Spatial distribution of in-patient service use of psychiatric patients: sematic departments versus psychiatric units

Background: It has long been recognized that a high proportion of psychiatr ic patients are admitted to emergency, medical and surgical wards. However, until now no assessment has been made of which urban general hospitals wou ld be most appropriate for the establishment of specific psychiatric facili ties. Method Our study concerned Germany's second largest city, Hamburg (po pulation 1.7 million), and involved an evaluation of psychiatric principal diagnoses in general and psychiatric hospitals. The research was based on d ata collected between 1988 and 1994 embracing approximately 77% of all psyc hiatric patients (n = 64,000) in 41 hospitals. The evaluation was carried o ut using the statistics programs SPSS and DismapWin. Results: We establishe d that the proportion of male patients discharged from somatic wards, mainl y internal medicine, with alcohol and drug abuse as well as with neuroses a nd personality disorders or illegal drug abuse was surprisingly high (70%, 34% and 24% respectively). For female patients the figures were 67%, 40% an d 35% respectively. A geographical analysis of spatial heterogeneity of hos pitalization risks showed that general hospitals admit a disproportionately high number of patients from areas of lower social status - both male and female - from the above-mentioned diagnostic categories. A rank correlation between the classification of areas based on the heterogeneity model and t he social status of the areas supports this hypothesis, at least for males. Conclusion: Our findings lead us to the conclusion that the establishment of new psychiatric services should focus on internal wards in hospitals loc ated in areas of low social status.