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OBJECTIVES: When comparing patient management and patient outcomes, the available services within a catchment area appear to be a major confounding factor. The ESMS aims to classify services and measure their activity in a standardized way, which opens new opportunities to adjust for service offer. The ESMS allows to map the services available in a set of catchment areas and to identify different profiles. In addition we evaluate the accuracy of the French standardized classification of mental health services and the applicability of the instrument in France. METHODS: 171 services in 24 catchment areas were involved in the study, which focused on the French public mental health care system. Each service was classified according to the ESMS and data were collected on service use. The data for each catchment area were aggregated in residential use, structured day activities, continuous out patient care and emergency out patient care, then a cluster analysis was performed. The ESMS classification of the services based on function was compared to the official French description of services. RESULTS: Four classes were identified: Class 1 high activity in all services, class 2 low activity in all services, class 3 low activity in continuous ambulatory care, class 4 high activity in continuous ambulatory care. The ESMS confirmed the consistency between the French official description of the services' missions and the actual activity. 10% of the services had at least one additional “non official” function. The study showed that the ESMS was adapted for use in France, but it requires expert supervision for large‐scale implementation. CONCLUSIONS: The ESMS proves to be useful not only in mental health service research, but can also bring the possibility to adjust for the catchment area's service profile in outcomes research.

OBJECTIVES: In France a large part of acute hospitalisation beds are occupied by long‐term hospitalisation of schizophrenic patients. A model was developed to compare Intensive Case Management (ICM) to Standard Case Management (SCM) for long‐term hospitalised chronic schizophrenic patients. METHODS: A model was used to evaluate the number of patients that are either successfully dechronized, experiencing failure, or are readmitted to hospital within a year for a cohort of 100 chronic schizophrenic patients. With these figures, it was possible to estimate the needs in terms of number of beds and employees in the catchment area of Clermont‐Ferrand in France, for the 1st, 2nd and 3rd year after the ICM strategy have been implemented. RESULTS: At the beginning of the first year, 100 hospitalisation beds, 30 nurses, 10 psychologists and 5 psychiatrists were needed. After 1 year these numbers were respectively reduced to 50, 15, 10 and 2.5 due to the success of the ICM strategy. This positive trend is also recorded for the second year of implementation. At the end of the 3rd year a steady point level is nevertheless reached with the model, due to the fact that there will always be patients that can not be dechronized; the numbers at this point will be 11 beds, 3 nurses, 1 psychologist and a half‐time psychiatrist. CONCLUSIONS: Due to the important caseload of ICM, it remains more costly than SCM at implementation, but will reduce cost from year 1, and be less costly than SCM from year 3. This model can therefore evaluate the economic impact of creating a dechronization unit in a catchment area and make budgetary prevision for large‐scale implementation of ICM in France.

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