OBJECTIVES: This paper reviews studies of patients who are heavy users
of psychiatric services and identifies areas in which further research and
evaluation are indicated. METHODS: Extensive searches were conducted of the
English language psychiatric and psychological literature before 1994.
Important references from initially identified studies were followed up.
More than 200 articles were reviewed, 72 of which are described in this
review. The 72 papers were selected because they dealt with three
questions: What is heavy service use? What patient characteristics
contribute to it? What service delivery characteristics contribute to it?
RESULTS AND CONCLUSIONS: Criteria for identifying and defining heavy users
of psychiatric services vary among studies. Few studies of heavy service
users have attempted to examine use of all psychiatric services, both
inpatient and community based. In most studies, 10 to 30 percent of
patients are identified as heavy users, those who utilize between 50 and 80
percent of service resources. This group consists of a constantly changing
cohort of patients who generally have psychotic illnesses as well as
comorbid personality disorders and high levels of drug and alcohol misuse.
Few studies have examined social issues such as isolation, homelessness,
and social support, although these factors appear to contribute
significantly to heavy service use. Few attempts have been made to define
heavy-user groups in fiscal terms. More research on heavy users of
psychiatric services is clearly needed to improve providers' ability to
plan appropriately targeted mental health services for this disabled group
of patients who use expensive resources.