Youth mental health services in Italy: An achievable dream?

Abstract

LIF project showed that psychological problems, associated with impaired psychosocial functioning, are very common among help-seeking young people. The help-seeking behaviour of young people is in contrast with the barriers presented by the Italian community mental health system that is modelled around adults' requirements. A need of a strong, stigma-free, young oriented system of care for young people up to the mid-20s emerged.

The “Reggio Emilia At‐Risk Mental States” program: A diffused, “liquid” model of early intervention in psychosis implemented in an Italian Department of Mental Health

“…The baseline prevalence of UHR diagnosis among individuals entering the ReARMS protocol was 26.3%, similar to what observed in Italian comparable studies (24.7% [Cocchi et al, ]; 18.9% [Masillo et al, ]). In line with findings reported in the literature (Fusar‐Poli et al, ; Fusar‐Poli, Raballo, & Parnas, ), our UHR subjects almost exclusively met APS criteria (more than 90%), and major depression was the most frequent diagnosis (> 50%) at initial examination, followed by anxiety disorders (about 30%).…”

“…However, more than two thirds were offered a dedicated protocol of care: of them, approximately 75% accepted and were enrolled in the program, 10% refused and 15% dropped out during the first year of treatment (ie, after accepting the therapeutic proposal). These findings are substantially in line with those reported by Cocchi et al (2013) in ten years of activity of "Programma 2000" (ie, 25.4% = subjects who were rejected because they did not comply with UHR/FEP criteria, 61.1% = subjects who were proposed the specific EIP treat- [Cocchi et al, 2013]; 18.9% [Masillo et al, 2018]). In line with findings reported in the literature (Fusar-Poli et al, 2016;Fusar-Poli, Raballo, & Parnas, 2017), our UHR subjects almost exclusively met APS criteria (more than 90%), and major depression was the most frequent diagnosis (> 50%) at initial examination, followed by anxiety disorders (about 30%).…”

“…Secondly, in comparing our findings with those of other Italian study (Cocchi et al, ; Masillo et al, ), it is necessary to take into consideration any possible regional difference in terms of catchment area size and local organization of mental health services. Indeed, since health care in Italy is provided and financed by eminently regional organisms, there could be considerable structural and functional gaps among different departments of mental health.…”

“…Still on the Italian scene, but in line with our finding, about 340 help‐seeking young individuals, aged 12 to 35 years, were included in the “Liberiamo Il Futuro” (LIF) project between January 2012 and June 2015. LIF was a project carried out by the contribution of Sapienza University of Rome and all the AMHS and CAMHS of one of the eight Local Health Districts of Rome (ie, the Rome area H, a catchment area of approximately 500 000 inhabitants), with the aim of deeper assessing psychological problems of adolescents and young adults and identifying individuals at high‐risk for developing psychosis (Masillo et al, ).…”

“…In comparison with the referral rate observed in "Programma 2000" (Cocchi, Balbi, et al, 2015;Cocchi, Cavicchini, et al, 2015), our finding is definitely higher, suggesting that a diffused, "liquid" infrastructure specifically involving all the local CAMHS and AMHS is probably more able to effectively meet and respond to the care needs of help-seeking users, placing in services and discontinuity of care (Singh & Toumainen, 2015). In this regards, data suggest that only a small proportion (approximately 20%) of adolescents treated by CAMHS move to AMHS in Italy (Stagi, Galeotti, Mimmi, Starace, & Castagnini, 2015), and Italian programs addressing the problem of the lack in continuity of care for various reasons struggle to be established (Masillo et al, 2018). As focusing on transitional care has the potential for transforming outcomes in youth mental health, it is therefore necessary to urgently develop and implement reformed service models that are specifically geared to meeting the unique needs and preferences of adolescents and young adults rather than strictly aligned to chronology and rigid diagnostic boundaries, and provide high-quality evidence-based interventions that promote well-being, self-sufficiency, and autonomy (Raballo, Poletti, & McGorry, 2017).…”