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REGISTER STUDY: A small cohort of multiple‐service‐users from a geographically circumscribed area

Since 1974 a psychiatric case register, covering an urban population of approximately 43,000 in one of the northern provinces, has been operated by the Department of Social Psychiatry of the State University of Groningen, along the lines of the Camberwell Case Register. The complexity of the Dutch network of mental health services and the problem of continuity of care is studied from the delivery of care to a small cohort of 31 people, who contacted at least 4 different services during 1977 and 1978. A case register which collects unduplicated and cumulative data lends itself particularly well for such a study. Of the total intake of 1,594 patients from the register area from December 31, 1973 to January 1, 1976, 28% had contact with two or more services, 9.3% with three or more, and 2.4% with four or more. The 31 patients who used four or more services during 1977 and 1978 were analysed in more detail. This group did not differ much from other patients with regard to their social and medical characteristics. They tend to use intensively many services during brief periods of time, and spend most of their time in the community without any care. Their pattern of using the services shows how disconnected the network of mental health services really is.