How size matters: exploring the association between quality of mental health services and catchment area size

Abstract

BackgroundThe diversity of mental health and substance abuse services (MHS) available to service users is seen as an indicator of the quality of the service system. In most countries MHS are provided by a mix of public, private and third sector providers. In Finland, officially, the municipalities are responsible for organizing the services needed, but the real extent and roles of private and third sector service providers are not known.Our previous study showed that the catchment area population size was strongly associated with diversity of mental health services. It is not known whether this was due to some types of services or some provider types being more sensitive to the size effect than others.The aim of this study was to investigate the association between area population size and diversity of mental health services, i.e. which types of services and which service providers’ contributions are sensitive to population size.MethodsTo map and classify services, we used the ESMS-R. The diversity of services was defined as the count of main types of care. Providers were classified as public, private or third sectors.ResultsThe diversity of outpatient, residential and voluntary services correlated positively with catchment area population size. The strongest positive correlation between the size of population and services available was found in third sector activities followed by public providers, but no correlation was found for diversity of private services.The third sector and public corporations each provided 44 % of the service units.Third sector providers produced all self-help services and most of the day care services. Third sector and private companies provided a significant part (59 %) of the residential care service units.ConclusionsSignificant positive correlations were found between size of catchment area population and diversity of residential, outpatient and voluntary services, indicating that these services concentrate on areas with larger population bases. The third sector seems to significantly complement the public sector in providing different services.Thus the third sector be needs to be functionally integrated with other MHS services to achieve a diversified and integrated service system.Electronic supplementary materialThe online version of this article (doi:10.1186/s12888-016-0992-5) contains supplementary material, which is available to authorized users.

Identifying Local and Centralized Mental Health Services—The Development of a New Categorizing Variable

“…We used the ESMS-R data collected by trained researchers from Southern Finland between 2012 and 2014. The data collection has been described previously [ 24 , 25 , 36 ]. Briefly, the study area included four hospital districts: Helsinki and Uusimaa, Carea, Etelä-Karjala, and Varsinais-Suomi.…”

“…The services were classified by their vertical organizational level: primary care, secondary care or integrated care. Horizontally, the services were classified by their legal status: public, third sector, or private companies [ 24 , 35 ].…”

“…The European Service Mapping Schedule-Revised (ESMS-R) was designed to map mental health services, to describe their major characteristics, the provision of services, as well as resource allocation. The ESMS-R instrument allows for a good-quality common description of the socioeconomic profile of the population of a specified area, alongside key features of mental health service provision, including those provided by primary care and social services [ 17 , 23 , 24 , 25 ]. The first version of the ESMS has been used previously in Finland [ 11 , 26 ] and other European countries [ 27 , 28 , 29 ] as well as in Chile [ 30 ].…”

Regional Correlates of Psychiatric Inpatient Treatment

“…The study is contributing to the evidence base needed to plan reforms in financing and the integration of the MHS and overall health care system. Details of the FIN-REFINEMENT, the Finnish part of project, have been described previously [20,24,25]. Briefly, in this study, the study area included four hospital districts (regions) in the southernmost part of Finland: the Hospital District of Helsinki and Uusimaa, Kymenlaakso (Carea), Etelä-Karjala (Eksote), and the Hospital District of South-Western Finland [20].…”

“…The ESMS-R allows for a standardized description of the key features of mental health service structures and provision, including those services provided by primary care and social services [20,24,25,26,27,28]. The data collection and instrument has been described previously [20,23,24]. Briefly, mental health services are classified into 89 different “Main Types of Care” (MTC) in the ESMS-R classification.…”