5 - The local level

Summary

Defining the local level

By local level we mean the catchment area for which an integrated system of care for general adult mental health services can be provided. The population size will vary between countries and regions, but is generally between 50 000 to 250 000 total residents. In some countries the scale of the local level is smaller where a single generic team is the main service provider (as in South-Verona in Italy), whereas in other settings (for example in Victoria in Australia) the main unit of organisation driving the whole service is the 24-hour Crisis Assessment Team, leading to a larger-scale ‘local level'of about a quarter of a million population.

Where local services are organised on the basis of catchment areas at the local level, these are often called sectors. The concept of the sector has permeated community mental health service development. Following the emergence of the first sectors in France in 1947, by 1961 over 300 had been established. In the USA the Community Mental Health Centres Act (1963) introduced the principle of a catchment area for each CMHC, and by 1975, 40% of the population had sectorised services. In Europe, throughout the 1970s sector development grew but sizes varied between countries (Lindholm, 1983). Germany has sector sizes in the range of 250 000, the Netherlands around 300 000, while the areas for the Scandinavian countries are smaller with Denmark averaging 60–120 000, Finland 100 000, Norway 40 000,and Sweden 25–50 000. Of all countries, however, Italy has most comprehensively adapted the concept by virtue of Law 180, passed in 1978,which established sectors in the range of 50–200 000 population. A further range of factors can also affect the choice of sector size and they are shown in Table 5.1.