Recurrent Episodes of Psychiatric Service to
Adolescents in Maryland

The utilization of facilities by 5,000 adolescents, during a 3-year period, was examined in a recent study based on the Maryland Psychiatric Case Register (28). Seventy-seven percent of these adolescents were seen in outpatient facilities only, 13 percent were inpatients only, and 9 percent received both types of care (table 10). Fifteen percent of the adolescents had multiple admissions. These included a relatively high proportion of patients who were hospitalized, children with psychosis or brain syndromes, and referrals from social or welfare agencies.

An unexpected finding concerned the disposition of the patient's case following his first admission. Approximately the same proportion of cases was discharged with a disposition of "further care not indicated" whether this was the first of several admissions or the only admission in this period (30 percent). Such a finding would suggest the need for a study of the treatment and discharge policies of psychiatric facilities involved.

Monroe County, New York, Psychiatric
Case Register

Data from the Monroe County Psychiatric Case Register are of particular interest because they are collected not only from psychiatric facilities but from private psychiatrists (25). Seven percent of the 570 children under 15 years of age admitted to psychiatric care were seen in private psychiatric practice. Over 90 percent were seen in outpatient clinics. Onetenth of the children seen in private practice were seen in other psychiatric facilities also.

RELATIONSHIP OF HOUSEHOLD FACTORS TO PATTERNS OF CARE FOR MENTAL ILLNESS

Louisiana-Maryland Socioeconomic Study

Research on the etiology and the ecology of mental illness has stressed the importance of

family characteristics and living arrangements on the risk of needing psychiatric care.

The socioeconomic study previously mentioned attempted to identify segments of the population having a high risk of psychiatric admissions (29). Records on admissions to ali psychiatric facilities in Louisiana and Maryland. during the year following the 1960 census, were matched against census schedules so that data on family characteristics, income, occupation, etc.. were available. Several findings specific for children were consistent in both States:

(1) Rates for children in husband-wife families decreased with increasing family size (figures 15, 16).

(2) Rates for children in "other male" families were unusually high in families of size 2 (no mother) and in those of six or more members.

(3) Rates for children of female-head families were unusually high in families of size 2 (no father) in Louisiana. In Maryland, rates for children of female-head families were twice as high as rates for husband-wife families, regardless of size of family (families of size 2 excluded)

(4) Although most children were first admitted to outpatient services, a relatively larger proportion in lower income families tended to go to State mental hospitals (figure 17).

Baltimore Ecology Study

A study stemming from the Maryland register on the ecology of diagnosed mental illness in Baltimore indicated a positive association between high psychiatric admissions and such factors as adult crime, juvenile delinquency, unemployment, poor housing. low educational and occupational attainment, and children not living with both parents (30).

Use of Maryland Psychiatric Facilities by Adolescents, 10 to 17 Years of Age, July 1, 1961 According to Number of Admissions and Length of Time Between Episodes.

Source: Recurrent Episodes of Psychiatric Service in en Adolescent Population by A.K. Bahn and M.S. Oleinick, ΝΙΜΗ July 1966.