Table Of ContentEstimating Needs
for Mental Health Care
A Contribution of Epidemiology
Edited by H. Hafner
With 25 Figures
Springer-Verlag
Berlin Heidelberg New York 1979
Prof. Dr. Dr. Heinz Hafner,
Zentralinstitut fUr Seelische Gesundheit, J 5, D-6800 Mannheim 1
ISBN -13 :978-3-540-09425-8 e-ISBN -13: 978-3-642-67338-2
DOl: 10.1007/978-3-642-67338-2
Library of Congress Cataloging in Publication Data.
Main entry under title: Estimating needs for mental health care. Bibliography: p.
Includes index. 1. Social psychiatry. 2. Mental health services. 3. Epidemiology.
I. Hafner, Heinz. RC455.E84 362.2'04'22 79-12839
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Contents
List of Contributors. . . . . . . . . . . . . . . . . . . . . . . . . . . . .. VII
Preface. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. IX
Acknowledgement. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. X
1 Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
1.1 Hafner, H.:
Estimation of Needs by Epidemiological Instruments. . .. 1
2 Morbidity, Needs, and Utilization: General Contributions . 19
2.1 Wing, I. K.:
Ideas in Psychiatric Epidemiology. ................ 19
2.2 Katschnig, H.:
Prospects for Epidemiological Research in Neurosis ..... 30
2.3 Stromgren, E., Kyst, E., Ryberg, I., Weeke, A.:
Estimation of Need on the Basis of Field Survey Findings. 37
3 Psychiatric Case Register as a Basis for Estimation and
Monitoring of Needs ......................... 43
3.1 Dupont, A.:
Psychiatric Case Registers. . . . . . . ............... 43
3.2 Fryers, T.:
Estimation of Need on the Basis of Case Register Studies:
British Case Register Data ...................... 52
3.3 Helgason, T.:
Estimation of Need on the Basis of Case Register Studies:
Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64
4 Psychiatric Morbidity and Needs for Care in General
Practice .................................. 69
4.1 Zintl-Wiegand, A., Cooper, B.:
Psychiatric Morbity in General Practice in a West-German
City .................................... 69
4.2 Robak,O.H.:
Psychiatric Morbidity and Treatment in General Medical
Practice: Discussion .......................... 80
5 Suicidal Attempts in Hospital-Emergency Units. ....... 85
5.1 Welz, R.:
Social and Ecological Background of Attempted Suicides
in Mannheim . . . . . . . ....................... 85
6 Epidemiological Studies in Child Psychiatry. . . . . . . . .. 97
6.1 Graham, Ph. .
Child Psychiatry: Recent Epidemiological Advances. . . .. 97
6.2 Wing, L.:
Mentally Retarded Children in Camberwell (London) .... 107
v
6.3 Liepmann, M. C.:
Mentally Handicapped Children in Mannheim. . . . . . . . . 113
7 Needs for Mental Health Care and Utilization of Services
Monitored by Field Studies. . . . . . . . . . ........... 125
7.1 Nielsen, J ., Nielsen, J. A.:
Incidence of First Contacts and Need of Staff and Beds
in a Community Psychiatric Service . . . . . . . . . . . . ... 125
7.2 Lehtinen, V., Viiisiinen, E.:
Estimate of the Need for Psychiatric Services, as Indicated
by a Social-Psychiatric Survey of the Finnish Population. . 131
SubjectIndex. . . . . . . . . . . . . . . . ................... 135
VI
List of Contributors
Cooper, B., Prof. Dr. med.
Zentralinstitut fUr Seelische Gesundheit, J 5, D-6800 Mannheim
Dupont, A., M. D.
Institut of Psychiatry, Aarhus Psychiatric Hospital,
8240 Risskov, Denmark
Freyers, R., M. D., M. F. C. M., D. P. H.
Department of Community Medicine, University of Manchester,
Stopford Building, Oxford Road, Manchester M13 9PT, United
Kingdom
Graham, P., FRCP, FRCPsych
Department of Child Psychiatry, The Hospital for Sick Children,
Great Ormond Street, Londong WC1N 3JH, United Kingdom
Hafner, H., Prof. Dr. med. Dr. phil.
Zentralinstitut fUr Seelische Gesundheit, J 5, D-Mannheim
Helgason, T., Prof. Dr. med.
Department of Psychiatry, University of Iceland, Reykjavik,
Iceland
Katschnig, H., PD Dr. med.
Psychiatrische Klinik, Universitat Wien, A-1097 Wien
Kyst, E., Dr.
Psychiatric Hospital, 8240 Risskov, Denmark, Institute of
Psychiatric Demography
Lehtinen, V., Prof. Dr. med.
Department of Psychiatry, University of Turku, 20700 Turku,
Finland
Liepmann, M. C., Dr. phil.
Zentralinstitut fUr Seelische Gesundheit, J 5, D-Mannheim
Nielsen,J.,M. D.
Institut of Psychiatric Demography, Aarhus Psychiatric Hospital,
8240 Risskov, Denmark
Nielsen, J. A., M. D.
Institute of Psychiatric Demography, Aarhus Psychiatric Hospital,
8240 Risskov, Denmark
Robak, O. H., Prof. Dr. med.
Dikemark Hospital, Dept. 2, 1385 Solberg, Norway
VII
Ryberg, I., Social Worker
Psychiatric Hospital, 8240 Risskov, Denmark
Stromgren, E., Prof. Dr. med.
Institute of Psychiatry, University of Aarhus, 8240 Risskov,
Denmark
Viiisiinen, E., Prof. Dr. med.
Department of Psychiatry, University ofOulu, 90210 Oulu,
Finland
Weeke, A., Dr.
Institute of Psychiatric Demography, Psychiatric Hospital,
8240 Risskov, Denmark
Welz, R., Dr. rer. soc.
Zentralinstitut fUr Seelische Gesundheit, J 5, D-6800 Mannheim
Wing, J. K., Prof. M. D., Ph. D.
Medical Research Council, Social Psychiatric Unit, Institute of
Psychiatry, De Crespigny Patk, London SE5 8AF, United Kingdom
Wing, L., M. D.
Medical Research Council, Social Psychiatric Unit, Institute of
Psychiatry, De Crespigny Park, London SE5 8AF, United Kingdom
Zintl-Wiegand, A., Dr. med.
Zentralinstitut fUr Seelische Gesundheit, J 5, D-6800 Mannheim
VIII
Preface
The many significant changes that have come about in the mental
health service of different countries in the last two decades have made
administrative and political decision making in the distribution of care
services a much more hazardous business. In the United States, for
example, the number of occupied psychiatric beds fell from 550,000
in 1955 to 190,000 in 1977. England and Wales experienced similar if
less pronounced changes, while in the Federal Republic of Germany
the same trend became apparent some five years ago, although here
the initial hospitalisation rates were lower.
Enquiry into the real needs for various forms of mental health care,
especially the need for hospital beds, for places in homes and hostels,
and for specialist out-patient treatment, has now become a funda
mental aim of research in social psychiatry. To achieve this goal by epi
demiological concepts and methods, including the investigation of
true morbidity rates and the estimation of the related need for care,
must be used.
The First European Symposium on Social Psychiatry, which was
held in Mannheim in 1977 on the occasion of the opening of the
Central Institute of Mental Health, was dedicated to this topic which
is so relevant to the present and important to the future of our health
services. This volume contains some of the papers presented. Based as
they are on epidemiological principles, they elucidate the pre-con
ditions necessary for the estimation of mental health care needs and
contribute relevant findings from recent research programmes in this
area. Thereby, the volume offers the reader a well-founded orientation
toward recent work including an overview of the "state of the art" in
this field of research especially among groups currently working in
Europe.
Mannheim, December 1978 H. Hafner
IX
Acknowledgements
Thanks are due to Mrs. Christa Khalil and Professor Michael Kelleher,
Cork/Eire, for their assistance in the English translation and to Dr.
Wagner Gattaz for preparing the subject index. Acknowledgement is
also due to the Volkswagen Foundation for its generous financial
support.
1 Introduction
1.1 Estimation of Needs by Epidemiological Instruments
H. Hafner
1.1.1 Introduction
The majority of industrial nations provide comprehensive systems of medical care and
some of them also provide extensive networks of social services. These systems, which
protect against sickness and the hazards of economic and social distress, were
established through great sacrifices by individuals and society. Many years were spent
in their development. Presently they consume a large part of the gross national product
of most countries. The organisers and administrators of these services are subjected to
everlasting pressure to justify to the public, who must foot the bill, their value in terms
of costs and benefits.
It follows that health care systems cannot continue to expand in the absence of
clearly defined goals. The growth of a service can be limited by the availability of
resources. This could occur when the total budget available is fixed beforehand or when
a ceiling is set on the number of trained personnel to be employed. In such cases of
limited disposable resources one must decide which needs are to take priority in the
distribution of limited services. These latter questions are of immediate interest to
developing countries because of the scant resources available to health care. Further
more, these countries now aim to avoid the mistakes committed by wealthier nations
so that, at least, they will make the best and most effective use of the means at their
disposal.
If the growth of a health care system, which to a large extent was unplanned and
spontaneous, is brought to a standstill by pressure from without, conflict between
existing institutions usually results in further resistance to necessary changes. These
external factors, however, which form the matrix of society while giving the health
system its meaning and determining its goals, do not themselves remain unaltered. They
are influenced by demographic and social changes, by the growth of knowl eg de and the
development of new techniques, by changes in the needs of clients and lastly, though
not least, by political decree. Examples that come to mind include the recent fall in the
birth rate in several European countries resulting in decreasing bed usage in maternity
and paediatric hospitals and the rise in the frequency of admission of patients diagnosed
as suffering from alcoholism, which in part may have resulted from the acceptance by
health insurance companies and others that alcoholism is a bona fide medical condition.
Earlier examples are the treatment of syphilis with penicillin and the outpatient treat
ment of eczema and other skin allergies with steroids which has led to a fall in the num
ber of in-patient admissions to dermatolOgical units. Finally, the new philosophy that
any form of care is superior to admission to a mental hospital for the chronically ill has
resulted in a huge reduction in the number of mental hospital beds currently occupied
in the United States of America, from approximately 550,000 in 1955 to 190,000 in
1977 (Greenblatt and Glazier, 1975, Greenblatt, 1977).
An undue increase in numbers of qualified personnel brings new problems in its train.
1
