Hostname: page-component-78c5997874-j824f Total loading time: 0 Render date: 2024-11-18T11:45:32.976Z Has data issue: false hasContentIssue false
  • English
  • Français

A Comparison of Community-Based Care for Schizophrenia in South Verona and South Manchester

Published online by Cambridge University Press:  02 January 2018

Richard Gater ,
Francesco Amaddeo ,
Michele Tansella ,
Gayle Jackson  and
David Goldberg
Richard Gater*
Affiliation:
Mental Illness Research Unit, University of Manchester, Withington Hospital, Manchester
Francesco Amaddeo
Affiliation:
Servizio di Psicologia Medica, Istituto di Psichiatria, Università di Verona, Verona, Italy
Michele Tansella
Affiliation:
Servizio di Psicologia Medica, Istituto di Psichiatria, Università di Verona, Verona, Italy
Gayle Jackson
Affiliation:
Mental Illness Research Unit, University of Manchester, Withington Hospital
David Goldberg
Affiliation:
Institute of Psychiatry, London
*
Dr R. Gater, Mental Illness Research Unit, University of Manchester, Withington Hospital, West Didsbury, Manchester M20 8LR
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

The community-oriented mental illness services providing care to defined populations in south Verona, Italy (17 628 adults) and south Manchester, England (12 021 adults) have been compared to explore relationships between service organisation and patterns of service use.

Method

The composition and function of the two services and the sociodemographic characteristics of the two centres are described and related to epidemiological data on service use in the community, out-patient clinic, day hospital and in-patient care.

Results

Treated incidence of all psychiatric diagnoses and of schizophrenia were significantly higher in south Manchester than south Verona, indicating that the referral filter between primary and secondary care is more permeable in Manchester. Patients known to the service were more likely to be admitted and to have shorter in-patient stays in south Verona, indicating that the filter between in-patient care and the community is more permeable in Verona than Manchester.

Conclusions

The organisation of services in Verona results in a smaller load on the mental health service; the shorter hospital stays can be related to better integration between hospital and community resources. The organisation of services in Manchester provides care for a greater proportion of the population, but would be likely to require increased resources for the mental health services over time.

Type
Papers
Information
The British Journal of Psychiatry , Volume 166 , Issue 3 , March 1995 , pp. 344 - 352
Copyright
Copyright © 1995 The Royal College of Psychiatrists 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

1.

The south Manchester service described in this paper was only available to residents of the Wythenshawe district of south Manchester who were registered with the 11 family doctors linked with the team. This service is not representative of the service available to patients elsewhere in south Manchester.

References

Balestrieri, M., Sytema, S., Gavioli, I., et al (1989) Patterns of psychiatric care in South-Verona and Groningen. A case-register follow-up study. Acta Psychiatrica Scandinavica, 89, 437–444.CrossRefGoogle Scholar
Balestrieri, M., Micciolo, R., De Salvia, D., et al (1992) Confronti e prospettive nella utilizzazione dei registripsichiatrici dei casi. Epidemilogia e Psichiatria Sociale, 1, 133–148.CrossRefGoogle Scholar
Balestrieri, M., Bon, M. G., Rodriguez-Sacristan, A., et al (1994) Pathways to psychiatric care in South Verona, Italy. Psychological Medicine, 24, 641–649.CrossRefGoogle ScholarPubMed
Gardner, M. J. & Altman, D. G. (1989) Statistics with Confidence – Confidence Intervals and Statistical Guidelines. London: BMJ Publications.Google Scholar
Gardner, M. J., Gardner, S. B. & Winter, P. D. (1989) Confidence Interval Analysis Version 0.5. London: BMJ Publications.Google Scholar
Gater, R. A. & Goldberg, D. P. (1991) Pathways to psychiatric care in South Manchester. British Journal of Psychiatry, 159, 90–96.CrossRefGoogle ScholarPubMed
Gibbons, J. L., Jennings, C. & Wing, J. K. (eds) (1964) Psychiatric care in 8 Register Areas. Statistics from 8 Psychiatric Case Registers in Great Britain 1976–1981. Series planned by the Joint UK Inter-Register Committee, Vol No 1, unpublished report, Southampton Psychiatric Register. Fareham: Knowle Hospital.Google Scholar
Goldberg, D. P., Tamtam, D., Gater, R., set al (1992) The Interface Between Primary Care and Specialist Mental Health Services in the Community. Final Report to DOH on Grant No. JR126/0486. Manchester: Mental Illness Research Unit.Google Scholar
ten Horn, G. H. M. M., Giel, R., Gulbinat, W. H., et al (1986) Psychiatric Case Registers in Public Health. A Worldwide Inventory 1960–1985. Amsterdam: Elsevier.Google Scholar
ten Horn, G. H. M. M., Moschel, G., Giel, R., et al (1988) Patterns of mental health care in two European areas: Mannheim, Federal Republic of Germany and Groningen, The Netherlands. Acta Psychiatrica Scandinavica, 77, 271–279.CrossRefGoogle ScholarPubMed
Jackson, G., Gater, R., Goldberg, D., et al (1993) A new community mental health team based in primary care: a description of the service and its effect on service use in the first year. British Journal of Psychiatry, 162, 375–384.CrossRefGoogle ScholarPubMed
Jackson, G., Percival, C., Gater, R., et al (1995a) Patterns of work in a multidisciplinary community mental health team (submitted).Google Scholar
Jackson, G., Saraf, T., Warner, R., et al (1995b) The care of patients with chronic schizophrenia: A comparison of two services (submitted).Google Scholar
Jarman, B. (1983) Identification of underprivileged areas. British Medical Journal, 286, 1705–1709.Google Scholar
Jarman, B. (1984) Underprivileged areas: validation and distribution of scores. British Medical Journal, 289, 1587–1592.CrossRefGoogle ScholarPubMed
McGrath, G. & Tantam, D. (1987) Long-stay patients in a psychiatric day hospital: A case note review. British Journal of Psychiatry, 150, 836–840.Google Scholar
Munk-Jorgensen, P. & Tansella, M. (1986) Hospital and community based psychiatry: a comparative study between a Danish and an Italian psychiatric service. International Journal of Social Psychiatry, 32, 6–15.Google Scholar
Rosenman, S. (1994) Psychiatric bed usage under different systems of care: a comparison of South-Verona (Italy) and Canberra (Australia). Epidemiologia e Psichiatria Sociale, 3, 163–170.CrossRefGoogle Scholar
Salokangas, R. K. R., Der, G. & Wing, J. K. (1985) Community psychiatric services in England and Finland. Social Psychiatry, 20, 23–29.Google Scholar
Sytema, S., Balestrieri, M., Giel, R., et al (1989) Use of mental health services in south Verona and Groningen: comparative case-register study. Acta Psychiatrica Scandinavica, 79, 153–162.Google Scholar
Sytema, S., Giel, R., ten Horn, G. H. M. M., et al (1989) The reliability of diagnostic coding in psychiatric case registers. Psychological Medicine, 19, 999–1006.CrossRefGoogle ScholarPubMed
Sytema, S., Laciga, J., Giel, R., et al (1992) Inpatient care in an eastern and a western European area. Social Psychiatry and Psychiatric Epidemiology, 27, 274–279.Google Scholar
Tansella, M. (1986) Community psychiatry without mental hospitals. The Italian experience: a review. Journal of the Royal Society of Medicine, 79, 664–669.Google Scholar
Tansella, M. (1993) The Research Unit of the Servizio di Psicologia Medica at the Institute of Psychiatry of the University of Verona, 1980–1991. Psychological Medicine, 23, 239–247.Google Scholar
Tansella, M. & De Salvia, D. (1986) Case registers in comprehensive community psychiatric service areas in Italy. In Psychiatric Case Registers in Public Health. Worldwide Inventory 1960–1985 (eds ten Horn, G. H. M. M. et al), pp. 140–145. Amsterdam: Elsevier.Google Scholar
Tansella, M., Balestrieri, M., Meneghelli, G., et al (1991) Trends in the provision of psychiatric care 1979–1988. In Community-based Psychiatry. Long-term Patterns of Care in South-Verona (ed. Tansella, M.), pp. 5–16. Psychological Medicine Monograph Supplement 19. Cambridge: Cambridge University Press.Google Scholar
Thornicroft, G. (1991) Social deprivation and rates of treated mental disorders: developing statistical models to predict psychiatric service utilisation. British Journal of Psychiatry, 158, 465–484.Google Scholar
Thornicroft, G., Bisoffi, G., De Salvia, D., et al (1993) Urban-rural differences in the associations between social deprivation and psychiatric service utilization in schizophrenia and all diagnoses: a case-register study in Northern Italy. Psychological Medicine, 23, 487–496.CrossRefGoogle ScholarPubMed
Torre, E. & Marinoni, A. (1985) Register studies: data from four areas in Northern Italy. In Focus on the Italian Psychiatric Reform (eds Perris, C. & Kemali, D.). Acta Psychiatrica Scandinavica, suppl. 316, pp. 87–94. Copenhagen: Munksgaard.Google Scholar
Tranchina, P., Archi, G. & Ferrara, M. (1981) The new legislation in Italian psychiatry: an advanced law originating from alternative practice. International Journal of Law and Psychiatry, 4, 181–190.Google Scholar
Warner, R., Gater, R., Jackson, G., et al (1993) Effects of a community mental health service on the practice and attitudes of general practitioners. British Journal of General Practice, 43, 507–511.Google ScholarPubMed
Wing, J. K. & Fryers, T. (1976) Psychiatric Services in Camberwell and Salford. Statistics from the Camberwell and Salford Psychiatric Registers, 1964–1974. London: Institute of Psychiatry.Google Scholar
World Health Organization (1990) The WHO International Classification of Mental Health Care: Part I – Curative Activities. Copenhagen: WHO Regional Office for Europe.Google Scholar
World Health Organization (1992) The ICD–10 Classification of Mental and Behavioural Disorders, Conversion Tables between ICD–8, ICD–9 and ICD–10. Geneva: WHO Division of Mental Health.Google Scholar
World Health Organization (1993) Classificazione Internationale aell'Assistenza fornita dai Servizi di Salute Mentale (WHO-CIASM). Parte I – Attivita Curative. (Italian translation by Amaddeo, F. & Ruggeri, M.) Epidemiologia e Psichiatria Sociale, 2, 54–65.Google Scholar
Submit a response

eLetters

No eLetters have been published for this article.