Mental Health Service Utilization Among Patients with Severe Mental Disorders

Abstract

In light of healthcare reforms, the study aims to assess variables associated with mental healthcare service utilization in general and in both primary and specialized care by patients with severe mental disorders (SMD, mainly schizophrenia). The study is based on a sample of 140 patients with SMD from five regions in Quebec (Canada). Variables were organized in accordance with Andersen's conceptual model into four factors: predisposing, enabling, needs, and service utilization. Secondary analyses were also conducted comparing patients who were hospitalized or used emergency rooms (H.ER-Group) with patients who did not use such services (WH.ER-Group). Accessibility of services, continuity of care, and having a case manager appear to be core variables that enable service utilization. Compared with the WH.ER-Group, the H.ER-Group used twice as many services. The study highlights the importance of developing a gamut of coordinated services, easily accessible in local networks, including case managers, family physicians, and shared-care development.

Demand and characteristics of a psychiatric 24-hour emergency service performed by mandatory rotation of licensed psychiatrists in Swiss primary care

“…These findings are in line with other studies on psychiatric services2,12,13 and do not come as a surprise since 75% of patients with schizophrenic disorders have relapses and continued disability, and one-third fail to respond to standard treatment 14…”

Predictors of Healthcare Service Utilization for Mental Health Reasons

“…Despite the pervasive need for mental health treatment among individuals with mental disorders, it is generally acknowledged that a great proportion of them do not use healthcare services [ 15 , 16 , 17 , 18 , 19 ]. Canadian studies report that less than 40% of Canadians suffering from mental disorders consult a healthcare professional or services for mental health reasons [ 20 , 21 ].…”

“…The decision to seek help for mental disorders is a complex process that involves personal socio-demographic characteristics, culturally mediated interpretations of symptoms, availability of healthcare services, economic and socio-structural factors, and healthcare service organization [ 22 ]. A number of healthcare service utilization models exist [ 23 , 24 , 25 , 26 , 27 , 28 , 29 ], but most studies of healthcare service utilization for mental health reasons have used the behavioral model developed by Andersen in the 1960s [ 15 , 16 , 17 , 18 , 30 , 31 , 32 ]. This model conceptualized healthcare service utilization as a function of individuals’ predisposing, enabling, and needs characteristics [ 33 , 34 ].…”

Primary Mental Healthcare and Integrated Services

“…In our research, few general practitioners managed patients with serious mental disorder on a consistent basis. A parallel random cohort study of 140 patients with serious mental disorder released from hospital 12 months before the survey and living in five of Quebec's administrative health regions (Fleury et al, 2010b) showed that 93% of patients were followed by a psychiatrist, 84% by a case manager, and only 50% by a general practitioner. There are many reasons explaining why only a minority of general practitioners manage patients with severe mental disorder.…”