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Objectives: Small area analysis is a health services research technique that facilitates geographical comparison of services supply and utilization rates between health service areas (HSAs). HSAs are functionally relevant regions around medical facilities within which most residents undergo treatment. We aimed to identify HSAs for psychiatric outpatient care (HSA‐PSY) in Switzerland. Methods: We used HSAr, a new and automated methodological approach, and comprehensive psychiatric service use data from insurances to identify HSA‐PSY based on travel patterns between patients' residences and service sites. Resulting HSA‐PSY were compared geographically, demographically and regarding the use of inpatient and outpatient psychiatric services. Results: We identified 68 HSA‐PSY, which were reviewed and validated by local mental health services experts. The population‐based rate of inpatient and outpatient service utilization varied considerably between HSA‐PSY. Utilization of inpatient and outpatient services tended to be positively associated across HSA‐PSY. Conclusions: Wide variation of service use between HSA‐PSY can hardly be fully explained by underlying differences in the prevalence or incidence of disorders. Whether other factors such as the amount of services supply did add to the high variation should be addressed in further studies, for which our functional mapping on a small‐scale regional level provides a good analytical framework. [ABSTRACT FROM AUTHOR]

Background: No randomised controlled study (RCT) on the effectiveness of Independent Supported Housing (ISH) vs. housing as usual (HAU) settings for non-homeless individuals with severe mental illness (SMI) has been conducted to date because of limited feasibility. Alternative designs, such as observational studies, might be suitable for providing adequate evidence if well conducted. To test this hypothesis, this article reports on a prospective, direct comparison of the designs of two parallel studies in this field. Methods: A two-centre, parallel-group non-inferiority effectiveness study was conducted at two locations in Switzerland using identical instruments and clinical hypotheses. One centre applied an RCT design and the other an observational study (OS) design with propensity score methods (ClinicalTrials.gov: NCT03815604). The comparability of the two study centres was investigated in terms of participants, procedures, and outcomes. The primary outcome was social inclusion and the secondary outcomes were quality of life and psychiatric symptoms. Results: The study included 141 participants (RCT: n = 58; OS: n = 83). Within one year, 27% study dropouts occurred (RCT: 34%; OS: 22%). A similar balance of sample characteristics was achieved in the RCT and the OS using propensity score methods (inverse probability of treatment weighting). After one year, ISH was non-inferior to the control condition regarding social inclusion (mean differences [95% CI]) in the RCT (6.28 [-0.08 to 13.35]) and the OS (2.24 [-2.30 to 6.77]) and showed no significant differences in quality of life (RCT: 0.12 [-0.52 to 0.75]; OS: 0.16 [-0.26 to 0.58]) and symptoms (RCT: -0.18 [-0.75 to 0.40]; OS: 0.21 [-0.17 to 0.60]) in both study centres. However, strong and persistent preferences for ISH in the RCT control group reduced participants' willingness to participate. Because of several limitations in the RCT, the results of the RCT and the OS are not comparable. Conclusion: Participants were comparable in both study sites. However, there were significant problems in conducting the RCT because of strong preferences for ISH. The OS with propensity score methods provided results of more stable groups of participants and revealed balanced samples and valid outcome analysis. Our results do not support further investment in RCTs in this field. [ABSTRACT FROM AUTHOR]

Background: Social inclusion is essential for an adequate rehabilitation process for people with serious mental illness (SMI). Various supported housing settings aim to promote housing competencies and social inclusion in service users. Nevertheless, there is a strong preference in service users for independent living. We aim to evaluate the effectiveness and efficiency of Independent Housing and Support (IHS) compared to institutionalised residential care settings and other treatment as usual conditions (RCS/TAU) in two cities in Switzerland. Methods: This is a prospective multi-centre, four-arm, non-inferiority cohort study investigating the effectiveness and efficiency of IHS and RCS/TAU for people with SMI. Effectiveness will be measured by a standardised measure of social inclusion as primary outcome as well as by measures of functioning and well-being. Efficiency will be analysed on the basis of service usage and costs associated with the different housing settings. Participants will be consecutively recruited and subsequently enrolled between April 2019 and December 2020 and assessed at baseline and after six, twelve and after 24 months. At one study site, 56 participants will be randomly assigned to one of the conditions; the other study site will be conducted as an observational study investigating 112 admitted participants. Discussion: While the UN Convention of the Rights of People with Disabilities aims to promote the opportunity to choose one's place of residence, the limited supply of alternative forms of housing does not guarantee genuine freedom of choice. Increased diversification and flexibility of housing support is essential. If IHS shows non-inferiority in terms of their effectiveness and efficiency, users should be allowed to choose their kind of housing support. Trial registration: ClinicalTrials.gov: NCT03815604, December 04, 2019. [ABSTRACT FROM AUTHOR]

Objective: Identification of predictors that contribute to explaining regional variance of involuntary admission (IA) in Switzerland., Methods: Multiple regression analysis including potential predictors and regional rates of IA at the level of utilisation-based care regions., Results: Authorisation to issue involuntary admission, assistance/guardianship, outpatient consultation rate in psychiatric practices, hospitalisation rate and urbanisation are significantly related to regional variation in IA rates., Conclusion: Restrictive regulation of the authority to issue IA and voluntary outpatient psychosocial and administrative support measures can contribute to a reduction in the rates of IA., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Objective: To examine sociodemographic and clinical characteristics of persons hospitalized in five psychiatric hospitals from regions with different structural characteristics compared with persons hospitalized voluntarily., Methods: Descriptive analyses of routine data on approximately 57000 cases of 33000 patients treated for a primary ICD-10 psychiatric diagnosis at one of the participating hospitals from 2016 to 2019., Results: Admission rates, length of stay, rates of further coercive measures, sociodemographic and clinical characteristics of the affected persons differ between the different regions., Conclusion: There are considerable regional differences between regulations and implementation of the admission procedures and the sample. Causal relationships between regional specifics and the results cannot be inferred., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).)

Background: The night clinic which is part of the psychiatric department of the University of Zurich is a part-time treatment option with psychiatric treatment and support in the evening. This study aimed to characterize the patients and detect different functions of the treatment setting., Methods: Data of 253 patients covering a six-year period from 2008 up to 2013 were retrospectively assessed using descriptive methods. Subgroups according to the situation before admission and after discharge were compared., Results: Patients admitted from home differed considerably from those who were transferred from a psychiatric ward concerning sociodemographic and clinical factors. They were more frequently single, unemployed, received disability funds and suffered from a psychotic disorder. They were also more likely to be discharged in a supported housing condition., Conclusions: The night clinic serves as an alternative to full inpatient treatment for individuals who have work as well as a rehabilitative option for homeless patients with severe mental illness. It contributes to a reduction of avoidance of inpatients stays for those groups of patients.

Objective This study aims to assess psychiatric morbidity and self-rated health (SRH) of homeless people in Zurich, Switzerland. Methods Cross-sectional study of N = 338 homeless people, assessement of psychiatric disorders (ICD-10), level of functioning (GAF, HoNOS), self-rated health. Comparison of SRH among homeless people with a sample of Zurich (N = 956) and Swiss (N = 21 579) population. Results 96 % of the homeless people had at least one psychiatric disorder, most of them drug- (60.9 %) or alcohol-dependence (41.5 %). Homeless people had a far lower SRH than the Zurich population. Higher impairment in HoNOS was associated with lower levels of SRH. Low SRH was associated with help care seeking (OR = 1.9, p < 0.001) and medication (OR = 1.5, p = 0.006). Conclusions The prevalence of psychiatric disorders is far higher among homeless people compared to the general population in Zurich. Implications for providing help at the intersection of social and health care are discussed., Competing Interests: Interessenkonflikt: Die Autoren geben an, dass kein Interessenkonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)

Subject: This study aims at investigating the formal and content-related quality of medical certificates directing compulsory hospital admissions before the scheduled alteration of the Swiss civil legislation in January 2013. A comparison between physicians with different professional backgrounds concerning certificates and patients was conducted., Methods: Retrospective investigation of medical records of involuntary inpatients at the University Hospital of Psychiatry in Zurich during a period of six months (N=489)., Results: Considerable deficits concerning formal and particularly content-related aspects of the certificates were found. Psychiatrists issued certificates of the highest quality followed by emergency physicians, hospital doctors and general practitioners. Patients differed with respect to several sociodemographic and clinical variables., Conclusions: The quality of certificates directing involuntary hospital admission has to be improved considering the impact on the individual concerned. The consequences of the new legislation on the quality of the admission practices should be inquired in order to improve professional training on the issue.

Subject: Providing care and support for individuals with severe mental illness in sheltered and supported housing facilities is frequently characterized by difficult courses, particularly if it concerns residents with "heavy user" profiles. These individuals often times change their residence and are extensively hospitalized on acute psychiatric wards. To date, little is known about the needs of providers of sheltered and supported housing concerning cooperation with psychiatric hospitals and support by psychiatric services., Methods: An explorative survey was conducted among the sheltered and supported housing facilities in the canton of Zurich. A short questionnaire was distributed among all 140 institutions in written form. The responses were analyzed thematically with respect to four predefined categories., Results: Fifty-six institutions providing 1,600 places (about 50 % of the capacity in the canton of Zurich) responded. Experiences and problems with the focus group of residents as well as causes for problematic courses are described. A sound working routine with the psychiatric hospitals was considered as a precondition for the provision of high quality housing support. The needs concerned regular and flexible cooperation with psychiatric hospitals as well as open communication in particular at discharge from the clinic and intake at the housing facility., Conclusions: Concentration of competencies and knowledge within psychiatric hospitals about sheltered housing institutions and their needs could improve service provision and may result in higher certitude of housing facilities. Thereby, their ability to manage patients with severe mental illness could be improved and extensive hospitalization of individuals from this group could be reduced.

Objective: This paper describes socio-demographic, clinical, and treatment-related parameters of psychiatric patients who were hospitalized for at least two months on an acute psychiatric ward compared to patients with a shorter inpatient treatment episode. Furthermore, it is evaluated how frequent these long-staying patients are awaiting a room in a sheltered housing facility., Methods: We investigated the longest inpatient treatment period of all patients aged between 18 and 65 years on an acute ward of the Psychiatric University Hospital Zurich (n = 3,928) using the basic documentation of the years 2006 to 2010., Results: 20 % of all patients on acute wards had a stay of more than 60 days. Socio-demographic and clinical characteristics are similar to those of "heavy users" of mental health services. Social work is involved more frequently, and placement in sheltered housing facilities is intended in one third of those patients., Conclusions: A substantial part of the patients who stay at least once longer than two months on an acute ward are discharged to sheltered housing. Besides severity of illness it is likely that lack of availability of an adequate housing option contributes to length of stay. Intensified cooperation of the psychiatric clinic with sheltered housing facilities as well as alternative options for those in need of assisted housing and mental health care might help to reduce their extensive usage of inpatient treatment capacities. Interventions and services have to be adapted to local conditions., (© Georg Thieme Verlag KG Stuttgart · New York.)

Questions Under Study: This study represents a first attempt at estimating Swiss resource allocation to brain research including both public and private spending., Methods: In order to estimate public spending (by governments and charities) a survey was conducted to evaluate the way brain research is funded across Europe and especially in Switzerland. Industry funding was measured using different approaches including a survey of pharmaceutical expenditures and the costs of developing new drugs., Results: Private spending is at a reasonable level because a highly developed Swiss pharmaceutical industry invests significantly in this branch of science. However, public spending is at a low level compared to other European countries, although Switzerland is the only European country where the total funding per capita exceeds that of US funding., Conclusions: A detailed investigation of Swiss resource allocation to different branches of biomedical research is warranted. Brain research should be an important part of such a study. The United States and the European Union have selected brain research as one of their priority areas within health related research. The present figures indicate that this may also be justified in Switzerland.

Questions Under Study: This study aims at estimating the costs of disorders of the brain in Switzerland based on the published epidemiological and economic evidence., Methods: the data presented for Switzerland are derived from the "cost of disorders of the brain in Europe" study of the European Brain Counsil (EBC). Available Swiss data were integrated., Results: There are an estimated 2 million people currently living with a brain disorder in Switzerland. This number amounts to about 25% of all people living in Switzerland. The total annual costs are estimated to amount to 8.9 billion Euros corresponding to 1200 Euros per inhabitant and per year. Direct medical expenditure accounts for 33% of all expenditure, while indirect costs add up to 49%. Mental disorders account for approximately 2/3 of the total costs of brain disorders, ie, 5.6 billion Euros. This cost estimate comes very close to the current expenses for mental health in Switzerland with 5.3 billion Euros constituting 16% of total health care costs. : The present study probably underestimates the full economic burden of brain and especially mental disorders in Switzerland. In order to better understand the impact of brain disorders on Swiss society prospective field studies are needed in all disorders of the brain.