Care across all phases of schizophrenia and initiation of treatment: discrepancy between routine practice and evidence. The SIEP-DIRECT's Project

Abstract

SUMMARYAims– To evaluate the quality of psychiatric care in Italian community-based services and the discrepancy between real practices and NICE recommendations for the treatment of schizophrenia concerning the elements common to all phases of care and the first episode of psychosis.Methods– Data concerning 14 indicators on common aspects of care in all phases and 11 indicators concerning psychosis onset, drawn from NICE Recommendations, were collected in 19 Departments of Mental Health.Results– An optimistic attitude seems to prevail in the staff in all phases of care, while remarkable discrepancies between service practice and recommendations have been found in relation to systematic assessment, availability of informative leaflets and support to relatives. Concerning the treatment of first episode, a lack of specific services and differentiated activities, and paucity of practices based on specific guidelines has been detected. However, Italian community based services proved to have a good capacity to provide help quickly to those seeking help for a psychotic onset, to maintain regular contact with them in the subsequent year, and provide pharmacological treatment reasonably in line with the scientific evidence. Instead, little specific support is provided to the relatives.Conclusions– The results show critical points concerning capacity of assessment and treatment standardization, in all aspects of care and specifically in the treatment for the first episode. Differentiation of activities specifically dedicated to the patients at their first episode should be promoted as well as strategies to support relatives in a more specific way.Declaration of Interest:none.

Cost‐effectiveness of treating first‐episode psychosis: five‐year follow‐up results from an Italian early intervention programme

“…A specific protocol of care is not active for patients with psychosis at their first episode. Patients are seen within 7–15 days from the request for intervention: they receive a clinical interview to ascertain diagnosis and co‐morbidity, and are prescribed pharmacotherapy and individual supportive psychotherapy 25 . Contacts are one‐two per month, unless a patient requires more frequent visits.…”

“…The beds available for hospital treatment were 10 per 100 000 when the study was performed. Families receive information on the illness and psychological support when needed, but structured psychoeducation and family therapy are not provided 25 …”

“…Patients are seen within 7-15 days from the request for intervention: they receive a clinical interview to ascertain diagnosis and co-morbidity, and are prescribed pharmacotherapy and individual supportive psychotherapy. 25 Contacts are one-two per month, unless a patient requires more frequent visits. In this case, patients are usually admitted to day-hospital or community residential or semi-residential facilities.…”

“…Families receive information on the illness and psychological support when needed, but structured psychoeducation and family therapy are not provided. 25…”

The SIEP-DIRECT's Project on the discrepancy between routine practice and evidence. An outline of main findings and practical implications for the future of community based mental health services

“…The participating services reported finding it fairly easy to use the indicators developed within the purview of the SIEP-DIRECT'S Project in the self-evaluation process (Ruggeri et al, 2008;Lora et al, 2008a, b;Semisa et al, 2008c): More than 75% of the Centres responded to 69 of the 103 indicators (67%), and less than half of the Centres responded to only 6 indicators (5.8%).…”