This article discusses the possible links between urbanisation, demographic variables and psychiatric admission rates. Inpatient psychiatric admission rates were determined for the 647 Dutch municipalities. Then urbanisation was determined using 'area address density', a unit of measurement developed by the Dutch Central Statistical Office. Five degrees of urbanisation are distinguished. Twentynine demographic variables which might have a theoretical link with admission rates were collated for all municipalities.The results show that standardised total admission rates increase with urbanisation.The mean admission rate for the least urbanised municipalities is 2.02 per 1000 resident population, the rate for the most urbanised municipalities is 3.72 per 1000. It was then found that the prevalence of demographic risk factors increased with urbanicity. At the same time, it was found that almost all demographic variables correlated with admission rates. A multiple regression model -which accounts for 22% of variance -shows that income distribution, address density and mortality all contribute significantly to the variance in admission rates for the 647 Dutch municipalities.
In Amsterdam in the Netherlands, in 1993, an intensive case management project was initiated. This article describes this well-known Dutch project as it was tested in a randomised clinical trial using regular outpatient and inpatient care as the control conditions. All the patients in this project are very ill and most of them suffer from schizophrenia. The new form of care has the same effect on everyday problems as regular care. The basis of this data is too narrow for the drawing of conclusions about the risk of suicide. Longer follow-up would be advisable in order to improve our understanding of this problem. There has been no drop in compulsory admissions. On the other hand, there has been a spectacular decrease in the number of bed days (a reduction of 66% in the second year of the ACT programme).
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