UNPLANNED FIRST CONTACT AS A PREDICTOR OF FUTURE INTENSIVE USE OF MENTAL-HEALTH-SERVICES

The scheduled appointment system, widely used in most mental health se rvices, has never been evaluated. This study attempts such an evaluati on within a community-based mental health service that permits unplann ed access to specialist care, by comparing further service use of firs t-episode patients who come unannounced to seek psychiatric care with that of patients with a planned (scheduled) initial appointment. All p atients with first lifetime psychiatric contact who contacted psychiat ric services reporting to the South-Verona Psychiatric Case Register b etween I January 1982 and 31 December 1989 (n = 1261) were identified, A total of 1056 patients entered the study and were followed for 2 ye ars, Poisson regression with the generalised estimating equation (GEE) method (to take into account both overdispersion of contacts between subjects and correlation between contacts within subjects was used to evaluate the effects of the type of first-ever contact (defined as pla nned or unplanned according to whether or not a regular appointment wa s previously arranged) and of other selected variables, including soci odemographic characteristics, on the annual late of planned and unplan ned care in the follow-up period. Thirty-six percent of first-ever con tacts were unplanned. Patients who began with unplanned contact, as co mpared with others, tt ere more often widowed, separated oi-divorced, unemployed and with a diagnosis of schizophrenia or organic psychosis. Moreover, they had, in the following 2 years, significantly higher ra tes of both unplanned and planned community care, as well as more in-p atient care (higher admission rate and a longer mean length of stay) T hese results at follow-up were confirmed when the rates for the type o f first-ever contact were adjusted for ail other clinical and sociodem ographic variables at initial contact. Step-down Poisson multiple regr ession analysis showed that the rates of both unplanned and planned co ntacts in the follow-up period were significantly and independently as sociated with: type of first-ever contact, diagnosis and type of servi ce first contacted. Unplanned cases at initial contact require particu lar attention and are confirmed as at risk for placing higher demands on mental health services in the following 2 years. The results of the present study mar also have implications for other, non-psychiatric h ealth services.