Patterns of mental health service utilization in a general hospital and outpatient mental health facilities

Analysis of 365,262 psychiatric consultations
  • Enrique Baca-GarciaEmail author
  • Maria M. Perez-Rodriguez
  • Ignacio Basurte-Villamor
  • F. Javier Quintero-Gutierrez
  • Juncal Sevilla-Vicente
  • Maria Martinez-Vigo
  • Antonio Artes-Rodriguez
  • Antonio L. Fernandez del Moral
  • Miguel A. Jimenez-Arriero
  • Jose L. Gonzalez de Rivera



Mental health is one of the priorities of the European Commission. Studies of the use and cost of mental health facilities are needed in order to improve the planning and efficiey of mental health resources. We analyze the patterns of mental health service use in multiple clinical settings to identify factors associated with high cost.

Subjects and methods

22,859 patients received psychiatric care in the catchment area of a Spanish hospital (2000–2004). They had 365,262 psychiatric consultations in multiple settings. Two groups were selected that generated 80% of total costs: the medium cost group (N = 4,212; 50% of costs), and the high cost group (N = 236; 30% of costs). Statistical analyses were performed using univariate and multivariate techniques. Significant variables in univariate analyses were introduced as independent variables in a logistic regression analysis using “high cost” (>7,263$) as dependent variable.


Costs were not evenly distributed throughout the sample. 19.4% of patients generated 80% of costs. The variables associated with high cost were: age group 1 (0–14 years) at the first evaluation, permanent disability, and ICD-10 diagnoses: Organic, including symptomatic, mental disorders; Mental and behavioural disorders due to psychoactive substance use; Schizophrenia, schizotypal and delusional disorders; Behavioural syndromes associated with physiological disturbances and physical factors; External causes of morbidity and mortality; and Factors influencing health status and contact with health services.


Mental healthcare costs were not evenly distributed throughout the patient population. The highest costs are associated with early onset of the mental disorder, permanent disability, organic mental disorders, substance-related disorders, psychotic disorders, and external factors that influence the health status and contact with health services or cause morbidity and mortality.


Variables related to psychiatric diagnoses and sociodemographic factors have influence on the cost of mental healthcare.

Key words

health care costs health services research mental health services logistic models 


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Copyright information

© Springer 2007

Authors and Affiliations

  • Enrique Baca-Garcia
    • 1
    • 2
    • 3
    Email author
  • Maria M. Perez-Rodriguez
    • 4
  • Ignacio Basurte-Villamor
    • 2
  • F. Javier Quintero-Gutierrez
    • 2
  • Juncal Sevilla-Vicente
    • 2
  • Maria Martinez-Vigo
    • 2
  • Antonio Artes-Rodriguez
    • 5
  • Antonio L. Fernandez del Moral
    • 6
  • Miguel A. Jimenez-Arriero
    • 7
    • 8
  • Jose L. Gonzalez de Rivera
    • 2
  1. 1.Department of Neurosciences, New York State Psychiatric InstituteColumbia University Medical CenterNew YorkUSA
  2. 2.Department of PsychiatryFundacion Jimenez Diaz HospitalMadridSpain
  3. 3.Department of Psychiatry, Faculty of MedicineAutonoma University of MadridMadridSpain
  4. 4.Department of PsychiatryRamon y Cajal HospitalMadridSpain
  5. 5.Department of Signalling Theory, Telecommunication Engineering FacultyCarlos III UniversityLeganes, MadridSpain
  6. 6.Mental Health Center of Centro DistrictMadridSpain
  7. 7.Mental Health Center of Arganzuela DistrictComplutense University of MadridMadridSpain
  8. 8.Servicio de Psiquiatria (Edif. Medicina Comunitaria)University Hospital 12 de OctubreMadridSpain

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