Are long-term psychiatric patients causing more crisis consultations outside office hours in mental health care?
BACKGROUND
As well as an improvement in community services, the de-institutionalization of patients receiving long-term psychiatric care can lead to marginally staffed mental health services, more homelessness, rising admission rates and more people in prison cells. It is assumed that an imbalance between community and hospital care for chronic patients puts pressure on crisis services.


OBJECTIVE
In this study, the central question is whether patients receiving long-term psychiatric care in Amsterdam do indeed put pressure on the city's emergency mental health services. We compare the pressure exerted by this group with the pressure resulting from the use of these services by all registered patients.


METHODS
Data were taken from the client registration systems of three mental health organizations in Amsterdam in the period from 2000 to 2004. Inclusion criteria for long-term psychiatric patients were age above 19 years and uninterrupted receipt of mental health care for a minimum of two successive years.


RESULTS
Annually, 6%-8% of all non-long-term patients experienced a crisis outside office hours in the period under investigation; this was 4%-6% for long-term patients. The non-long-term patients accounted for 83% of crisis contacts outside office hours over the entire study period, with long-term patients accounting for 17%.


CONCLUSIONS
The assumption that crises are more prevalent in long-term patients in the community seems to be an example of stigmatization rather than an observation based on fact.
Arkin Institute for Mental Health, Amsterdam, The Netherlands. jack.dekker@arkin.nl
J
J
Dekker
J
J
Theunissen
R
R
Van
M
M
Kikkert
L
L
van der Post
J
J
Zoeteman
J
J
Peen
D000328:Adult; D039602:After-Hours Care / Q000379:methods / Q000706:statistics & numerical data*; D003419:Crisis Intervention / Q000379:methods / Q000706:statistics & numerical data*; D004637:Emergency Services, Psychiatric / Q000379:methods / Q000706:statistics & numerical data*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008134:Long-Term Care; D008297:Male; D001523:Mental Disorders / Q000628:therapy*; D008605:Mental Health Services / Q000706:statistics & numerical data*; D009426:Netherlands; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D055815:Young Adult