Community psychiatric services in England and Finland

Summary

The study deals with the development of community psychiatric services in England and Finland, and in two urban areas (Camberwell and Turku) of these countries. The comparison between England and Finland is based on the official statistics for the countries since 1950, and the comparison between Camberwell and Turku on the samples of patients in contact with psychiatric facilities in 1965, 1970, 1975 or 1980. In England, the in-patient rates decreased steadily from the peak of 344 per 100,000 in 1954 to 161 in 1980. In Finland, the rates increased from 235 in 1954 to 425 in 1972, but thereafter decreased to 362 in 1980. During the 1970s, the number of “old” long-stay patients decreased in England but slightly increased in Finland. There are more day-hospital places in England than in Finland. On the other hand out-patient care increased more rapidly in Finland than in England in the 1960s and 1970s. In Camberwell, where there are more facilities for psychiatric patients than in most English districts, the combined rate for in-patients and those attending day hospitals, day centres or workshops remained quite stable during the 1970s. In Turku, where the out-patient care is more extensive but where other extramural facilities are less available than in Camberwell, the rates for long-stay and elderly in-patients did not decrease in the 1970s as they did in Camberwell. The results of this study support the view that overall the number of psychiatric beds (in-patients) is determined by the policy of health authorities and the government. In the 1950s and 1960s local authorities in Finland, encouraged by the government, built new hospitals for chronic psychiatric patients, while the official policy of the British government since the beginning of the 1960s has been to reduce the number of beds in mental hospitals. In Finland the same policy was not adopted until the 1970s. In Finland, extramural care, which has been based on Community Mental Health Centres operating mainly as out-patient clinics without beds, has not prevented the continued accumulation of long-stay and elderly in-patients. In England, on the other hand, extramural care includes day hospitals, day centres, workshops, hostels and group homes, and thus offers more social support than out-patient care alone. This may partly account for the fact that the number of long-stay and elderly in-patients in English mental hospitals is decreasing.