Psychiatric outpatient care before and after sectorization

The utilization of outpatient care was studied in a Swedish district with 147,000 inhabitants. Outpatient visits were counted and analyzed during 2 weeks in the late autumn of 1985 and two comparable weeks in 1990. The psychiatric care had been fundamentally reorganized in the years between the index periods. The mainly hospital-based psychiatric services in the area were changed to community mental health units with increased outpatient resources. The number of available hospital beds was at the same time substantially reduced. It was found that the number of outpatient visits and the number of patients had not changed markedly, but there were some indications of increased accessibility to the care system. The number of emergency cases was significantly reduced, and the geographic distribution of patient residences was equalized between urban and rural areas. Formerly the population living close to the central hospital had utilized the care system more. This was now the case only for the emergency cases. There had also been a shift towards more seriously ill patients. The diagnostic groups of psychoses, personality disorders, neuroses, and crisis reactions had increased in size, but there were much fewer patients with drinking and psychosocial problems. The staff judged in 1985 that 60.5% of the visits were actual psychiatric cases; in 1990 this proportion was 83.5%. There was a shift from visits to physicians in training to psychiatric specialists. Psychotherapeutic treatment, supportive treatment, psychiatric evaluation, and social training had increased significantly, and psychopharmacologic treatment was slightly reduced. It was concluded that the community mental health services had succeeded to some extent in fulfilling their goals of greater accessibility to outpatient care and a more qualified care with increased psychotherapeutic resources.