Community mental health services and responsibility of psychiatrists in Italy: Lessons for the globe

In 1978, in Italy, approval of Basaglias reform law marked a shift from an asylum-based to a community-based mental health system. The main aim of the reform was to treat patients in the community and no longer in psychiatric hospitals. Following the Italian model, similar reforms of mental health care have been approved worldwide. The community-based model aims to promote integration and human rights for people with mental disorders on the basis of their freedom to choose treatment options. By 2000, all psychiatric hospitals had been closed and all patients discharged. Mental health care is organized through the Department of Mental Health, which is the umbrella organization responsible for specialist mental health care in the community; this includes psychiatric wards located in general hospitals, residential facilities, mental health centres, and day-hospital and day-care units. Approval of Law 180 led to a practical and ideological shift in the provision of care to patients with mental disorders. In particular, the reform highlighted the need to treat patients in the same way as any other patient, and mental health care moved from a custodialistic to a therapeutic model. Progressive consolidation of the community-based system of mental health care in Italy has been observed in the past 40 years. However, some reasons for concern still exist, including low staffing levels, potential use of community residential facilities as long-stay residential services, and a heterogeneity in the availability of resources for mental health throughout the country.

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“…Following the Italian model of mental health care, similar initiatives have been carried out in other countries worldwide. 1 …”

Section: Introductionmentioning

confidence: 99%

Community Mental Health Services in Italy

Sampogna

Vecchio

Rosa

et al. 2021

Consortium Psychiatricum

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“…The global risk for professional liability proceedings in psychiatry is generally low (Martin-Fumad o et al 2015), although in Italy several judgements of the Supreme Court have progressively extended the psychiatrists' duty of care. These judgements have defined new perspectives in the field of professional liability in psychiatry (Catanesi et al 2016), and have increased the possible risk of legal proceedings following an adverse event, such as suicide of a patient or a violent act committed by a patient for whom one held a duty of care (Terranova and Rocca 2016).…”

Section: Introductionmentioning

confidence: 99%

Evaluation of official procedures for suicide prevention in hospital from a forensic psychiatric and a risk management perspective

Ferracuti

Barchielli

Napoli

et al. 2020

International Journal of Psychiatry in Clinical Practice

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Background: Suicide is a severe public health problem, in 2008 the Italian ministerial recommendation n 4 on the management of suicide defined key areas for the identification of suicidal risk in hospital wards. The guidelines are important in defining professional liability issues, in line with Law 24 of 8/3/ 2017 'Gelli-Bianco'. Our study aimed to investigate the appropriateness of the official documents on suicide prevention delivered by Italian hospitals and their compliance with the ministerial recommendation. Methods: The Italian hospitals' public procedures on suicide prevention issued between 2008 and 2019 (n ¼ 33) were retrieved thorough web search and further evaluated according to their compliance with the 2008 Italian ministerial recommendations. Results: The guidelines documents were generally in line with the ministerial recommendation. However, we found a lack of implementation in the specific training of health professionals. Most guidelines provided no risk stratification, nor specific procedures for different risk degrees or diagnoses. More than half of the documents did not report standardised tools for the assessment of suicidal risk. Conclusions: The public procedures on suicide prevention in Italian hospitals present general indications, leaving room for interpretation. Public procedures should be implemented with greater attention to the elements of judgement in the assessment of suicidal risk. KEY POINTS Procedures for suicide prevention are of uttermost importance for psychiatrist working in hospital. Standards in suicide risk evaluations are needed. Comparison between procedures can improve risk assessment and evaluation ARTICLE HISTORY

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Predictors of Client Satisfaction with Outpatient Mental Health Clinic Services in Italy and New York

Pauselli

Galletti

Verdolini

et al. 2017

Community Ment Health J

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The aim of this cross-sectional study was to assess factors associated with client satisfaction in two mental health outpatient settings in Italy and the US. Sociodemographic and clinical variables, hope, and personality characteristics were evaluated in 18-65-year-old patients who had been receiving services for at least 2 months in one of two outpatient clinics, in Italy and the US. Patients were administered: the Healthy Days Core Module, the Kessler Screening Scale for Psychological Distress, the Verona Service Satisfaction Survey, the Client Satisfaction Inventory, the Health Service OutPatient Experience questionnaire, the Herth Hope Index, and the NEO Five-Factor Inventory-3. Bivariate tests for differences between the two samples were conducted, a Satisfaction Composite z-score was computed, and a stepwise, backward elimination, multiple linear regression model-including the variables that were significantly associated with Satisfaction Composite Score in bivariate tests-was built. From July 1, 2015 to April 30, 2016, 184 patients (121 in Foligno, 63 in New York City) were enrolled in the study. Predictors of client satisfaction included: receiving services in New York City, being older, having lower educational attainment, having inner positive readiness and expectancy as well as interconnectedness with self and others, and high scores on the agreeableness personality domain. Interestingly, diagnosis and treatment characteristics did not influence satisfaction. Client satisfaction with outpatient mental health services is mainly influenced by sociodemographic characteristics and personality factors more than clinical variables or patterns of care. These findings could have implications regarding trends toward value-based payment models.

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Community mental health services and responsibility of psychiatrists in Italy: Lessons for the globe

Cited by 6 publications

References 8 publications

Community Mental Health Services in Italy

Community Mental Health Services in Italy

Evaluation of official procedures for suicide prevention in hospital from a forensic psychiatric and a risk management perspective

Predictors of Client Satisfaction with Outpatient Mental Health Clinic Services in Italy and New York

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