductions in the use of compulsory psychiatric care. The reductions were found not only among patients with psychotic conditions, but also among patients given other diagnoses. The proportion of committed patients in relation to the total number of in-patients increased during the latter half of the 1980s. Area variations in the 26 counties (or corresponding health administrative areas) were significant and increased after the new legislation in 1992. The three large city areas had higher psychiatric bed rates and also higher compulsory care rates than other areas in the country. In the counties outside the large city areas, no connection was found between number of beds and prevalence of committed patients, and no relation was found between locus of care and rates of compulsory psychiatric care.