Utilization of the psychiatric emergency service in Mannheim: ecological and distance-related aspects

Ecologically oriented research of psychiatric service utilization has almost exclusively dealt with regular in- and out-patient services. There are hardly any results on the ecological distribution of utilization rates of psychiatric emergency services. This study aims at investigating the topographic distribution of utilization rates of the psychiatric emergency service out of office hours at the Central Institute of Mental Health (CIMH, Mannheim) from 1982 to 1993. Within this period of time 6463 patients with a total of 14,628 contacts were registered at the CIMH. In order to explain topographic differences in the utilization rates, ecological variables, the distance between patients' residence and service location, and diagnosis were taken into account. The study shows that ecological, distance-related and diagnostic factors all influence the utilization of the psychiatric emergency service in Mannheim. First contact and contact rates decrease from the city centre toward the outskirts. There was a strong general effect of ecological variables: the utilization rates were higher for districts with worse ecological conditions and specific for some diagnostic groups. The greatest difference in utilization rates between the city centre and the outskirts was found for schizophrenia and psychoactive substance use disorders, whereas there was no difference with regard to organic and symptomatic mental disorders. With increasing spatial and time-related distance between residence and service location, the utilization rate decreases. No relation was found between diagnosis and distance. The study also shows an interaction between time-related distance and the ecological variables. The influence of the ecological factors on service utilization is amplified with decreasing distance.