Pathways into psychiatric care : user characteristics, settings and the referral process.
The thesis grew out of the recognition that there is a dearth of information on the users of
mental health services. It set out to describe the characteristics of users across a range of
health settings and to consider the role of such characteristics in the mental health referral
The early phases of this research project were strongly influenced by a model of the referral
process developed by Goldberg & Huxley (1980). They conceptualized users of health care
existing on 5 levels ranging from people living in the community to users in hospital.
Hypothetical filters are said to operate between each level to govern who is referred on to
the next level of services.
This research project borrowed the notion of filters and their arrangement of services in a
referral sequence. However, the focus of this research is on the characteristics of users, and
not the detail of the filters per se. What is described is the effect of the referral process not
the mechanism. This thesis also moves substantially beyond the five settings in the Goldberg
& Huxley model to produce a uniquely comprehensive analysis of the users of all the main
mental health care providers in one health district.
The research project uses a wholly quantitative methodology. The challenge has been to
design a range of compatible survey forms to collect data in seven separate study settings,
to collate information on over one thousand one hundred users, to describe the user profiles
in each study and to develop a comparative analysis of users across a range of settings.
The emphasis throughout has been to align the research with contemporary developments
in health care policy, and as the project has progressed, to make a practical contribution to
the important debate about information systems in mental health service planning.
The thesis has been divided into four parts. Part I introduces and sets the context of the
research, and describes the methodology. In seven chapters, Part II of the thesis reports the
.findings of each of the seven study settings. Part III of the thesis reports the demographic
and utilization characteristics comparatively across all the study settings. The conclusions
of the thesis are reported in Part IV of the thesis, where the theoretical, research and policy
implications are discussed.The research project makes a contribution to knowledge on 4levels. Firstly, it identifies and
describes the characteristics and the typical profiles of mental health service users in a range
of study settings, in one area. Secondly, it identifies the differences between users in each
study setting. Thirdly, it identifies the overlap in use of one service and another. It is
argued that the findings have profound implications for both developing a clearer picture of
the referral processes and for highlighting for planners, producers, and providers possible
complementary or inefficient service utilization patterns. On the fourth and macro level, this
research project has developed a revised model of mental health service referral routes. This
model provides a framework for further investigation, and has potential as a planning tool
in and beyond the geographical boundaries of the current study area.