Patterns in the delivery of psychiatric care in Saskatchewan 1971-1972 (II). Types of contacts and some patient career characteristics.

A previous paper dealt with an overview of service sectors and patient volumes (2), whereas this one concentrates on types of contacts and some patient career characteristics. Analysis of a comprehensive psychiatric care utilization data file for Saskatchewan for the 1971-1972 period shows that 'public' sector patients were hospitalized for a greater average length of time than were 'private' sector patients. This may reflect differences in the styles of practice, exigencies of the demand for hospital beds in the 'private' as opposed to the 'public' sector and/or intrinsic differences in the nature of the problem treated in each sector. Some interesting facts regarding patterns of contact were uncovered. The bimodal nature of the 'psychiatric population' was further evident from the data which show that the majority of patients used relatively few services whereas a few used a large number of services. This suggests that the majority of the people seen for psychiatric reasons by medical practitioners were suffering from relatively minor psychiatric disorders. Heavy users of services were much more likely to have had some'public' or University Hospital-based contact. Conversely, light users were predominantly private sector patients. In the 'public' sector, those who had had some in patient treatment were consistently higher users of all services. It is evident that psychiatrists held a dominant position in this community-oriented public sector, having seen a large number of patients, but having had a low average rate of services per patient. In contrast, community nurses saw relatively few patients but saw them very often. This no doubt reflects their role in providing 'maintenance' services to chronic patients in approved homes in the community. In the 'private' sector, 69 percent of the services were delivered by GPs and 23 percent by psychiatrists were more likely to have had 'public' sector activity than were those seen only by GPs; also once in the 'public' sector, they were likelier to have had in patient as well as outpatient treatment. This suggests a 'sifting' of the more "difficult" patients through the private specialist sector into the public sector.