Lamont A, Ukoumunne O C, Tyrer P, Thornicroft G, Patel R, Slaughter J
Department of Public Mental Health, Imperial College School of Medicine, London, UK.
Soc Psychiatry Psychiatr Epidemiol. 2000 Apr;35(4):164-9. doi: 10.1007/s001270050199.
There is currently great concern over the demands on psychiatric services in metropolitan areas in most developed countries, and this is exemplified in capital cities. These greater demands were not anticipated by those planning psychiatric services and the consequences have led to insufficient 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.
The geographical mobility of the severely mentally ill was determined by taking a random sample of all psychiatric admissions to hospitals serving residents in the London area over the calendar year of 1994 (n = 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 to interview.
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-eight 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 community psychiatric team were less than half as likely to have changed address over the previous year as the in-patients, and none of the community team's patients had changed address more than once over the previous year. The geographically mobile patients had significantly longer periods in hospital than geographically stable patients.
Geographical mobility of psychiatric patients in London is high and is particularly marked for those presenting for in-patient treatment. These findings suggest that greater mobility could be one of the most important reasons for the higher than expected demands on psychiatric services and the difficulties in maintaining contact with patients in London in general and inner London in particular. More attention should be paid to geographical mobility as a predictor of psychiatric service use, and it is recommended that it is recorded regularly in information systems.
目前，大多数发达国家的大都市地区对精神科服务的需求备受关注，首都城市尤为如此。精神科服务规划者并未预料到这些更高的需求，其后果是许多地区床位不足。我们调查了在大伦敦地区接受服务的患者的地理流动性（过去两年内的住址变更次数），以确定这是否可能是需求增加的一个因素。
通过对1994年全年为伦敦地区居民服务的所有精神病住院患者（n = 156）以及一个地区（帕丁顿）一个成熟社区精神卫生团队中的同等数量患者（n = 74）进行随机抽样，确定重症精神病患者的地理流动性。在访谈前的两年内确定地理移动的程度。
与伦敦外围地区的患者相比，居住在伦敦市中心的住院患者以及在其服务区外医院住院的患者的地理移动性更大。28%的住院患者样本在入院前一年更改了住址（其中13%更改不止一次），39%在入院前两年内更改了住址。相比之下，社区精神科团队诊治的患者在上一年更改住址的可能性不到住院患者的一半，且社区团队的患者在上一年中没有一人更改住址超过一次。地理流动性大的患者住院时间明显长于地理稳定性高的患者。
伦敦精神病患者的地理流动性很高，对于那些寻求住院治疗的患者尤为明显。这些发现表明，更大的流动性可能是对精神科服务需求高于预期以及在伦敦尤其是伦敦市中心难以与患者保持联系的最重要原因之一。应更多地关注地理流动性作为精神科服务使用预测指标的作用，并建议在信息系统中定期记录。
