Social Psychiatry and Psychiatric Epidemiology

, Volume 54, Issue 11, pp 1419–1427 | Cite as

Mental health supported accommodation services in England and in Italy: a comparison

  • Alessandra MartinelliEmail author
  • Laura Iozzino
  • Mirella Ruggeri
  • Louise Marston
  • Helen Killaspy
Original Paper



England and Italy are considered pioneers in the development of community mental health services. Both have implemented supported accommodation services for those with more complex needs, which can be broadly categorized into three main types with similar specification. The aim of this study was to compare the characteristics of these services and their users in England and Italy.


Data from two cross-sectional surveys of supported accommodation services undertaken across England and in Verona, Italy (England—619 service users from 87 services; Verona—167 service users from 25 services) were compared.


Service users in the two samples had similar socio-demographic and clinical characteristics; most were male, unmarried and unemployed, with a primary diagnosis of schizophrenia or other psychosis and over 15 years contact with mental health services. Supported accommodation occupancy was high in both samples. The actual length of stay was greater than the expected length of stay for all three service types but overall turnover was similar between countries (p = 0.070). Across services, total needs and quality of life were higher for Italian compared to English service users (p < 0.001 for both) but, unmet needs were lower amongst English service users (p < 0.001). Around 40% in both samples moved to more independent accommodation successfully within 30 months.


England and Italy have similar mental health supported accommodation pathways to assist those with more complex needs to gain skills for community living, but individuals tend to require longer than expected at each stage.


Supported accommodation Psychiatric rehabilitation Quality of life Met needs Deinstitutionalization 



This study was unfunded and represented a secondary analysis of existing data.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests.


  1. 1.
    WHO (2005) Mental Health Atlas: 2005, mental health: evidence and research. WHO, GenevaGoogle Scholar
  2. 2.
    WHO Regional Office for Europe (2013) The European Mental Health Action Plan. Regional Office for Europe. WHO Regional Office for Europe, CopenhagenGoogle Scholar
  3. 3.
    McPherson P, Krotofil J, Killaspy H (2018) Mental health supported accommodation services: a systematic review of mental health and psychosocial outcomes. BMC Psychiatry 18(1):128CrossRefGoogle Scholar
  4. 4.
    English Ministry of Health (1962) The Hospital Plan for England and Wales (Cmnd, 1604) HMSO. English Ministry of Health, LondonGoogle Scholar
  5. 5.
    NHS England (2017) Bed availability and occupancy. NHS England website Accessed 7 Sept 2017
  6. 6.
    Department of Health and Social Security (1981) Care in the community HMSO. Department of Health and Social Security, LondonGoogle Scholar
  7. 7.
    Department of Health (1990) National Health Service and Community Care Act. Department of Health, LondonGoogle Scholar
  8. 8.
    Department of Health (1998) Partnerships in action-new opportunities for joint working between health and social services: a discussion document. HMSO Department of Health, LondonGoogle Scholar
  9. 9.
    ODPM (2002) The NHS and the supporting people strategy: building the links. NHS, LondonGoogle Scholar
  10. 10.
    Ramon S (1983) Psichiatria democratica: a case study of an Italian community mental health service. Int J Health Serv 13(2):307–324CrossRefGoogle Scholar
  11. 11.
    De Girolamo G, Barbato A, Bracco R et al (2007) Characteristics and activities of acute psychiatric in-patient facilities: national survey in Italy. Br J Psychiatry 191(2):170–177CrossRefGoogle Scholar
  12. 12.
    Medeiros H, MCDaid D, Knapp M, MHEEN Group (2008) Briefing, Shifting care from hospital to the community in Europe: Economic challenges and opportunities. MHEEN II Policy Briefing 4, Personal Social Services Research Unit, LondonGoogle Scholar
  13. 13.
    McDaid D, Thornicroft G (2005) Policy brief mental health II. Balancing institutional and community-based care. WHO European Centre for Health Policy, CopenhagenGoogle Scholar
  14. 14.
    Ministero Italiano della salute (2015/6) Rapporto salute mentale, Analisi dei dati del Sistema Informativo per la Salute Mentale (SISM), Anno 2016. Ministero Italiano della salute, ItalyGoogle Scholar
  15. 15.
    Holloway F (2005) The forgotten need for rehabilitation in contemporary mental health services. RC of PsychiatristsGoogle Scholar
  16. 16.
    Priebe S, Saidi M, Want A et al (2009) Housing services for people with mental disorders in England: patient characteristics, care provision and costs. Soc Psychiatry and Psychiatr Epidemiol 44:805–814CrossRefGoogle Scholar
  17. 17.
    Boardman J, Currie A, Killaspy H, et al (2010) Social inclusion and mental health. RC of PsychiatristsGoogle Scholar
  18. 18.
    Department of Communities and Local Government (2006) Research into the effectiveness of floating support services for the Supporting People programme. Final report. Communities and Local Government, LondonGoogle Scholar
  19. 19.
    Joint Commissioning Panel for Mental Health (2012) Guidance for commissioners of rehabilitation services for people with complex mental health needs RC of Psychiatrists, London, UK (updated 2016) Google Scholar
  20. 20.
    Consiglio Regionale del Veneto (X Legislatura), Quinta Commissione Consiliare Permanente (2018) Parere alla Giunta regionale n. 320, Programmazione del sistema di offerta residenziale extra-ospedaliera per la salute mentale, Richiesta di parere alla Commissione Consiliare (articolo 10, comma 1, legge regionale n. 23/2012). In: Bollettino Ufficiale Regione Veneto, edizione 1 del 04 giugno 2018, Veneto, ItalyGoogle Scholar
  21. 21.
    Macpherson R, Shepherd G, Thyarapp P (2012) Supported accommodation for people with severe mental illness: an update. Adv Psychiatr Treat 18:381–391CrossRefGoogle Scholar
  22. 22.
    Killaspy H, Priebe S, Bremner S et al (2016) Quality of life, autonomy, satisfaction, and costs associated with mental health supported accommodation services in England: a national survey. Lancet Psychiatry 3(12):1129–1137CrossRefGoogle Scholar
  23. 23.
    De Girolamo G, Picardi A, Micciolo R et al (2002) Residential care in italy. National survey of non-hospital facilities. Br J Psychiatry 181:220–225CrossRefGoogle Scholar
  24. 24.
    Iozzino L, Cristofalo D, Bovo C et al (2018) Medical comorbidities in patients receiving residential treatment: results from the VALERE (eVALuation of outcomE in REsidential facilities) project. J of Psychosomatic Res 109:110CrossRefGoogle Scholar
  25. 25.
    Priebe S, Saidi M, Kennedy J et al (2008) How to select representative geographical areas in mental health service research. Soc Psychiatry Psychiatr Epidemiol 43:1004–1007CrossRefGoogle Scholar
  26. 26.
    Amaddeo F (2018) Using large current databases to analyze mental health services. Epidemiol Prev 42(1):98–99PubMedGoogle Scholar
  27. 27.
    Slade M, Thornicroft G, Loftus L, et al (1999) The Camberwell Assessment of Need (CAN). RC of PsychiatristsGoogle Scholar
  28. 28.
    Priebe S, Huxley P, Knight S et al (1999) Application and results of the Manchester short assessment of quality of life (MANSA). Int J Soc Psychiatry 45:7–12CrossRefGoogle Scholar
  29. 29.
    Killaspy H, Marston L, Omar RZ et al (2013) Service quality and clinical outcomes: an example from mental health rehabilitation services in England. Br J Psychiatry 202(1):28–34CrossRefGoogle Scholar
  30. 30.
    Nyer M, Kasckow J, Fellows I et al (2010) The relationship of marital status and clinical characteristics in middle-aged and older patients with schizophrenia and depressive symptoms. Ann Clin Psychiatry 22(3):172–179PubMedGoogle Scholar
  31. 31.
    Diggle J, Butler H, Musgrove M et al (2017) Brick by brick: a review of mental health and housing. Mind, LondonGoogle Scholar
  32. 32.
    Sandhu S, Priebe S, Leavey G (2017) Intentions and experiences of effective practice in mental health specific supported accommodation services: a qualitative interview study. BMC Health Services Res 17:471CrossRefGoogle Scholar
  33. 33.
    NHS (2018) Bed availability and occupancy data—overnight. Unify2 data collection—KH03, 21st August 2014 edn. NHS EnglandGoogle Scholar
  34. 34.
    WHO (2014) Global status report on alcohol and health. WHO Press, LuxembourgGoogle Scholar
  35. 35.
    Ministero Italiano della salute (2017) Relazione del ministro della salute al parlamento sugli interventi realizzati ai sensi della legge 30.3.2001 n. 125 “legge quadro in materia di alcol e problemi alcol correlati”. Ministero Italiano della salute, ItalyGoogle Scholar
  36. 36.
    NHS Digital, Lifestyles Statistics Team (2018) Statistics on Alcohol: England, 2018. National Statistics, V1.0 edn. NHS EnglandGoogle Scholar
  37. 37.
    EMCDDA, European Monitoring Centre for Drugs and Drug Addiction (2018) European Drug Report 2018: trends and developments. Publications Office of the European Union, LuxembourgGoogle Scholar
  38. 38.
    Regione Veneto, Settore Salute Mentale e Sanità Penitenziaria (2014) La residenzialità psichiatrica nel Veneto. Regione Veneto, VenetoGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement ScienceUniversity of VeronaVeronaItaly
  2. 2.IRCCS Istituto Centro San Giovanni di Dio FatebenefratelliBresciaItaly
  3. 3.Department of Primary Care and Population HealthUniversity College LondonLondonUK
  4. 4.Division of PsychiatryUniversity College LondonLondonUK

Personalised recommendations