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A five-year survey of a psychiatric service in a geographically delimited rural population given easy access to this service

1965; Elsevier BV; Volume: 6; Issue: 3 Linguagem: Inglês

10.1016/s0010-440x(65)80032-3

1532-8384

Johannes Nielsen, Niels Juel‐Nielsen, Erik Strömgren,

Mental Health and Patient Involvement

This is a five-year-survey of the work in the psychiatric clinic in Samsø which is situated in the Kattegat between Jutland and Zealand, two hours by ferry boat from Århus in Jutland and Kalundborg in Zealand. The island consists of 28,151 acres of which 22,396 acres are farming land. The population of 6,189 is a rather wealthy farming population. During the first 5 years, 472 patients aged 15+ were referred to the clinic, counting only patients referred for the first time. These patients made up 9.7 per cent of the population of 4,860 aged 15+ in the middle of the five-year-period, giving an average referral rate of 19.4 per 1,000 per year. Of this population 50.8 per cent were men and 49.2 per cent women compared to 37.9 per cent men and 60.4 per cent women among the patients referred to the clinic. The percentage of women referred is especially high in the age group 20–34 with a peak of 18 per cent in the age group 20–29. The percentage of men referred is exceptionally low in the age group 35–39. The average referral rate is 7.9 for men and 11.9 for women. The only statistically significant difference in the distribution by marital status (both among the population and the patients) is found in the group of divorced women with 1.4 per cent among the population and 3.7 per cent among the patients (p < 0.01). The percentage of female patients born outside the island is higher than the percentage of the female population born in the island; 44.2 per cent compared to 36.7 per cent (p < 0.02). The percentage of patients with psychoses has increased from 30 per cent in 1957 to 46.5 per cent in 1961, the percentage of character disorders has decreased from 12 to 4.9 per cent, and the percentage of neuroses has decreased from 37.0 to 24.8 per cent during the same period. The total number of patients referred is about the same per year during the five-year-period the clinic has existed. For the five-year-period, the rate per 1,000 for psychoses is 34.4 for women and 36.8 for men, whereas for neuroses, the rate is 42.2 for women and 10.9 for men. The total rate for mental illness is higher for women than for men; 119.2 per 1,000 for women and 75.7 for men. When women and men are taken together the rate is 97.0 per 1,000 for the total five-year-period. The number of consultations to the 472 patients has been 3,228 with 1,571 consultations in the clinic and 1,451 in the patients' homes, 241 patients have been visited at least once in their homes and many of those have been visited many times in their homes. Of the 472 patients referred, 270 were treated by the psychiatrists, 61 of those were much improved, 136 were improved and 73 were unchanged. The total number of patients was divided into three groups according to where and by whom they were considered to be treated best and most practically; 43 per cent might be treated by the general practitioners after examination of the patients by the psychiatrist and advice to the general practitioner concerning treatment; 46 per cent might be treated as out-patients in the psychiatric clinic in the island, and 11 per cent were in need of treatment in a psychiatric hospital. Of the 472 patients referred, 242 had a clearly defined subjective need of treatment. In the Samsø-Project it has been shown that there is a great need for community psychiatric service in close cooperation with the physicians in the community, but it has also been shown that 90 per cent of the patients referred to this service can be treated without being hospitalized—leaving admission rate to psychiatric hospital as low as 2/1,000 per year, even with maximum opportunities for psychiatric treatment offered.