The impact of an expanding community mental health service on patterns of bed usage: evaluation of a four-year period of implementation.

In the city of Mannheim the introduction of an extensive community mental health service has been shown, by means of case-register data over 41/2 years, to have led to a considerable increase in utilization, mainly at the out-patient level of care. The rates of admission to hospital increased very little. Due to the simultaneous decline in long-term bed occupancy, the overall need for psychiatric beds remained stable at a rate of about 1.2/1000, a rate which is very low by international standards. The sharp decline in the "old' long-stay population was followed by a smaller increase in "new' long-stay patients which it has not been possible to prevent. These patients are, however, admitted for a long-term stay significantly later than formerly, and their diagnostic composition has changed significantly. The increase in the bed requirements for short- and medium-term stay patients resulted from different sources: an increasing morbidity in some groups of disorders, the rising utilization in case of emergencies and severe crises, and the transfer of long-stay patients to alternative care services. The level of these needs was very similar in Mannheim, Salford, Samsø and Camberwell, whereas the rates for long-term beds still show clear national differences.