ebook img

Estimating Needs for Mental Health Care: A Contribution of Epidemiology PDF

144 Pages·1979·4.872 MB·English
Save to my drive
Quick download
Download
Most books are stored in the elastic cloud where traffic is expensive. For this reason, we have a limit on daily download.

Preview Estimating Needs for Mental Health Care: A Contribution of Epidemiology

Estimating Needs for Mental Health Care A Contribution of Epidemiology Edited by H. Hafner With 25 Figures Springer-Verlag Berlin Heidelberg New York 1979 Prof. Dr. Dr. Heinz Hafner, Zentralinstitut fUr Seelische Gesundheit, J 5, D-6800 Mannheim 1 ISBN -13 :978-3-540-09425-8 e-ISBN -13: 978-3-642-67338-2 DOl: 10.1007/978-3-642-67338-2 Library of Congress Cataloging in Publication Data. Main entry under title: Estimating needs for mental health care. Bibliography: p. Includes index. 1. Social psychiatry. 2. Mental health services. 3. Epidemiology. I. Hafner, Heinz. RC455.E84 362.2'04'22 79-12839 This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, specifically those of translation, reprinting, re-use of illustrations, broadcasting, reproduction by photocopying machine or similar means, and storage in data banks. Under § 54 of the German Copyright Law where copies are made for other than private use, a fee is payable to the publisher, the amount of the fee to be determined by agreement with the publisher. © Springer-Verlag Berlin Heidelberg 1979. The use of registered names, trademarks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. Typesetting, SatzStudio Pfeifer, Germering 2127/3321 543210 Contents List of Contributors. . . . . . . . . . . . . . . . . . . . . . . . . . . . .. VII Preface. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. IX Acknowledgement. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. X 1 Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 1.1 Hafner, H.: Estimation of Needs by Epidemiological Instruments. . .. 1 2 Morbidity, Needs, and Utilization: General Contributions . 19 2.1 Wing, I. K.: Ideas in Psychiatric Epidemiology. ................ 19 2.2 Katschnig, H.: Prospects for Epidemiological Research in Neurosis ..... 30 2.3 Stromgren, E., Kyst, E., Ryberg, I., Weeke, A.: Estimation of Need on the Basis of Field Survey Findings. 37 3 Psychiatric Case Register as a Basis for Estimation and Monitoring of Needs ......................... 43 3.1 Dupont, A.: Psychiatric Case Registers. . . . . . . ............... 43 3.2 Fryers, T.: Estimation of Need on the Basis of Case Register Studies: British Case Register Data ...................... 52 3.3 Helgason, T.: Estimation of Need on the Basis of Case Register Studies: Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64 4 Psychiatric Morbidity and Needs for Care in General Practice .................................. 69 4.1 Zintl-Wiegand, A., Cooper, B.: Psychiatric Morbity in General Practice in a West-German City .................................... 69 4.2 Robak,O.H.: Psychiatric Morbidity and Treatment in General Medical Practice: Discussion .......................... 80 5 Suicidal Attempts in Hospital-Emergency Units. ....... 85 5.1 Welz, R.: Social and Ecological Background of Attempted Suicides in Mannheim . . . . . . . ....................... 85 6 Epidemiological Studies in Child Psychiatry. . . . . . . . .. 97 6.1 Graham, Ph. . Child Psychiatry: Recent Epidemiological Advances. . . .. 97 6.2 Wing, L.: Mentally Retarded Children in Camberwell (London) .... 107 v 6.3 Liepmann, M. C.: Mentally Handicapped Children in Mannheim. . . . . . . . . 113 7 Needs for Mental Health Care and Utilization of Services Monitored by Field Studies. . . . . . . . . . ........... 125 7.1 Nielsen, J ., Nielsen, J. A.: Incidence of First Contacts and Need of Staff and Beds in a Community Psychiatric Service . . . . . . . . . . . . ... 125 7.2 Lehtinen, V., Viiisiinen, E.: Estimate of the Need for Psychiatric Services, as Indicated by a Social-Psychiatric Survey of the Finnish Population. . 131 SubjectIndex. . . . . . . . . . . . . . . . ................... 135 VI List of Contributors Cooper, B., Prof. Dr. med. Zentralinstitut fUr Seelische Gesundheit, J 5, D-6800 Mannheim Dupont, A., M. D. Institut of Psychiatry, Aarhus Psychiatric Hospital, 8240 Risskov, Denmark Freyers, R., M. D., M. F. C. M., D. P. H. Department of Community Medicine, University of Manchester, Stopford Building, Oxford Road, Manchester M13 9PT, United Kingdom Graham, P., FRCP, FRCPsych Department of Child Psychiatry, The Hospital for Sick Children, Great Ormond Street, Londong WC1N 3JH, United Kingdom Hafner, H., Prof. Dr. med. Dr. phil. Zentralinstitut fUr Seelische Gesundheit, J 5, D-Mannheim Helgason, T., Prof. Dr. med. Department of Psychiatry, University of Iceland, Reykjavik, Iceland Katschnig, H., PD Dr. med. Psychiatrische Klinik, Universitat Wien, A-1097 Wien Kyst, E., Dr. Psychiatric Hospital, 8240 Risskov, Denmark, Institute of Psychiatric Demography Lehtinen, V., Prof. Dr. med. Department of Psychiatry, University of Turku, 20700 Turku, Finland Liepmann, M. C., Dr. phil. Zentralinstitut fUr Seelische Gesundheit, J 5, D-Mannheim Nielsen,J.,M. D. Institut of Psychiatric Demography, Aarhus Psychiatric Hospital, 8240 Risskov, Denmark Nielsen, J. A., M. D. Institute of Psychiatric Demography, Aarhus Psychiatric Hospital, 8240 Risskov, Denmark Robak, O. H., Prof. Dr. med. Dikemark Hospital, Dept. 2, 1385 Solberg, Norway VII Ryberg, I., Social Worker Psychiatric Hospital, 8240 Risskov, Denmark Stromgren, E., Prof. Dr. med. Institute of Psychiatry, University of Aarhus, 8240 Risskov, Denmark Viiisiinen, E., Prof. Dr. med. Department of Psychiatry, University ofOulu, 90210 Oulu, Finland Weeke, A., Dr. Institute of Psychiatric Demography, Psychiatric Hospital, 8240 Risskov, Denmark Welz, R., Dr. rer. soc. Zentralinstitut fUr Seelische Gesundheit, J 5, D-6800 Mannheim Wing, J. K., Prof. M. D., Ph. D. Medical Research Council, Social Psychiatric Unit, Institute of Psychiatry, De Crespigny Patk, London SE5 8AF, United Kingdom Wing, L., M. D. Medical Research Council, Social Psychiatric Unit, Institute of Psychiatry, De Crespigny Park, London SE5 8AF, United Kingdom Zintl-Wiegand, A., Dr. med. Zentralinstitut fUr Seelische Gesundheit, J 5, D-6800 Mannheim VIII Preface The many significant changes that have come about in the mental health service of different countries in the last two decades have made administrative and political decision making in the distribution of care services a much more hazardous business. In the United States, for example, the number of occupied psychiatric beds fell from 550,000 in 1955 to 190,000 in 1977. England and Wales experienced similar if less pronounced changes, while in the Federal Republic of Germany the same trend became apparent some five years ago, although here the initial hospitalisation rates were lower. Enquiry into the real needs for various forms of mental health care, especially the need for hospital beds, for places in homes and hostels, and for specialist out-patient treatment, has now become a funda mental aim of research in social psychiatry. To achieve this goal by epi demiological concepts and methods, including the investigation of true morbidity rates and the estimation of the related need for care, must be used. The First European Symposium on Social Psychiatry, which was held in Mannheim in 1977 on the occasion of the opening of the Central Institute of Mental Health, was dedicated to this topic which is so relevant to the present and important to the future of our health services. This volume contains some of the papers presented. Based as they are on epidemiological principles, they elucidate the pre-con ditions necessary for the estimation of mental health care needs and contribute relevant findings from recent research programmes in this area. Thereby, the volume offers the reader a well-founded orientation toward recent work including an overview of the "state of the art" in this field of research especially among groups currently working in Europe. Mannheim, December 1978 H. Hafner IX Acknowledgements Thanks are due to Mrs. Christa Khalil and Professor Michael Kelleher, Cork/Eire, for their assistance in the English translation and to Dr. Wagner Gattaz for preparing the subject index. Acknowledgement is also due to the Volkswagen Foundation for its generous financial support. 1 Introduction 1.1 Estimation of Needs by Epidemiological Instruments H. Hafner 1.1.1 Introduction The majority of industrial nations provide comprehensive systems of medical care and some of them also provide extensive networks of social services. These systems, which protect against sickness and the hazards of economic and social distress, were established through great sacrifices by individuals and society. Many years were spent in their development. Presently they consume a large part of the gross national product of most countries. The organisers and administrators of these services are subjected to everlasting pressure to justify to the public, who must foot the bill, their value in terms of costs and benefits. It follows that health care systems cannot continue to expand in the absence of clearly defined goals. The growth of a service can be limited by the availability of resources. This could occur when the total budget available is fixed beforehand or when a ceiling is set on the number of trained personnel to be employed. In such cases of limited disposable resources one must decide which needs are to take priority in the distribution of limited services. These latter questions are of immediate interest to developing countries because of the scant resources available to health care. Further more, these countries now aim to avoid the mistakes committed by wealthier nations so that, at least, they will make the best and most effective use of the means at their disposal. If the growth of a health care system, which to a large extent was unplanned and spontaneous, is brought to a standstill by pressure from without, conflict between existing institutions usually results in further resistance to necessary changes. These external factors, however, which form the matrix of society while giving the health system its meaning and determining its goals, do not themselves remain unaltered. They are influenced by demographic and social changes, by the growth of knowl eg de and the development of new techniques, by changes in the needs of clients and lastly, though not least, by political decree. Examples that come to mind include the recent fall in the birth rate in several European countries resulting in decreasing bed usage in maternity and paediatric hospitals and the rise in the frequency of admission of patients diagnosed as suffering from alcoholism, which in part may have resulted from the acceptance by health insurance companies and others that alcoholism is a bona fide medical condition. Earlier examples are the treatment of syphilis with penicillin and the outpatient treat ment of eczema and other skin allergies with steroids which has led to a fall in the num ber of in-patient admissions to dermatolOgical units. Finally, the new philosophy that any form of care is superior to admission to a mental hospital for the chronically ill has resulted in a huge reduction in the number of mental hospital beds currently occupied in the United States of America, from approximately 550,000 in 1955 to 190,000 in 1977 (Greenblatt and Glazier, 1975, Greenblatt, 1977). An undue increase in numbers of qualified personnel brings new problems in its train. 1

See more

The list of books you might like

Most books are stored in the elastic cloud where traffic is expensive. For this reason, we have a limit on daily download.