[Evaluation of effectiveness of community mental health system in Kawasaki City--a comparison with national statistics].
The pioneering community mental health system of Kawasaki was evaluated by comparison with national statistics using the data from a citywide survey of patients with schizophrenia.


METHODS
Subjects were citizens of Kawasaki who were receiving medical treatment for schizophrenia (ICD-9) in the city. All inpatients (565 cases) and a random sample of outpatients (685 cases; extraction rate was 1/3) who met the criteria were asked to complete the questionnaires by themselves. The responsible medical staffs of the subjects were also asked to complete the questionnaires. In order to calculate the total prevalence rate in the city, the number of patients who received medical treatment outside the city was estimated by extrapolation.


RESULTS
Higher outpatient rate and lower inpatient rate of Kawasaki were indicated despite the almost equal prevalence (i.e. 32.7 per 10,000 population) compared to the national rate. The outpatient rate was 70.6% in Kawasaki, which was 16% higher than the national average. And the rate of outpatients with schizophrenia living alone in Kawasaki was three times higher. While national outpatient rates declined significantly when patients became 40 years old, such a decline was not evident in Kawasaki. On the other hand, as patients with schizophrenia got older, the rate of outpatients living alone or living with spouse increased in Kawasaki due to the change of caregivers' generation.


CONCLUSIONS
The higher outpatient rate especially of people over 40 years old and the higher rate of patients who lived alone may be explained by the effective community care system in Kawasaki. However, more an intensive support system which provides' daily services such as home-help and group home services should be developed, as the living conditions of outpatients who lived alone were very difficult.
Oshima
I
I
Department of Mental Health, Graduate School of Medicine, University of Tokyo.
Naito
K
K
Tokunaga
J
J
D000328:Adult; D003156:Community Mental Health Services / Q000592:standards*; D005260:Female; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012559:Schizophrenia / Q000453:epidemiology; D011795:Surveys and Questionnaires