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Int. J. Environ. Res. Public Health 2016, 13(12), 1204;

Regional Correlates of Psychiatric Inpatient Treatment

University of Helsinki and Helsinki University Hospital, Välskärinkatu 12, Helsinki FI-00029, Finland
Unit for Mental Health, National Institute for Health and Welfare (T.H.L.); Mannerheimintie 168, Helsinki FI-00270, Finland
Public Health Medicine, University of Helsinki and Helsinki University Hospital, Helsinki FI-000014, Finland
University of Tampere School of Health Sciences, and Tampere University Hospital, Lääkärinkatu 1, Tampere FI-33014, Finland
Turku University Hospital and University of Turku, Kiinanmyllynkatu 4-8, Turku FI-20520, Finland
University of Turku, Turku FI-20014, Finland
Department of Social Services and Health Care, City of Helsinki, Helsinki FI-00099, Finland
Author to whom correspondence should be addressed.
Academic Editor: Paul B. Tchounwou
Received: 21 September 2016 / Revised: 13 November 2016 / Accepted: 30 November 2016 / Published: 5 December 2016
(This article belongs to the Section Global Health)
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Current reforms of mental health and substance abuse services (MHS) emphasize community-based care and the downsizing of psychiatric hospitals. Reductions in acute and semi-acute hospital beds are achieved through shortened stays or by avoiding hospitalization. Understanding the factors that drive the current inpatient treatment provision is essential. We investigated how the MHS service structure (diversity of services and balance of personnel resources) and indicators of service need (mental health index, education, single household, and alcohol sales) correlated with acute and semi-acute inpatient treatment provision. The European Service Mapping Schedule-Revised (ESMS-R) tool was used to classify the adult MHS structure in southern Finland (population 1.8 million, 18+ years). The diversity of MHS in terms of range of outpatient and day care services or the overall personnel resourcing in inpatient or outpatient services was not associated with the inpatient treatment provision. In the univariate analyses, sold alcohol was associated with the inpatient treatment provision, while in the multivariate modeling, only a general index for mental health needs was associated with greater hospitalization. In the dehospitalization process, direct resource re-allocation and substituting of inpatient treatment with outpatient care per se is likely insufficient, since inpatient treatment is linked to contextual factors in the population and the health care system. Mental health services reforms require both strategic planning of service system as a whole and detailed understanding of effects of societal components. View Full-Text
Keywords: psychiatry; mental health services; hospitalization; integrative medicine psychiatry; mental health services; hospitalization; integrative medicine

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Ala-Nikkola, T.; Pirkola, S.; Kaila, M.; Saarni, S.I.; Joffe, G.; Kontio, R.; Oranta, O.; Sadeniemi, M.; Wahlbeck, K. Regional Correlates of Psychiatric Inpatient Treatment. Int. J. Environ. Res. Public Health 2016, 13, 1204.

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