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International recommendations for mental health care have advocated for a reduction in the length of stay (LOS) in full-time hospitalization and the development of alternatives to full-time hospitalizations (AFTH) could facilitate alignment with those recommendations. Our objective was therefore to assess whether the development of AFTH in French psychiatric sectors was associated with a reduction in the LOS in full-time hospitalization. Using data from the French national discharge database of psychiatric care, we computed the LOS of patients admitted for full-time hospitalization. The level of development of AFTH was estimated by the share of human resources allocated to those alternatives in the hospital enrolling the staff of each sector. Multi-level modelling was carried out to adjust the analysis on other factors potentially associated with the LOS (patients’, psychiatric sectors’ and environmental characteristics). We observed considerable variations in the LOS between sectors. Although the majority of these variations resulted from patients’ characteristics, a significant negative association was found between the LOS and the development of AFTH, after adjusting for other factors. Our results provide first evidence of the impact of the development of AFTH on mental health care and will provide a lever for policy makers to further develop these alternatives.

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BackgroundInvoluntary psychiatric care remains controversial. Geographic disparities in its use can challenge the appropriateness of the care provided when they do not result from different health needs of the population. These disparities should be reduced through dedicated health policies. However, their association with the supply of health and social care, which could be targeted by such policies, has been insufficiently studied. Our objectives were therefore to describe geographic variations in involuntary admission rates across France and to identify the characteristics of the supply of care which were associated with these variations.MethodsInvoluntary admission rate per 100,000 adult inhabitants was calculated in French psychiatric sectors’ catchment areas using 2012 data from the national psychiatric discharge database. Its variations were first described numerically and graphically. Several factors potentially associated with these variations were then considered in a negative binomial regression with an offset term accounting for the size of catchment areas. They included characteristics of the supply of care (public and private care, health and social care, hospital and community-based care, specialised and non-specialised care) as well as adjustment factors related to epidemiological characteristics of the population of each sector’s catchment area and its level of urbanization. Such variables were extracted from complementary administrative databases. Supply characteristics associated with geographic variations were identified using a significance level of 0.05.ResultsSignificant variations in involuntary admission rates were observed between psychiatric sectors’ catchment areas with a coefficient of variation close to 80%. These variations were associated with some characteristics of the supply of health and social care in the sectors’ catchment areas. Notably, an increase in the availability of community-based private psychiatrists and the capacity of housing institutions for disabled individuals was associated with a decrease in involuntary admission rates while an increase in the availability of general practitioners was associated with an increase in those rates.ConclusionsThere is evidence of considerable variations in involuntary admission rates between psychiatric sectors’ catchment areas. Our results provide lines of thoughts to reduce such variations, in particular by supporting an increase in the availability of upstream and downstream care in the community.Electronic supplementary materialThe online version of this article (10.1186/s12913-018-3064-3) contains supplementary material, which is available to authorized users.

A study aimed at determining individual factors associated with participation in community treatment with ivermectin was conducted in a village hyperendemic for onchocerciasis in northern Cameroon. The respective influences of sex, age, place of residence, distance between the compound and the dosing point, compound size, and participation in treatment by authoritative individuals in the compound was evaluated using univariate and multivariate analysis. Participation in treatment was closely associated with the attitude of the compound heads. Participation of compound heads in treatment increased as the household size increased, and as the distance to the distribution point diminished. This may be explained by the fact that getting information on health programmes is easier in large households whose members are involved in various social activities, and in compounds located near the village centre. Staff involved in health education should take this issue into account, and try to ensure circulation of information particularly to those living in small or remote compounds.