The geographical mobility of severely mentally ill residents in London

Background: There is currently great concern over the demands on psychiatri c services in metropolitan areas in most developed countries, and this is e xemplified in capital cities. These greater demands were not anticipated by those planning psychiatric services and the consequences have led to insuf ficient beds in many areas. We investigated the geographical mobility (the number of changes of address in the past 2 years) of patients presenting to services in greater London, to determine whether this might be a possible factor in the increased demand. Method: The geographical mobility of the se verely mentally ill was determined by laking a random sample of all psychia tric admissions to hospitals serving residents in the London area over the calendar year of 1994 (M = 156) and an equivalent sample of patients in an established community mental health team (n = 74) in one area (Paddington). The extent of geographical movement was determined for the 2 years prior t o interview. Results: Greater geographical movement in the in-patient group was found for those living in inner London compared with outer London and for patients admitted to hospitals outside their catchment area. Twenty-eig ht percent of the in-patient sample had changed address in the year before admission (including 13% more than once) and 39% had changed address in the 2 years prior to admission. By contrast, the patients seen by the communit y psychiatric team were less than half as likely to have changed address ov er the previous year as the in-patients, and none of the community team's p atients had changed address more than once over the previous year. The geog raphically mobile patients had significantly longer periods in hospital tha n geographically stable patients. Conclusion: Geographical mobility of psyc hiatric patients in London is high and is particularly marked for those pre senting for in-patient treatment. These findings suggest that greater mobil ity could be one of the most important reasons for the higher than expected demands on psychiatric services and the difficulties in maintaining contac t with patients in London in general and inner London in particular. More a ttention should be paid to geographical mobility as a predictor of psychiat ric service use, and it is recommended that it is recorded regularly in inf ormation systems.