Das Projekt "High users des psychiatrischen Notfalldienstes: Desintegrierte Klienten oder Patienten auf dem Weg in die Desintegration?" wird vom Umweltbundesamt gefördert und von Universität Heidelberg, Fakultät für Klinische Medizin Mannheim, Zentralinstitut für Seelische Gesundheit durchgeführt. There are findings of former studies on repeat users of psychiatric emergency services showing characteristics of social disintegration, despite the investigated services differ from each other in regard to place and function. The aim of the present study on high users of the psychiatric emergency in Mannheim/Germany is not only to replicate these findings but mainly to investigate the courses of patients careers of high users of the emergency service over time. The retrospective longitudinal study over 18 years was concerned with 182 high users of the psychiatric emergency service with more than 9 contacts within 5 years in comparison with two control groups: low users with only 1 contact within the whole observation period and 110 high users with more than 9 psychiatric treatment episodes in regular in- or outpatient services within 5 years. A comprehensive standardized psychiatric record system supplied the data for this study. Besides socio-demographic and clinical characteristics the courses of patient careers were analyzed: Type of transition between different psychiatric services duration of treatment episodes and of intervals. Additionally an operationalization of objective need vs subjective demand for care was applied for differentiation between high and low users and types of career. It is found that high users of the emergency service show signs of increasing disintegration in their social situation and in their psychiatric care while their demand is growing and their need for treatment ist diminishing. Therefore it should be considered whether early identification, special attention and treatment organization would improve the social situation and the psychiatric care of the former high users of the emergency service.
Das Projekt "Die Inanspruchnahme des psychiatrischen Notfalldienstes in Mannheim unter oekologischen und distanzbezogenen Aspekten" wird vom Umweltbundesamt gefördert und von Universität Heidelberg, Fakultät für Klinische Medizin Mannheim, Zentralinstitut für Seelische Gesundheit durchgeführt. This study aims at investigating the topographic distribution of utilization rates of the psychiatric emergency service at the Central Institute of Mental Health (Mannheim/Germany) from 1982-1993. In order to explain topographic differences in the utilization rates ecological variables, the distance between patients' residence and service location and diagnoses were taken into account. The study shows that ecological, distance-related and diagnostic factors influence the utilization of the psychiatric emergency service in Mannheim. First contact and contact rates decrease from the city centre toward the outskirts. There was a strong general effect of ecological variables: the utilization rates were higher for districts with worse ecological conditions and specific for some diagnostic groups. The greatest difference in utilization rates between the city centre and the outskirts was found for schizophrenia and psychoactive substances use disorders whereas there was no difference with regard to organic and symptomatic mental disorders. With increasing spatial and time-related distance between residence and service location, the utilization rate decreases. No relation was found between diagnoses and distance. The study also shows an interaction between the time-related distance and the ecological variables. The influence of the ecological factors on service utilization is amplified with decreasing distance.