Population-based trends in treatment rates in psychiatry in Oxfordshire, 1975-1986.

Routinely collected abstracts of medical records for patients in Oxfordshire were used to identify each individual's first contact with specialist psychiatric in-patient, out-patient or community care services over a 12-year period (1975-1986). During this period first-contact rates for people under 65 years of age declined by 3.3 per cent. The decline was observed for contacts with specialist care outside hospital as well as for in-patient care. It is therefore not attributable simply to a shift away from in-patient care. The decline was seen in most major diagnostic groups including schizophrenia, affective psychosis and the neuroses, and it is therefore not attributable to changing diagnostic practices between these groups. Increases in first-contact rates in this age group were found for alcohol-related disorders in women and self-harm in men. First-contact rates for people aged 65 years and over increased by 3 per cent per year. The condition that mainly accounted for the increase over time was dementia, which was by far the commonest recorded psychiatric diagnosis in this age group. Although the increase was seen in all modes of care, it was the domiciliary visiting service that contributed most to the upward trend. The implications of these trends for service planning and their limitations as measures of changes in morbidity are discussed.