title: How size matters: exploring the association between quality of mental health services and catchment area size.
abstract: The diversity of mental health and substance abuse services (MHS) available to service users is seen as an indicator of the quality of the service system. In most countries MHS are provided by a mix of public, private and third sector providers. In Finland, officially, the municipalities are responsible for organizing the services needed, but the real extent and roles of private and third sector service providers are not known. Our previous study showed that the catchment area population size was strongly associated with diversity of mental health services. It is not known whether this was due to some types of services or some provider types being more sensitive to the size effect than others. The aim of this study was to investigate the association between area population size and diversity of mental health services, i.e. which types of services and which service providers' contributions are sensitive to population size.
  
  
  
  To map and classify services, we used the ESMS-R. The diversity of services was defined as the count of main types of care. Providers were classified as public, private or third sectors.
  
  
  
  The diversity of outpatient, residential and voluntary services correlated positively with catchment area population size. The strongest positive correlation between the size of population and services available was found in third sector activities followed by public providers, but no correlation was found for diversity of private services. The third sector and public corporations each provided 44 % of the service units. Third sector providers produced all self-help services and most of the day care services. Third sector and private companies provided a significant part (59 %) of the residential care service units.
  
  
  
  Significant positive correlations were found between size of catchment area population and diversity of residential, outpatient and voluntary services, indicating that these services concentrate on areas with larger population bases. The third sector seems to significantly complement the public sector in providing different services. Thus the third sector be needs to be functionally integrated with other MHS services to achieve a diversified and integrated service system.
authors: University of Helsinki and Helsinki University Hospital, Psychiatry, Välskärinkatu 12, FI-00029, Helsinki, Finland. taina.ala-nikkola@hus.fi.|Mental Health Unit, National Institute for Health and Welfare (THL), Mannerheimintie 170, FI-00270, Helsinki, Finland. taina.ala-nikkola@hus.fi.
authors: Taina
authors: 0000-0003-0834-1195
authors: T
authors: Ala-Nikkola
authors: Mental Health Unit, National Institute for Health and Welfare (THL), Mannerheimintie 170, FI-00270, Helsinki, Finland.|Department of Social Services and Health Care, City of Helsinki, FI-00099, Helsinki, Finland.|Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Välskärinkatu 12, FI-00029, Helsinki, Finland.
authors: Minna
authors: M
authors: Sadeniemi
authors: Department of Public Health, Faculty of Medicine, University of Helsinki and Helsinki University Hospital, FI-000014, Helsinki, Finland.
authors: Minna
authors: M
authors: Kaila
authors: Turku University Central Hospital and University of Turku, Kiinanmyllynkatu 4-8, 20520, Turku, Finland.
authors: Samuli
authors: S
authors: Saarni
authors: Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Välskärinkatu 12, FI-00029, Helsinki, Finland.
authors: Raija
authors: R
authors: Kontio
authors: University of Tampere and Mental Health Unit, National Institute for Health and Welfare (THL), Mannerheimintie 170, FI-33014, Tampere, Finland.
authors: Sami
authors: S
authors: Pirkola
authors: University of Helsinki and Helsinki University Hospital, Stenbäckinkatu 9, FI-00029, Helsinki, Finland.
authors: Grigori
authors: G
authors: Joffe
authors: Turku University Central Hospital and University of Turku, Kiinanmyllynkatu 4-8, 20520, Turku, Finland.
authors: Olli
authors: O
authors: Oranta
authors: Mental Health Unit, National Institute for Health and Welfare (THL), Mannerheimintie 170, FI-00270, Helsinki, Finland.
authors: Kristian
authors: K
authors: Wahlbeck
mesh_terms: D002391:Catchment Area, Health; D005387:Finland; D006801:Humans; D008605:Mental Health Services / Q000592:standards*; D017150:Public Sector; D011787:Quality of Health Care / Q000592:standards*
keywords: Diversity; Mental health services; Private sector; Public corporation; Service providers; Third sector