Social Psychiatry and Psychiatric Epidemiology

, Volume 40, Issue 2, pp 149–159 | Cite as

Patterns of mental health service utilisation in Italy and Spain

An investigation using the European Service Mapping Schedule
  • Luis Salvador-Carulla
  • Giuseppe Tibaldi
  • Sonia Johnson
  • Elena Scala
  • Cristina Romero
  • Carmine Munizza



Methods for comparing local mental health service systems are needed to allow identification of different patterns of service provision and of inequities within and between countries.


The aim of this study was to describe and compare mental health service systems in 13 catchment areas in Spain and Italy. Within each country, a range of area characteristics was represented.


The European Service Mapping Schedule (ESMS) and European Socio-Demographic Schedule (ESDS) were used to describe: (i) socio-demographic and geographical area characteristics; (ii) services provided; and (iii) service utilisation in each area.


Great differences emerged in patterns of service provision and use between and within countries. In contrast to Northern Europe, high unemployment rates were not associated with high service utilisation rates, but areas with large numbers of single-person households tended to have high service use. Most service utilisation rates were substantially below those reported from Northern European studies. Spanish centres tended to have low rates of hospital service utilisation despite limited development of community-based services. Trieste, where there has been a strong emphasis on developing innovative community services, showed a distinctive pattern with low hospital bed use and high rates of day service use and of contacts in the community.


This methodology yielded useful data, which raise significant questions regarding equity and the implementation of mental health policy. The very large variations indicate that underlying local patterns of service provision must be investigated and taken into account in the interpretation of research evaluations of interventions.

Key words

mental health services service utilisation service comparison European Mapping Schedule socio-demographic factors 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Becker T, Ismann S, Knudsen HC, Martiny K, Amaddeo F, Herran A, Knapp M, Schene AH, Tansella M, Thornicroft G, Vásquez-Barquero JL (2002) Provision of services for people with schizophrenia in five European regions. Soc Psychiatry Psychiatr Epidemiol 37:465–474Google Scholar
  2. 2.
    Beecham J, Johnson S, the EPCAT group (2000) The European Socio-demographic schedule (ESDS): rationale, principles and development. Acta Psychiatr Scand 102(Suppl 405):33–46Google Scholar
  3. 3.
    Beecham J, Munizza C (2000) Assessing Mental Health in Europe: Introduction. Acta Psychiatr Scand 102(Suppl 405):5–7Google Scholar
  4. 4.
    Böcker FM, Jeschke F,Briege P (2001) Psychiatrische Versorgung in Sachsen-Anhalt: Einrichtungen und Dienste im Uberblick—Eine Erhebung mit dem “European Services Mapping Schedule” (ESMS). Psychiatrische Praxis 28:393–401Google Scholar
  5. 5.
    Burns T, Priebe S (1996) Mental health care systems and their characteristics: a proposal. Acta Psychiatr Scand 94:381–385Google Scholar
  6. 6.
    Burti L (2001) Italian Psychiatric Reform 20 plus years after. Acta Psychiatr Scand 104(Suppl 410):41–46Google Scholar
  7. 7.
    Chisholm D, Knapp MR, Knudsen HC, Amaddeo F, Gaite L, van Wijngaarden B (2000) Client Socio-Demographic and Service Receipt Inventory-European version: Development of an instrument for international research. EPSILON study 5. European psychiatric services: Inputs linked to outcome domains and needs. Br J Psychiatry (Suppl) 39:28–33Google Scholar
  8. 8.
    Gater R, Amaddeo F, Tansella M, Jackson G, Goldberg D (1995) A comparison of community-based care for schizophrenia in South Verona and South Manchester. Br J Psychiatry 166:344–352Google Scholar
  9. 9.
    Glover G, Barnes D (2004) Mental Health Service Provision for Working Age Adults in England. Published on the internet at Durham: Centre for Public Mental HealthGoogle Scholar
  10. 10.
    Haro JM, Salvador-Carulla L, Cabasés J, Madoz V, Vázquez-Barquero JL, the PSICOST Group (1998) Utilisation of mental health services and costs of patients with schizophrenia in three areas of Spain. Br J Psychiatry 173:334–340Google Scholar
  11. 11.
    Harrison J, Barrow S, Creed F (1997) Social deprivation and psychiatric admission rates among different diagnostic groups. Br J Psychiatry 167:456–462Google Scholar
  12. 12.
    Johnson S, Salvador-Carulla L, the EPCAT Group (1998) Description and classification of mental health services: a European perspective. Eur Psychiatry 13:333–341Google Scholar
  13. 13.
    Johnson S, Kuhlmann R, the EPCAT Group (2000) The European Service Mapping Schedule (ESMS): development of an instrument for the description and classification of mental health services. Acta Psychiatr Scand 102(Suppl 405):14–23Google Scholar
  14. 14.
    Kammerling RM, O’Connor S (1993) Unemployment rate as a predictor of psychiatric admission. BMJ 307:1536–1539Google Scholar
  15. 15.
    Knapp M, Chisholm D, Leese M, Amaddeo F, Tansella M, Schene A, Thornicroft G, Vázquez-Barquero J-L, Knudsen HC, Becker T, the EPSILON group (2002) Comparing patterns and costs of schizophrenia care across five European countries: the EPSILON study. Acta Psychiatr Scand 105:42–54Google Scholar
  16. 16.
    Löffler W, Häfner H (1999) Ecological pattern of first admitted schizophrenics in two German cities over 25 years. Soc Sci Med 49:93–108Google Scholar
  17. 17.
    López-Casasnovas G (2000) La financiación autonómica de la sanidad. Algunas afirmaciones, valoraciones y constataciones. Gaceta Sanitaria 14:4Google Scholar
  18. 18.
    Mezzina R, Vidoni D (1995) Beyond the mental hospital: crisis intervention and continuity of care in Trieste.A four-year follow-up study in a community mental health centre. Int J Soc Psychiatr 41:1–20Google Scholar
  19. 19.
    Munizza C, Tibaldi G, Zuccolin M, Palazzi C, Scala E, Cesano S, Dazzi R, Fantini G (1999a) Standardised service assessment in Italy. In: Guimòn J, Sartorius N (eds) Manage or Perish? Challenges of Managed Mental Health Care in Europe. New York: Plenum PressGoogle Scholar
  20. 20.
    Munizza C, Tibaldi G, Scala E, EPCAT (1999b) Standardizzazione e comparazione dei servizi di assistenza psichiatrica. In: Scapicchio PL, Trabucchi M (eds) I servizi psichiatrici nella sanità riformata. Bologna: Il MulinoGoogle Scholar
  21. 21.
    Munizza C, Tibaldi G, Cesano S, Dazzi R, Fantini G, Scala E, Zuccolin M (2000) Mental health care in Piedmont: a description of its structure and components using a new technology for service assessment. Acta Psychiatr Scand 102(Suppl 405):47–58Google Scholar
  22. 22.
    Peen J, Dekker J (2001) Social deprivation and psychiatric service use for different diagnostic groups. Soc Sci Med 53:1–8Google Scholar
  23. 23.
    Ramsay R, Thornicroft G, Johnson S, Brooks L, Glover G (1997) Levels of in-patient and residential provision throughout London. In: Johnson S, Ramsay R, Thornicroft G, Brooks L, Lelliott P, Peck E, Smith H, Chisholm D, Audini B, Knapp M, Goldberg D (eds) London’s Mental Health. London: Kings FundGoogle Scholar
  24. 24.
    Romero C (2000) Descripción y clasificación estandarizada de servicios de salud mental en España. El European Service Mapping Schedule. Doctoral thesis. University of Cádiz, Cádiz (Spain)Google Scholar
  25. 25.
    Salize HJ, Moreno-Küstner B, Torres-González F, Reinhard I, Estevez JFJ, Rössler W (1999) Needs for care and effectiveness of mental health care provision for schizophrenic patients: a comparison between Granada (Spain) and Mannheim (Germany). Acta Psychiatr Scand 100:328–334Google Scholar
  26. 26.
    Salvador-Carulla L, Atienza C, Romero C, the Psicost Group (1999) Use of the EPCAT Model for Standard Description of Psychiatric Services: the Experience in Spain. In: Guimon J, Sartorius N (eds) Manage or Perish: The Challenges of Managed Mental Health Care in Europe. New York: Plenum PressGoogle Scholar
  27. 27.
    Sytema S, Micciolo R, Tansella M (1996) Service utilization by schizophrenic patients in Groningen and South-Verona: an event-history analysis. Psychol Med 26:109–119Google Scholar
  28. 28.
    Sytema S, Burgess P (1999) Continuity of care and readmission in two service systems: a comparative Victorian and Groningen case-register study. Acta Psychiatr Scand 100:212–219Google Scholar
  29. 29.
    Tansella M, Thornicroft G (1998) A conceptual framework for mental health services: the matrix model. Psychol Med 28:503–508Google Scholar
  30. 30.
    Thornicroft G, Bisoffi G, Desalvia D, Tansella M (1993) Urbanrural differences in the associations between social deprivation and psychiatric-service utilisation in schizophrenia and all diagnoses—a case register study in Northern Italy. Psychol Med 23:487–496Google Scholar
  31. 31.
    Vázquez-Barquero J, García J, Torres-Gonzales F (2001) The Spanish psychiatric reform: what can be learned from two decades of experience? Acta Psychiatr Scand 104(Suppl 410):89–95Google Scholar
  32. 32.
    Women and Equality Unit (2001) Women and Work: Challenge and Opportunity. Published on the internet at Scholar
  33. 33.
    World Health Organisation (2001a) The World Health Report. Mental Health: New Understanding, New Hope. Geneva: World Health OrganisationGoogle Scholar
  34. 34.
    World Health Organisation (2001b) Atlas: Mental Health Resources in the World. Geneva: WHO Department of Mental Health and Substance DependenceGoogle Scholar

Copyright information

© Steinkopff Verlag 2005

Authors and Affiliations

  • Luis Salvador-Carulla
    • 1
  • Giuseppe Tibaldi
    • 2
  • Sonia Johnson
    • 3
  • Elena Scala
    • 2
  • Cristina Romero
    • 1
  • Carmine Munizza
    • 2
  1. 1.RIRAG/PSICOST Research NetworkJerezSpain
  2. 2.Centro Studi e Ricerche in Psichiatria (CSRP)TorinoItaly
  3. 3.Dept. of Mental Health SciencesRoyal Free and University College London Medical Schools, Wolfson BuildingLondon W1W 7EYUK

Personalised recommendations