Psychotic disorders in urban areas: an overview of the Study on Low Prevalence Disorders

Objective: This paper reports on a study designed within the framework of t he National Survey of Mental Health and Wellbeing to: estimate the prevalen ce of psychoses in urban areas of Australia; identify profiles of symptomat ology, impairments and disabilities; collect information on services receiv ed and needed; and explore quality of life issues in a broadly representati ve sample of people with psychotic illnesses. Method: The study was conducted over four areas in the Australian Capital T erritory, Queensland, Victoria and Western Australia, as a two-phase survey : (i) a census and screening for psychosis of all individuals who made cont acts with mental health services during a period of 1 month in 1997; and (i i) interviews with a stratified random sample (n = 980) of the screen-posit ive individuals (n = 3800) using a standardised instrument. Results: The point prevalence (1 month) of psychotic disorders in the urban population aged 18-64 is in the range of 4-7 per 1000 with a weighted mean of 4.7 per 1000. People with psychotic disorders experience high rates of functional impairments and disability, decreased quality of life, persisten t symptoms, substance-use comorbidity and frequent side effects of medicati on. Although the utilisation of hospital-based and community mental health services, as well as of public and non-governmental helping agencies, is hi gh, the majority live in extreme social isolation and adverse socioeconomic circumstances. Among the many unmet needs, the limited availability of com munity-based rehabilitation, supported accommodation and employment opportu nities is particularly prominent. Conclusions: The so-called 'low-prevalence' psychotic disorders represent a major and complex public health problem, associated with heavy personal an d social costs. There is a need for a broad programmatic approach, involvin g various sectors of the community, to tackle the multiple dimensions of cl inical disorder, personal functioning and socioeconomic environment that in fluence the course and outcome of psychosis and ultimately determine the ef fectiveness of service-based intervention.