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The process of care in residential facilities

A national survey in Italy

  • Original Paper
  • Published:
Social Psychiatry and Psychiatric Epidemiology Aims and scope Submit manuscript

Abstract

Background

Although residential facilities (RFs) have largely replaced mental hospitals (MHs) in most developed countries for the long-term residential care of severely impaired patients, the process of care in RFs has not been well studied. The aim of this paper is to investigate the process of care in 265 RFs, representing 19.3% of all RFs in Italy, and to devise a classification of RFs based on process characteristics.

Methods

Structured interviews were conducted with the manager and staff of each RF. Residents were evaluated using standardized rating instruments.

Results

Most RFs had specific admission criteria, with one third having a waiting list that averaged about 3 months. There was no formal limitation to the length of stay in three quarters of RFs, and turnover rates were very low. Although a homelike atmosphere was found in many RFs, most facilities had restrictive rules on patients’ daily lives and behaviours. RFs carried out several external activities targeted at integrating patients within the local community. Standardized assessment instruments and written treatment plans were rarely used. A cluster analysis based on the levels of restrictiveness and the standardization of the process of care classified RFs into five groups that differed with respect to daily staff coverage, size, geographical distribution and proportion of former MH residents. No significant intercluster differences were associated with the current clinical and psychosocial characteristics of residents, or with several other outcome variables.

Conclusions

This study provides naturalistic evidence of the heterogeneity of the process of residential care on a large scale. Future efforts should focus on developing an empirical classification of RFs, as well as on national and international standards of care and staffing to address patients’ needs.

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Acknowledgements

The study was supported by a grant from the Italian National Institute of Health. Special thanks are due to Geoff Shepherd, Ph.D., and Richard Warner, M.D., for their very helpful comments.

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Authors and Affiliations

  1. Psychiatric Clinic, United Hospitals of Ancona and Politechnic University of Marche, Ancona, Italy

    Giovanni Santone

  2. Department of Mental Health, Azienda USL di Bologna, Viale Pepoli 5, 40123, Bologna, Italy

    Giovanni de Girolamo

  3. University of Auckland, Auckland, New Zealand

    Ian Falloon

  4. Programme on Mental Health and Pathological Dependence, Azienda USL of Rimini, Rimini, Italy

    Angelo Fioritti

  5. Biostatistics, University of Trento, Trento, Italy

    Rocco Micciolo

  6. National Institute of Health, Rome, Italy

    Angelo Picardi

  7. Department of Mental Health and Piedmont Region Mental Health Sector, Turin, Italy

    Enrico Zanalda

Authors
  1. Giovanni Santone
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  2. Giovanni de Girolamo
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  3. Ian Falloon
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  4. Angelo Fioritti
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  5. Rocco Micciolo
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  6. Angelo Picardi
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  7. Enrico Zanalda
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for the PROGRES Group

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Correspondence to Giovanni de Girolamo.

Additional information

The PROGRES Group includes: National Coordinators: G. de Girolamo, A. Picardi, P. Morosini (National Mental Health Project, National Institute of Health); Biostatistician: R. Micciolo (University of Trento); Regional Coordinators: P. Argentino, M. Casacchia, P. Ciliberti, G. Civenti, A. Colotto, G. Dell’Acqua, W. Di Munzio, G. Fagnano, A. Fioritti, N. Longhin, M. Miceli, M. Nicotera, M. Pisetta, R. Putzolu, E. Rossi, M. E. Rotunno, G. Borsetti, D. Semisa, R. Tomasi, P. Tulli, E. Zanalda; Researchers: C. Barbini, F. Basile, G. Bazzacco, R. Bracco, A. Calvarese, G. Canuso, E. Caroppo, L. Caserta, M. Colangione, S. Damiani, T. De Donatis, F. Di Donato, V. Di Michele, R. Esposito, M. Facchini, S. Ferraro, P. Fracchiolla, P. Gabriele, D. Gallicchio, G. Giardina, A. Greco, F. Grilletti, S. Guzzo, A. M. Lerario, M. R. Marinelli, C. Marino, E. Monzani, F. Picoco, L. Pinciaroli, C. A. Rossetti, P. Rubatta, G. Santone, F. Scorpiniti, V. Scrofani, M. Stefani, A. Svettini, A. Zaffarano, M. Cellini, A. Galli, K. Pesaresi, G. Pitzalis, L. Tarantino; Scientific Consultants: F. Amaddeo, I. Falloon

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for the PROGRES Group., Santone, G., de Girolamo, G. et al. The process of care in residential facilities. Soc Psychiat Epidemiol 40, 540–550 (2005). https://doi.org/10.1007/s00127-005-0922-1

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  • DOI: https://doi.org/10.1007/s00127-005-0922-1

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