Utilization of public mental health services in a random community sample.
OBJECTIVE
The aim of this study was to examine patterns of service utilization in the public mental health service in the Australian state of Victoria. Lifetime contact with the public mental health system will be used to approximate lifetime prevalence for schizophrenia in the community.


METHODS
A case-linkage design joined a statewide psychiatric register with a random sample of community members drawn from a statewide electoral roll (n = 4830). In cases where individuals had been in contact with public mental health services, their full contact history was extracted.


RESULTS
Members of the community come into contact with public mental health services for a variety of reasons, including those beyond the scope of psychiatric diagnosis and treatment, with 23% of those who made contact not receiving a psychiatric diagnosis and/or ongoing treatment. Although only 0.7% of the sample had a lifetime diagnosis of schizophrenia, these persons accounted for a significant proportion of public mental health service use. Schizophrenia-spectrum disorders were particularly prevalent among psychiatric crisis and extended care and supervision services.


CONCLUSIONS
The Australian public mental health system has undergone significant reform in recent years. As a result, there has been a shift towards community-based care and a marked reduction in inpatient facilities. The public mental health system is a service that primarily serves those with a psychotic illness, thereby dictating that persons with so-called high-prevalence disorders, including affective and/or substance use disorders, seek psychiatric treatment elsewhere.
Short
Tamsin
T
Centre for Forensic Behavioural Science and Victorian Institute of Forensic Mental Health, School of Psychology and Psychiatry, Monash University, 505 Hoddle Street, Clifton Hill, Vic. 3068, Australia. tamsin.short@med.monash.edu.au
Thomas
Stuart
S
Luebbers
Stefan
S
Ogloff
James R P
JR
Mullen
Paul
P
D000293:Adolescent; D000328:Adult; D003156:Community Mental Health Services / Q000706:statistics & numerical data* / Q000639:trends*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data / Q000639:trends; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D008875:Middle Aged; D019964:Mood Disorders / Q000175:diagnosis / Q000628:therapy; D011618:Psychotic Disorders / Q000175:diagnosis / Q000628:therapy; D011897:Random Allocation; D012042:Registries / Q000706:statistics & numerical data; D012494:Sampling Studies; D012559:Schizophrenia / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000628:therapy; D014739:Victoria / Q000453:epidemiology; D055815:Young Adult