How Does the Residential Care System Change? A Longitudinal Survey in a Large Region of Italy

Abstract

To describe 5-year changes in the provision of Residential Facilities (RFs) in a large Italian Region and in the characteristics of their staffing and patients. 2000 census data of all RFs with >4 residential beds in the Emilia-Romagna Region were compared with 2005 census data. The number of residential beds increased from 3.1 per 10,000 inhabitants in 2000 to 4.1 per 10,000 inhabitants in 2005. The RFs operated by private non-profit associations increased at a greater rate than the number of NHS-operated facilities, and the percentage of non-qualified staff has also risen at a greater rate than that observed for qualified staff. The number of individuals with comorbid substance abuse increased from 2.1% in 2000 to 5.7% in 2005. Patient turnover rates were low in both 5-year periods. A process of new institutionalization might be taking place. Mental health care policy-makers should take these findings into account to enhance the planning of effective services, including RFs granting a satisfactory quality of life to patients with severe disorders requiring long-term, eventually unlimited care.

Healthcare ecosystems research in mental health: a scoping review of methods to describe the context of local care delivery

“…Of the 46 eligible studies, 36 (78.3%) [19–54] were descriptive, and 10 (21.7%) were analytical [55–64]. Thirty six papers (80.4%) presented service availability data from a single country, of which 19 [20, 28, 32–34, 37, 40–42, 50, 51, 53–57, 59, 61, 64] took a regional or local approach, while 17 [19, 21–27, 30, 36, 38, 39, 43–46, 49] looked at availability from a national level. Ten papers presented service data from more than one country, of which seven [29, 35, 47, 48, 52, 58, 60] took a regional or local approach, and three [31, 62, 63] were at the national level.…”

“…ESMS/DESDE was developed for all long term care services. Fifteen studies did not use a structured framework [19, 26, 30, 32, 35–42, 46, 49, 57], of which five did not provide any method [37, 40–42, 46]. Four of these [37, 40, 41, 42] formed part of a group of seven papers in a special supplement related to a conference on mental health care in capital cities: however three of this seven papers were excluded from this study as they did not include any data on service availability.…”

Accommodation and Health Costs of Deinstitutionalized People with Mental Illness Living in Residential Services in Brazil

“…While deinstitutionalisation initiatives were started several decades ago within high-income countries, this topic is still relevant for evaluating mental health policies in terms of costs, quality and outcomes [16]. Furthermore, the re-institutionalisation rate [17] of individuals with mental disorders has been growing within some high-income countries. Additionally, the deinstitutionalisation process is still in progress across many low- and middle-income countries [18].…”

Psychiatric Rehabilitation in Italy: Cinderella No More—The Contribution of Psychiatric Rehabilitation Technicians

“…A more recent study, a census on all Emilia-Romagna region RFs with four or more residential beds, in 2000 and 2005, was conducted in order to describe five-year changes in the provision of RFs and in the characteristics of their staffing and patients in a large Italian region [24]. The study showed that the RFs operated by private nonprofit associations increased at a greater rate than the number of National Health System-operated facilities, and the percentage of nonqualified staff had also risen at a greater rate than that observed for qualified staff.…”

“…The study showed that the RFs operated by private nonprofit associations increased at a greater rate than the number of National Health System-operated facilities, and the percentage of nonqualified staff had also risen at a greater rate than that observed for qualified staff. In fact, despite a 50 percent increase in the employment of full-time clinical psychologists and rehabilitation therapists, the number of these highly trained professionals per facility remained extremely low, very likely due to lower personnel costs as compared to the overhead that is involved in employing qualified staff members [24]. In the light of this data, the inclusion of qualified professionals, such as the PRT, in the Italian mental health care system seems to be distant, primarily because of the lack of a strict requirement in the psychiatric staff of the MHDs and RFs and lack of financial resources.…”