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History of Psychiatry
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Service utilization in 1896 and 1996: morbidity and mortality data from North Wales

David Healy

North Wales Department of Psychological Medicine, University of Wales College of Medicine, Bangor LL57 2PW, UKhealy_hergest{at}compuserve.com

Margaret Harris

Pamela Michael

Dinah Cattell

Marie Savage

Padmaja Chalasani

David Hirst

The 1896 and 1996 populations of North-West Wales are similar in number, ethnic and social mix and rurality, enabling a study of the comparative prevalence of service utilization, as well as the morbidity and mortality associated with mental illness in 1894–96 and 1996. The 1996 data reveal a 15 times greater prevalence of admissions for all diagnoses, and three times greater prevalence of admissions by detention, compared with 1896. Patients now spend more time in a service bed than they did 100 years ago. Death as a direct consequence of mental illness is commoner now than 100 years ago. There is therefore a major disjunction between the rhetoric and the reality of mental health service utilization. General factors related to changing health care and expectations and specific factors linked to mental health appear to have led to an increased rate of service utilization in the modern period.

Key Words: history • mortality and morbidity from mental illness • psychiatry • rates of detention • service utilization • 19th century • 20th century

History of Psychiatry, Vol. 16, No. 1, 27-41 (2005)
DOI: 10.1177/0957154X05044604
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M. Harris, S. Chandran, N. Chakraborty, and D. Healy
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History of Psychiatry, December 1, 2005; 16(4): 423 - 434.
[Abstract] [PDF]