The spectrum of psychiatric morbidity in a defined geographical area

The concept of 'the pathway to psychiatric care' as described by Goldberg & Huxley (1980) using a scheme of five 'levels' and four 'filters', has provided a useful framework in investigating referral processes in places where health services are organized in a way similar to the British National Health Service. Previous estimates of psychiatric morbidity at each of the levels of this model have been calculated, based upon data obtained from diverse geographical areas and over different time frames. The value of these estimates for service planning is therefore limited by the heterogeneity of the data sources. This paper provides data related to all five levels based upon the same geographical area (South-Verona, Italy) and within the same time frame (one week in 1987). The importance of studying the full spectrum of psychiatric morbidity at all levels in the same area is discussed. In particular, it is shown that the assessment of morbidity in the primary medical care setting (levels 2 and 3) and data about filters 2 and 3 can provide useful information for the evaluation of specialist services (levels 4 and 5) as well as for understanding changes in the provision of specialist care.