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In 2010, a programme intended to increase the number of structured interviews after coercive measures (IC) was implemented in a psychiatric ward. The IC forms were collected before and after the implementation of the programme. The number of ICs was compared to the total amount of compulsion. A significant rise in the number of effectuated ICs was demonstrated. The patients' contentment underwent no change. The majority of the coercive measures were not followed by an IC. At the next audit of the psychiatric legislation we will suggest an adjustment of the paragraphs concerning ICs.

Introduction: This article describes the incidence of first contacts with the psychiatric hospital services in the County of North Jutland (NJA) and the Municipality of Copenhagen (KK), Denmark, from 1 January 1994 to 31 December 2002., Materials and Methods: All persons age 18 and over living in NJA and KK in the period from 1 January 1994 to 31 December 2002 were identified through the Central Office of Civil Registration. First contacts with the psychiatric hospital services in the two areas were identified through the Danish Psychiatric Central Research Register., Results: Standardised incidence rates of psychiatric diagnoses were generally higher in KK than in NJA. Overall, for all diagnoses, there were 37 first contacts for men per 10,000 person-years in KK and 21 in NJA. For women, there were 40 contacts in KK and 26 in NJA. For diagnoses in the F0 group, the frequency was higher in NJA, with 6.7 first contacts per 10,000 person-years for men and 7.3 for women in NJA, compared with 4.5 for men and 3.9 for women in KK. For women with F6 diagnoses, the frequency was also higher in NJA than in KK: 2.7 first contacts per 10,000 person-years in NJA compared with 1.6 in NJA. Outpatient diagnosis of first-contact patients was more frequent in NJA than in KK (66% in NJA and 59% in KK)., Conclusion: The incidence of psychiatric diagnoses was higher in the urban area of KK than in the rural area of NJA. The higher incidence of F0 diagnoses in NJA may be due to differences in ways of registration. This might also explain why, in this investigation, more diagnoses after outpatient evaluation were made in NJA than in KK. We believe it is essential that continuing work on guidelines for registration of illness treatment in Denmark be performed.

The study objective was to describe the service provision in geriatric psychiatry in 1997 and the trends in admission patterns for the elderly to psychiatric hospitals in Denmark from 1988 to 1996. Information concerning admission pattern was obtained from the Danish Psychiatric Case Register. The information on the supply of geriatric psychiatric services was collected by a questionnaire to the individual geriatric psychiatric departments. All geriatric psychiatric departments in Denmark have been identified. The number of demented patients admitted to psychiatric hospitals decreased considerably as did the length of stay for demented patients admitted from 1988 to 1996. For all other diagnoses the number of admissions increased in the same period. Four counties out of 14 did not have a special unit for geriatric psychiatry. There were considerable geographical variations in supply as well as target groups in the counties that supplied geriatric psychiatric service. The unequal access to geriatric psychiatric services and variations in target groups underlines the need for a discussion of future directions for this service provision.

The study was based on data from the Danish Psychiatric Central Register. It consisted of 11,753 persons with permanent residence in the municipalities of Aalborg or Arhus, who had 32,557 admissions to a psychiatric hospital in Denmark during the period 1982-1991. The admission rates declined by 30%. The involuntary admission rate increased during the later years of the period, it was higher at the Psychiatric Hospital in Arhus (PHA). The bedday use per admission was 5.5 weeks on average at Aalborg Psychiatric Hospital (AAPH) and nine weeks on average at PHA. Through the period the bed rate (beds in use) was gradually reduced by 40%, most significantly at PHA. It can be concluded that the treatment at AAPH was less time-consuming. This is mainly caused by there being fewer beds available. Indices for quality of outcome did not give reason for conclusions in regard to differences in quality of treatment.

Over a two week period (1994) the 27 physicians at Fjorden registered the time they used on direct and indirect treatment of in- and out-patients, administration, further training, supervision and research. Standardized criteria for the time spent on patient treatment were set up. Thirty-two percent of the total work time was used for direct treatment and a further 32% for indirect treatment (conferences, etc.) while the rest was used for other purposes. In relation to standardized 60 minutes or more treatment sessions, the survey revealed an average of 32-60% insufficient time spent on each patient per session. Fifty percent more physician time for direct treatment would be necessary to reach the standardized criteria for the total number of patients. We conclude that using 2/3 of the total work time available on treatment is acceptable. The great discrepancy between real and ideal use of physician time makes it important to further examine how to acknowledge dialogue as a psychiatric tool.

Postgraduate training for young doctors is an obligation for clinical departments. However there is a general impression that it has been difficult to acknowledge training as an activity in importance to patient treatment, and thus to give it the necessary priority. For a period of two weeks in 1994, all activities performed by doctors at a psychiatric hospital during working hours were registered. Special attention was given to activities concerning training and educational issues. These consisted of element such as theoretical courses, tutoring in daily clinical work and supervision of psychotherapy giving sessions. Furthermore it was registered whether the doctor had been receiving or giving the training. Junior registrars, senior registrars and consultants used 15, 13 and 5% of their time on training activities, however, during the period concerned the activities mainly consisted of attending external courses. Tutoring in the daily clinical work was non-existent. It is proposed that clinical positions that have training as a described part of their function should be secured.

Over a two week period (1994) the 27 physicians at a psychiatric hospital registered the time used on indirect treatment (conferences, rounds, etc.). This amounted to 21-37% of total time, while time spent on administration amounted to 7-46% of total time depending on the seniority of the doctor involved. An estimated one hour per week per patient was used for indirect treatment. An insignificant amount of time was spent on interviews with relatives. We conclude that although it would be desirable to reduce the time spent on indirect treatment, the new demands made on community psychiatry with involvement of relatives, etc., would rather tend to give rise to more obligations in this area.

The aim of the present study was to investigate geographical variations in first ever admission rates for manic-depressive psychosis during the period 1977 to 1993 at a county level. The analyses were based on data obtained from the national Danish Psychiatric Case Register comprising inpatient contacts to Danish psychiatric hospitals and psychiatric units in general hospitals. The results showed that the national first ever admission rates for manic-depressive psychosis in the age-group 15-74 years declined by 44% from 25.3 per 100,000 in 1977-1979 to 14.2 per 100,000 in 1991-1993. For the older age-group the rates were slightly increasing. Comparison of the individual counties revealed significantly geographical variations with respect to incidence level and temporal trends over the years 1977-1993. The results may reflect local differences in the provision of outpatient services and primary care facilities. However, there is also the possibility that some patients might never be treated.

In the period 1971-1990 the first admission rate to Danish psychiatric hospitals and wards decreased by approximately 45%. This might reflect the similar decrease in number of available psychiatric beds. Generally, the decrease of first admission rates was larger in the metropolitan area than in the rest of the country. Consequently, the disparity in admission rates between town and country was reduced. This is probably due to the decentralization initiated in the mid-seventies when the counties were made responsible for the psychiatric services in Denmark. Furthermore, changes in morbidity could add to the occurrence of regional variations. Number of available beds has gained increasing importance as a predictor of variations between counties and municipalities whereas the importance of distance to hospital and degree of urbanization has declined. As regards sociodemographic variables special importance should be attached to variables for the amount of social aid and the employment rate in the social and health sector. However, it is generally difficult to determine whether regional variations are due to differences in treatment facilities or morbidity differences.

This paper describes the admission and discharge pattern in Danish psychiatric hospitals for first-ever admitted demented patients (290, 293.09, 293.19 ICD-8) aged 65 years and over admitted in the period 1972 to 1988. The results are based on data from the Danish Psychiatric Register. The admission rate, the commitment rate and the length of stay decreased significantly from 1972 to 1988. The readmission frequency did not change during the period. A significantly increasing proportion of the patients were admitted from somatic hospitals, and there was a tendency to a higher discharge rate to somatic hospitals. Two factors may have caused the decline in admission rate, the improvement of the psychogeriatric services in the eighties and the decline in the number of psychiatric beds. The psychiatric hospitals no longer serve as nursing homes for demented patients. The results also seem to indicate that for institutional care for demented patients may have been transferred from the psychiatric hospitals to other services e.g. the somatic departments and nursing homes.

The purpose of this investigation was to register if the new Danish law concerning commitment and compulsory procedures in psychiatry from 1.10.1989 caused changes in the use of restraints. During the period 1.2.1988-30.9.1991 all compulsory procedures in the Department of Psychiatry, Frederiksberg Hospital, were registered. A total of 145 patients were restrained during 167 admissions. No changes were registered in the number of restraints in connection with the law reform, but the duration of the fixations increased by 42%. The number of medications given forcibly in connection with the restraints increased significantly. One of the purposes of the the law reform was to reduce the number and duration of restraints. This purpose has not been fulfilled.

This paper describes the admission and discharge pattern in a psychiatric hospital for 315 senile and arteriosclerotic demented patients (290.09, 293.09 ICD-8) aged 65 years and over and admitted for the first time. 47% (149) of the patients were admitted from other hospitals and temporary stays in nursing homes. A total of 203 (65%) of the patients experienced one or more changes of residence during the three months prior to admission to the psychiatric hospital. A Kaplan-Meier analysis showed that 25% of the patients were still hospitalized 48 weeks after admission. A total of 62 patients died in the psychiatric hospital, one patient was still hospitalized when the investigation ceased. Of those discharged alive 201, (80%) were discharged to nursing homes 26 (10%) to their own homes and 25 (10%) to hospitals. Of those who had their own home at the time of admission and were discharged alive only 16% were discharged to their own homes, the remainder were discharged to nursing homes and hospitals. On account of the many changes of environment the demented patients experience prior to admission to the psychiatric hospital, they risk developing confusional psychoses which may be disastrous to their physical and mental health.

Case records of 404 elderly patients (aged 65 years or more) who were admitted for the first time to the Psychiatric Hospital in Aarhus were investigated retrospectively. In 315 patients the diagnoses were senile dementia (290.09) and arteriosclerotic dementia (293.09) according to ICD-8. Information about use of psychotropic drugs before admission and on discharge alive was obtained from the patient case records. In the present study, the use of drugs was not found to be correlated with age, sex and degree of dementia. Significantly fewer committed patients were treated with psychoactive drugs and significantly fewer lived independently in their own homes. Only 42 (13%) patients had a crude psychiatric disorder while 251 (80%) were admitted on account of unacceptable behaviour. 90% of the latter group of patients had been treated with one or more psychoactive drugs on admission. The risks involved in the use of psychoactive drugs are discussed. On account of demographic changes in the Danish population and the recent decrease in psychiatric hospital beds and nursing home beds, it is recommended that the patterns of committed admissions of demented patients to psychiatric hospitals should be followed closely.

On April 1, 1976 the Danish State handed over the responsibility for treatment of psychiatric patients to the counties. None of the state hospitals were situated in the county of Vejle. The changes of the admission pattern of the inhabitants of Vejle county aged 15+ years during the years from 1973 to 1987 are described. The annual bed occupancy per 1,000 inhabitants decreased markedly during the period (from 829 in 1973 til 366 in 1986) while the admission rates were relatively stable. Vejle county has successfully reduced the number of admissions to mental hospitals in other counties, but was, however, still not self-sufficient in 1987. The decrease in bed occupancy was significant in the groups of schizophrenia, manic-depressive psychosis, organic states, neurosis, alcohol and drug addiction, while in the group of other psychoses and other conditions the decrease was not significant. In the group of personality disorder the bed occupancy increased, but not significantly.

During the period concerned, 50 children were admitted as emergencies to the Psychiatric Children's Hospital. These were compared with 90 children over the age of nine years who were admitted in the ordinary manner during the same period. The children admitted as emergencies were aged ten years or more, they were older than the control group and the sex distribution was more uniform. The emergency admissions were, as a rule, instigated by the parents. Half of the families involved had had contact with the Children's Psychiatric Hospital previously. The majority of the children in the control group were referred by school psychologists. The three most important reasons for emergency admission were psychotic symptoms, threats of suicide or attempted suicide and behavioural disorders. Nearly half of the children admitted as emergencies were hospitalized for less than three months and nearly one third were hospitalized for less than one month. Almost all of the children admitted as emergencies and all of the children in the control group had had contact with the social supportive agencies prior to admission. The recommendations on discharge did not differ essentially in the two groups.

From 18.4.1988 to 17.6.1988, 374 emergency referrals were registered and 495 other referrals to the psychiatric admission department, Frederiksberg Hospital. The two main reasons for the referrals, in both men and women, were alcoholism and/or psychosis. Compared to a similar study from the same period in 1983, the number of emergency referrals was stabilized while the number of other referrals increased by 63%. The majority of the 495 other referrals were chronic psychotic patients and/or addicts who were, as a rule, already under treatment in the day-care hospital or out-patient clinic. Previously, part of this group of patients remained in state mental institutions for long periods. After the change to district psychiatric treatment, the admission department acts as a semi-acute asylum, since suitable resorts outside the psychiatric institution are not available.