Has the attempt to reduce psychiatric inpatient treatment been successful in Finland?
The deinstitutionalisation process in Finland's psychiatric healthcare did not start until the late 1980s. Our aim is to evaluate how the use of psychiatric inpatient treatment was associated with deinstitutionalisation given the changes in the modality of treatment ideology (years 1987--1991) as well as being due to economic pressures (years 1991--1995). Special emphasis is given on the inpatient treatment of schizophrenia and other psychotic disorders. Data was retrieved using the national hospital discharge register of all treatment periods in psychiatric hospitals and treatment periods due to psychiatric disorders in other hospitals. Three years (1987, 1991, and 1995) were compared. Four healthcare districts in northern Finland were studied. Resource use was measured by number of treatment periods and inpatient days in relation to population. Psychiatric inpatient treatment was reduced in 1987--1991, when resources in community care increased. During the period of economic pressures (1991--1995), when community care resources no longer increased, inpatient treatment started to rise again. Over the whole period, psychiatric treatment in primary care institutions increased. Reduction of psychiatric beds results in increasing inpatient treatment in non-specialist institutions, especially when community care fails to serve the patients. In the future it is important to evaluate whether the quality of care remains in the standard of specialised services when treatment shifts away from the specialist level.
Kaltiala-Heino
R
R
Tampere School of Public Health, 33014 University of Tampere, Tampere, Finland. merihe@uta.fi
Laippala
P
P
Joukamaa
M
M
D000328:Adult; D000368:Aged; D003688:Deinstitutionalization / Q000639:trends*; D005260:Female; D005387:Finland / Q000453:epidemiology; D006301:Health Services Needs and Demand / Q000639:trends; D006302:Health Services Research; D006801:Humans; D007902:Length of Stay / Q000639:trends; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D010343:Patient Admission / Q000639:trends*; D010351:Patient Discharge / Q000639:trends; D011618:Psychotic Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000534:rehabilitation*; D012559:Schizophrenia / Q000175:diagnosis / Q000453:epidemiology / Q000534:rehabilitation*