Geographic variations in involuntary care and associations with the supply of health and social care: results from a nationwide study

Abstract

BackgroundInvoluntary psychiatric care remains controversial. Geographic disparities in its use can challenge the appropriateness of the care provided when they do not result from different health needs of the population. These disparities should be reduced through dedicated health policies. However, their association with the supply of health and social care, which could be targeted by such policies, has been insufficiently studied. Our objectives were therefore to describe geographic variations in involuntary admission rates across France and to identify the characteristics of the supply of care which were associated with these variations.MethodsInvoluntary admission rate per 100,000 adult inhabitants was calculated in French psychiatric sectors’ catchment areas using 2012 data from the national psychiatric discharge database. Its variations were first described numerically and graphically. Several factors potentially associated with these variations were then considered in a negative binomial regression with an offset term accounting for the size of catchment areas. They included characteristics of the supply of care (public and private care, health and social care, hospital and community-based care, specialised and non-specialised care) as well as adjustment factors related to epidemiological characteristics of the population of each sector’s catchment area and its level of urbanization. Such variables were extracted from complementary administrative databases. Supply characteristics associated with geographic variations were identified using a significance level of 0.05.ResultsSignificant variations in involuntary admission rates were observed between psychiatric sectors’ catchment areas with a coefficient of variation close to 80%. These variations were associated with some characteristics of the supply of health and social care in the sectors’ catchment areas. Notably, an increase in the availability of community-based private psychiatrists and the capacity of housing institutions for disabled individuals was associated with a decrease in involuntary admission rates while an increase in the availability of general practitioners was associated with an increase in those rates.ConclusionsThere is evidence of considerable variations in involuntary admission rates between psychiatric sectors’ catchment areas. Our results provide lines of thoughts to reduce such variations, in particular by supporting an increase in the availability of upstream and downstream care in the community.Electronic supplementary materialThe online version of this article (10.1186/s12913-018-3064-3) contains supplementary material, which is available to authorized users.

Service Characteristics and Geographical Variation in Compulsory Hospitalisation: An Exploratory Random Effects Within–Between Analysis of Norwegian Municipalities, 2015–2018

“…This association was slightly weaker between areas, but still robust to different model specifications. This is seemingly in contrast to the finding of Gandré et al ( 6 ) from France of increased levels of compulsorily hospitalised patients in areas with more GPs. However, their variable suffered from collinearity, and the 95% CI for the regression coefficient included 1.…”

“…The observed variation in the levels of compulsory hospitalisation within jurisdictions is noteworthy ( 6 – 12 ) and shows up to a sixfold difference between the highest and lowest average rate of compulsory hospitalisation per 100,000 inhabitants in hospital catchment areas ( 13 ). If such variation does not have any clear explanation, this could indicate that certain areas use more compulsion than strictly necessary and, thus, have a potential for reduction.…”

“…Providing public housing for individuals in high-risk groups might thus reduce the need for compulsory hospitalisation. A French study found lower rates of involuntary inpatients in areas with increased housing capacity for disabled individuals and slightly higher rates in areas with more general practitioners (GPs) ( 6 ). Explanations for the latter finding ranged from GPs' lack of ability to identify and treat mental health needs to a possible confounding with urbanisation.…”

Measuring the level of compulsory hospitalisation in mental health care: The performance of different measures across areas and over time

“…Event measures are most common and are usually based on counts of compulsory admissions (Riecher‐Rössler & Rössler, 1993; Zinkler & Priebe, 2002). Some studies employ counts of individuals with minimum one compulsory hospitalisation (Gandré et al., 2018; Keown et al., 2016; Sheridan Rains et al., 2019; Weich et al., 2017). A number of studies include measures based on duration , normally the number of days between admission and discharge (Aguglia et al., 2016; Girolamo et al., 2008; Wierdsma & Mulder, 2009), although it varies whether studies include days of voluntary stay during an admission (Iversen et al., 2009; Kelly et al., 2018).…”

“…A number of studies report practice variation when comparing the level of compulsory hospitalisation between countries (Hansson et al., 1999; Riecher‐Rössler & Rössler, 1993; Salize & Dressing, 2004; Sheridan Rains et al., 2019; Zinkler & Priebe, 2002) and within areas regulated by the same legislation (Bindman et al., 2002; Engberg, 1991; Keown et al., 2016; Kjellin, 1997). For instance, the highest admission rates among mental health departments in the Veneto region in Italy 2000–2007 were 14 times higher than the lowest rates (Donisi et al., 2016), while in France in 2012, the rate of compulsory hospitalised patients in the highest 10th percentile of psychiatric sectors' catchment areas was 10 times higher than the 90th percentile (Gandré et al., 2018). Such large differences indicate that some areas might use more compulsion than necessary.…”