Recent Trends in Mental Health Services in Italy: An Analysis of National and Local Data

Abstract

This paper reviews trends in Italian mental health services after the implementation of the 1978 Mental Health Act. Data available at the national level on public and private inpatient services, community mental health centres, residential and day care facilities are presented and discussed. Findings from two case-register areas, where comprehensive community services according to the Mental Health Act have been implemented, are discussed. Public mental hospitals are no longer used for psychiatric treatment, except for a small number of long stay patients. General hospital psychiatric units are the only setting in the public sector where psychiatric patients can be admitted. In private mental hospitals, the number of residents has decreased, while admissions have remained stable. However, community services are unevenly distributed and residential facilities are generally lacking. Little is known about quality of care provided, although data from some pilot studies are encouraging. Stable admission rates to forensic mental hospitals suggest that the criminalization of mentally ill has not increased. The effect of changing patterns of mental health care on suicide rates are discussed.

The mental health care delivery system in greece: regional variation and socioeconomic correlates

“…[3][4][5][7][8][9][10] Among the main factors predicting the regional distribution of both the professionals and the services, is the local level of socioeconomic development. [3][4][5][7][8][9][10] In the socially disadvantaged areas the patients are treated in mental hospitals due to the lack of alternatives to mental hospital treatment.…”

“…5,9 The uneven distribution of community-based mental health care and rehabilitation services in different geographical locations has also been the subject of analysis. 7,8,10 In the case of Greece, psychiatric care until 1980 was based on nine overcrowed anachronistic public mental hospitals and 40 private ones, both categories of settings inadequately staffed with a lack of rehabilitation programmes.…”

The geography of mental health

“…The geographical variations in the provision of community-based mental health care in different parts of Italy are well documented (Tansella et al, 1987;Donnelly, 1992;De Salvia & Barbato, 1993;Burti & Benson, 1996). An important finding from the research conducted in Verona was the wide variation in models of service delivery provided by the three different mental health services which operated within the city at the time of the research (1994).…”

Community psychiatry in Italy

“…Gia De Salvia & Barbato (1993) cercavano di superare tale rischio di infinita descrittivita (ove di fatto non si fa che ribadire che Nord, Centro e Sud godono di disponibilita diverse di servizi, senza tuttavia riuscire ad entrare nel merito delle funzioni reali svolte da questi servizi) cercando di «leggere» piu in profondita questi dati descrittivi. L'indagine CENSIS mostrava, ad esempio, che tutti i servizi psichiatrici territoriali offrono trattamenti ambulatoriali e visite domiciliari, ma che solo il 21% e dotato di un centro diurno e soltanto il 12% offre spazi per la riabilitazione.…”

“…Tutti i servizi territoriali risultavano funzionanti lungo l'arco delle ore lavorative diurne (dato che appare in realta ottimistico) ma soltanto il 5% operano durante le 24 ore dei sette giorni della settimana. II 50% degli interventi offerti e costituito da diagnosi e farmacoterapia e il 32% da interventi di sostegno psicoterapico, ma soltanto il 18% degli interventi sono di natura psicosociale (De Salvia & Barbato, 1993).…”