[Decentralized psychiatry. Evaluation of the first 5 years of psychiatric service based on a general hospital].

In 1977 the state parliament of Berne took the decision to reform the existing psychiatric health care. decentralized, community oriented institutions were to be established with the aim of preventing secondary disabilities due to psychiatric illness, and of enhancing or instigating rehabilitative measures. 4 different psychiatric services based in general hospitals were installed. The present report presents an analysis of statistical data collected during the first 5 years on one of these services. We found a linear increase of admission which appears to be due to several factors: demand, image, manpower, cooperation with other institutions, breadth of the offered service. Furthermore, the distance between the institution and the place of living proved to be an important factor influencing the incidence of psychiatric treatment and the degree of cooperation with other care services--this aspect being consistent with the arguments for a decentralization of care. The degree of consistency in the distribution of diagnoses and the changes of treatment was surprising: an average of 50% of our patients were referred on an out-patient basis, approx. 40% by general hospital wards, 16% remain under the care of the general hospital. Our statistical analysis shows that in an average of 61% of the cases in which a referral to a psychiatric hospital was discussed, this measure could be avoided (although there is a certain degree of subjectivity in this judgement). The psychiatric service does not appear to compete with private practice care: 44% of the patients are referred to general practitioners and practing psychiatrists for after care, while only half as many are referred from private practices.