12 - Sectorised services outcome research

Summary

Sectorised services

The main trend in the development of mental health care systems has, during the last decades, been the replacement of care in psychiatric hospitals with care in community-based settings. This deinstinationalisation movement has been defined as (1) the prevention of inappropriate mental hospital admission through the provision of community alternatives for treatment, (2) the release to the community of all institutionalised patients who have been given adequate preparation for such a change, (3) the establishment and maintenance of community support systems for non-institutionalised people receiving mental health services in the community (Bachrach, 1977). There has been a continuing debate concerning the success of this transformation of the care system, and a number of research reports concerning the failure of coordination between the depopulation of hospitals and the building up of adequate community-based services. The result has been increasing burdens on, in particular, long-term patients and their relatives (Braun et ai, 1981; Lehman et al., 1982).

A number of principles have evolved, guiding the building up of care systems directed towards care in the community. Some of these principles have been related to the organisation of care, while others have expressed public policy, care ideology or a philosophy of care, relying on social values which have been seen as consistent with, or as a base for, the development of these new services. Important goals and principles identified in this change process have been that psychiatric services should be comprehensive, coordinated, accessible, acceptable, accountable, efficient and effective (Huxley, 1990). These principles refer to both structure and content of services, and have also been seen as a means to increase effectiveness.

The concept of sectorisation or a sectorised service has been used as a description of an organisational framework which would facilitate the establishment of a community-based service system according to the above principles. However, the concept has become ambiguous since it has also been associated with many of the principles directing the content of community-based services. To avoid confusion, especially when we are discussing the evaluation of sectorised services, the term ‘sectorisation’ should be limited to the depiction of a way of formally organising a local service system which has a proposed potential for supporting the development of community-based care models.