[Integrated psychiatric care planning].

In order to design an integrated plan for services, all long-term psychiatric patients in Trondheim were registered by professionals on both municipality and county level. Data were obtained from interviews with the patients, supplemented by information from professional personnel. Individual plans, including type and amount of services needed, were prepared for each patient anonymously, to form the basis of a mutually beneficial integrated plan for psychiatric services. A total of 507 patients were registered (0.5% of the population over 18 years). Studying individual patients and their needs makes it possible to make optimal use of limited resources. The sharing of knowledge improves cooperation and coordination, to the benefit of a neglected group of patients.