Moving into the Community Evaluation of the Effects of a Structural Factor on Community Based Psychiatry and Low-Threshold Psychiatry

Objective In 2005 the ipw acute care units were relocated from the rural area of Rheinau into the outskirts of Winterthur, the second largest city in the canton Zurich. The objective of the present study is to answer the question whether relocation has made a verifiable contribution to community based psychiatry and low-threshold psychiatry. Methods The analysed data were taken from selected items of the cantonal psychiatric basis documentation and the ZUPAZ questionary of patient contentment. For each location, Rheinau and Winterthur, a sample was taken containing data of 12 months. The corresponding data was analysed retrospectively with Chi-Square statistics and paired T-Tests. Results The distance between patients' residence and the psychiatric institution was reduced significantly by 73%. Compulsory admission decreased overall by 10%, with affective disorders showing the most explicit reduction (28%). Regarding patient's contentment with the clinical treatment, there was a considerable increase. The degree of illness severity at the patient's admission was higher in Winterthur than in Rheinau. Conclusions The results indicate that relocation of the acute care units from a rural to an urban area has enhanced community based psychiatry (shorter distance) as well as low-threshold psychiatry (lower rate of compulsory admission, increase in patient's contentment). Nevertheless, there is a major limitation regarding the present study: the two concepts community based psychiatry and low-threshold psychiatry have been operationalised retrospectively. Further prospective empirical evaluations are needed to disclose the relation between community based psychiatry and low-threshold psychiatry.