The current state of mental health care in Italy: problems, perspectives, and lessons to learn

Abstract

After legislative changes in 1978, Italian psychiatry underwent a thorough overhaul, with the gradual closure of all Mental Hospitals. A nation-wide network of Departments of Mental Health now deliver outpatient and inpatient care, but also run semi-residential and residential facilities (the latter with 2.9 beds per 10,000 inhabitants). Hospital care is delivered through small psychiatric units (with no more than 15 beds). There are also many private inpatient facilities operating in Italy, and the number of private inpatient beds per 10,000 inhabitants exceeds the number of public beds; overall there are 1.7 acute beds per 10,000 inhabitants - one of Europe's currently lowest numbers. There is marked quanti- and qualitative variation in the provision of out- and inpatient care throughout the country, and service utilization patterns are similarly uneven. Studies examining quality of life report a fairly high degree of patient satisfaction, whereas patients' families frequently bear a heavy burden. In conclusion, the Italian reform law led to the establishment of a broad network of facilities to meet diverse care needs. Further efforts are required to improve quality of care and to develop a more effectively integrated system. Greater attention must be paid to topics such as quality of care and outcomes, public and private sector balance, and the coordination of various resources and agencies.

Viviendas supervisadas para personas con trastorno mental severo en Asturias: ¿ambiente restrictivo o abiertas a la comunidad?

“…Por otro lado, la situación de los dispositivos actuales, también en términos de acceso a servicios comunitarios, parece traducir una ubicación de los mismos en entornos residenciales normales, lo que favorece la integración y mejora la calidad de vida de los residentes, tal y como muestran diversos estudios (Contreras Nieves et al, 2007;De Girolamo et al, 2007;Florit Robles et al, 2007;Kyle y Dunn, 2008;López Álvarez et al, 2004López Álvarez et al, , 2005aMares et al, 2002;Rickard et al, 2002;Shepherd y Murray, 2001). Sin embargo, la utilización real que hacen de estos servicios es muy escasa, como demuestra la baja puntuación que obtienen los usuarios de las viviendas en participación e integración comunitaria.…”

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

“…Non-hospital RFs were located outside the hospital grounds and were designed as places where psychiatric patients reside receiving part of their therapeutic programme; this facilities have included a variety of residential settings, which internationally have been named in several ways over time, such as board homes, intermediate facilities, wards in the community, supervised hostels or apartments, etc. (de Girolamo et al 2007).…”

Mental health reform: Europe at the cross-roads

“…They may become homeless or have more contact with the criminal justice system. The onus may also fall on families to fill the gap and provide support, as has for example been seen in Italy and Denmark (de Girolamo et al, 2007, Munk-Jorgensen, 1999. Poorly planned and inadequately resourced hospital to community 'transfer' can thus serve to undermine public confidence in future investment in community-based care.…”