Child and adolescent psychiatric services in the canton of Zurich: A comparison of outpatient, day clinic, and inpatient referral populations

Findings in intervention research are an important basis for the discussion of issues pertaining to quality control. In Switzerland such findings have been rare. The present study of the entire 1988-1995 referred child and ad olescent population of the Child and Adolescent Psychiatric Service of the Canton of Zurich (N =7538 treated patients) concentrated on the demographic , diagnostic, and therapeutic attributes of the outpatient, day clinic, and inpatient populations that comprised the referred population. Marked diffe rences are found in comparable studies from Germany with regard to patients treated in an inpatient setting. For example, the mean age of the patients in the Zurich sample is lower and patients with conduct disorders are more frequently represented. On the other hand, patients with psychotic illness are missing and, on the average, the duration of treatment is considerably longer. The reasons for these differences are to be found in the various s tructural attributes of the cantonal services that are provided in Zurich. In the area of inpatient care, where in comparison to outpatient settings a nd also day care settings patients with severe disorders are treated, there is a lack of places for the short-term care of acutely ill patients - for example, psychotic patients. This is especially true for adolescent patient s. The limitations of traditional outpatient settings are frequently t mark ed by unsatisfactory treatment results in outpatients with conduct disorder s, developmental disorders, and a high impact of abnormal psychosocial circ umstances.