[Psychiatric past history and health care after compulsory admission. Care use as an indicator of the quality of care for patients in compulsory care in Rotterdam].

BACKGROUND In evaluations of the Act on Special Admissions to Psychiatric Hospitals in The Netherlands (Dutch acronym BOPZ) hardly any attention has been given to the use of mental health care services before and after a compulsory admission. AIM To investigate whether patterns of care before and after compulsory admissions can be considered as indicators of the quality of care provided by the mental health services. METHOD For 623 patients with first-time acute compulsory admissions in Rotterdam, the use of the care services was monitored over a period of 12 months before and after admission. The outcomes were compared for 3 different patient groups: 'old acquaintances', 'newcomers' and 'passers-by'. In order to identify differences before an after the introduction of the BOPZ Act of 1994, we compared the use made of care facilities by patients admitted between 1992 and 1993 and between 1996 and 1997. RESULTS More than one third of the patients admitted to acute compulsory care leaves the psychiatric hospital within three weeks. The average length of stay is more than two months and in more than half of the cases the first contact with mental health services occurs within one week after discharge. Within one year after the compulsory admission more than one third of patients is re-admitted and after one year more than fifty percent of patients are still receiving mental health care. Intensive care is targeted particularly at the patient group referred to as 'old acquaintances'. Following the introduction of the BOPZ Act the percentage of suicide-threats and cases of self-neglect increased. The number ofcompulsory re-admissions increased as well. CONCLUSION The research results provide an encouraging picture of the quality of care provided before and after compulsory admissions. However, the cases which fail to receive mental health care before emergency compulsory admission and miss out on outpatient follow-up emphasise the needfor alternative measures such as an earlier conditional compulsory admission (voorwaardelijke machtiging) and more intensive outpatient treatment.