Short-term Psychiatric Care from a Theoretical Planning and Empirical Point of View

Abstract

The main factors governing the consumption of mental care are the existence of illness, the subjective need for care (demand) and the objective need. Since there is no close relationship between diagnosis and need of care, the latter should be estimated separately in health planning studies. There is reason to include mental vulnerability (30% of a stratified normal population) in the health planning program, mainly as a factor requiring secondary prevention (e.g. crisis intervention) or tertiary prevention (e.g. prophylaxis against recurrences) and preferably also for primary prevention. Figures on the discrepancy between demand and need are given. This discrepancy is quantitatively small (6% in a mental out-patient material) but qualitatively important. The effect of health care availability on the later demand for care is demonstrated in a series of emergency patients, 68% of the cases being recidivists. The view is favoured that the need for hospital care should be measured stepwise: first among the outpatients in the same specialty, then if possible among the clientèle of the GP and in other specialties. There is considerable overlapping between mental and physical symptoms among psychiatric patients. The after care could in many cases be given by GPs. The number of these must, though, be increased and their training in minor psychiatry supplemented.