Does community care decrease length of stay and risk of rehospitalization in new patients with schizophrenia disorders? A comparative case register study in Groningen, The Netherlands; Victoria, Australia; and South-Verona, Italy

This was a long-term followup study of defined cohorts of new patients who met ICD-10 criteria for schizophrenia and related disorders. Three mental health service systems with psychiatric case registers were compared. In two areas (Victoria, Australia, and South-Verona, Italy), a comprehensive system of community-based psychiatric care was developed, with a substantial reduction of hospital beds (to 0.27 beds/1,000 people). In the third area (Groningen, the Netherlands), despite the presence of community psychiatric services, mental health care was still mainly hospital based (1.6 beds/1,000 people). Two hypotheses were tested: (1) the length of stay is shorter in a community-based system than in a hospital-based system; and (2) the risk of rehospitalization is independent of the characteristics of the mental health system, so that risk is expected to be similar in areas with community-based and hospital-based systems. The first hypothesis was confirmed. The risk of rehospitalization, however, was lower in Victoria than in the two other areas, which might show the potential impact of community care in reducing rehospitalization.