Socio-economic status and geographies of psychiatric inpatient service use. Places, provision, power and wellbeing

Abstract

This editorial briefly summarises some aspects of research on socio-economic status and use of mental health services that have particular relevance for the theme of this issue of Epidemiologia e Psichiatria Sociale. This discussion takes a view from the perspective of health geography, which examines how the relationships between individuals and their social and physical environment result in variations in health and health care use. Three particular issues are considered here. First, the geographical distribution and organisation of psychiatric services may interact with social and economic factors in ways that are important for service use. Second, increasingly sophisticated ecological modelling strategies have elucidated the associations between socio-economic factors and service use at the population level. Third, more intensive, qualitative research complements these statistical analyses and encouraged reflection on the socio-economic processes, within psychiatric care settings, as well as in wider society, which influence service use.

The gravitational force of mental health services: distance decay effects in a rural Swiss service area

“…In summary, our findings and their comparison with results from previous studies support the notion that the distance decay relationship in mental health services is not a simple and consistent one but rather results from a complex interaction between geographical proximity to services, socioeconomic conditions in local communities, the organization of mental health services, and the transportation infrastructure [ 2 , 3 ].…”

A conceptual framework for improving well-being in people with a diagnosis of psychosis

“…The four dimensions of influences on the transition can serve to identify targets for clinical interventions to improve well-being in people with psychosis. Distal influences, such as socio-economic status or green areas, have been shown to impact on well-being and mental health service use (Curtis, 2007; Losert et al 2012), but they will be the focus of population level interventions rather than mental health services. Feasible interventions exist for the remaining three dimensions.…”

What is the impact of socio-economic inequalities on the use of mental health services?

“…As discussed in detail in Sarah Curtis's editorial in this issue (Curtis, 2007), we know that the relationship between distance from hospital and service use is complex, with continued debate in the international research literature regarding the importance of proximity to static facilities as well as the best method to measure distance For the future we need a greater understanding of the relationship between social conditions and mental health service use, for two main reasons: Firstly, there is an urgent need to improve equity in the accessibility and utilization of mental health services in the less developed countries as well as in the developed ones. In countries with a well developed welfare state, like the UK and Italy, equality was until recently considered to be the equal distribution of services to every individual.…”

“…Furthermore, it needs to be acknowledged that service users will not necessarily access the health service closest to their home, for a variety of different reasons (Curtis et at, 2006). As detailed by Curtis (2007) researchers now have access to more sophisticated research tools to examine more closely the complex relationships between where service users live (or work), the mental health services they use, and the 'real' distance travelled to access those services. Future studies of this nature, seeking to explore service utilization in a more sophisticated way, have to potential to provide a greater understanding of the relationship between SES and mental health service use, guiding the decision-making of mental health planners and policymakers.…”