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The mental health system in Lombardy, Italy: access to services and patterns of care

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Abstract

Purpose

The psychiatric reform in Italy devolved to the regions the responsibility of implementing community psychiatric care. The aim of this paper is to evaluate the mental health system in Lombardy by assessing changes in accessibility and patterns of care occurred between 1999 and 2009.

Methods

Data on mental health services were collected through the regional mental health information system and analyzed in terms of treated prevalence, treated incidence, continuity of care and packages of care.

Results

Both treated incidence and treated prevalence in Lombardy increased between 1999 and 2009. There was an increasing access to psychiatric services of people with a better social integration. Incidence of schizophrenic and personality disorders decreased and that of affective and neurotic disorders increased dramatically, while increase in prevalence concerned all diagnostic groups. The percentage of patients in continuous care remained stable and was generally low. The majority of cases, even those with schizophrenia, are cared for on outpatient basis. The percentage of patients receiving integrated multiprofessional care declined. Rates of admission to inpatient services remained low and within the inpatient sector a shift from hospital towards residential care emerged, with decreasing hospital utilization and an increase in size of patient population entering community residences. Treatment gap is still a problem in schizophrenic disorders.

Conclusions

The Lombardy mental health system is strongly based on community care. However, it is reaching a turning point and it needs to be improved in some key areas: the shifting balance towards the care of common mental disorders, in the absence of resource allocations targeted to severely mentally ill, may hinder the system ability to deal with more disabled people. A focus on early intervention and an improvement of continuity of care for people with severe mental disorder, by strengthening community teams, is a priority.

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References

  1. Munk-Jørgensen P (1999) Has deinstitutionalization gone too far? Eur Arch Psychiatry Clin Neurosci 259:136–143

    Google Scholar 

  2. Salize HJ, Schanda H, Dressing H (2008) From the hospital into the community and back again. A trend towards reinstitutionalisation in mental health care? Int Rev Psychiatry 20:527–534

    Article  PubMed  Google Scholar 

  3. Manderscheid RW, Atay JE, Crider RA (2009) Changing trends in state psychiatric hospital use from 2002 to 2005. Psychiatr Serv 60:29–34

    Article  PubMed  Google Scholar 

  4. Piccinelli M, Politi P, Barale F (2002) Focus on psychiatry in Italy. Br J Psychiatry 181:538–554

    Article  PubMed  Google Scholar 

  5. Lora A (2009) An overview of the mental health system in Italy. Ann Ist Super Sanita 45:5–16

    PubMed  Google Scholar 

  6. World Health Organization (2007) Everybody’s business: strengthening health systems to improve health outcomes: WHO’s framework for action. WHO, Geneva

  7. Saraceno B (2007) Mental health systems research is urgently needed. Int J Ment Health Syst 1:2. doi:10.1186/1752-4458-1-2

  8. McEwan KL, Goldner EM (2002) Keeping mental health reform on course: selecting indicators of mental health system performance. Can J Commun Ment Health 21:5–16

    PubMed  Google Scholar 

  9. Regione Lombardia Sanità (2009) Il sistema di salute mentale della Regione Lombardia. Regione Lombardia, Milano. http://www.dgsan.lombardia.it/pubblicazionivarie/sistema_salute_mentale_19992005.pdf. Accessed 22 November 2010 (in Italian)

  10. Burns T, Catty J, White S, Clement S, Ellis G, Jones IR, Lissouba P, McLaren S, Rose D, Wykes T, for the ECHO group (2009) Continuity of care in mental health: understanding and measuring a complex phenomenon. Psychol Med 39:313–323

    Article  PubMed  CAS  Google Scholar 

  11. Sytema S, Giel R, ten Horn GH (1989) Patterns of care in the field of mental health. Conceptual definition and research methods. Acta Psychiatr Scand 79:1–10

    Article  PubMed  CAS  Google Scholar 

  12. NHS Executive (1997) Enabling information management and technology support for community focused care project. National Health Service, London

    Google Scholar 

  13. Lora A, Cosentino U, Gandini A, Zocchetti C (2007) Which community care for patients with schizophrenic disorders? Packages of care provided by Departments of Mental Health in Lombardy (Italy). Epidemiol Psichiatr Soc 16:330–338

    PubMed  Google Scholar 

  14. Wang PS, Aguilar-Gaxiola S, Alonso J, Angermeyer MC, Borges G, Bromet EJ, Bruffaerts R, de Girolamo G, de Graaf R, Gureje O, Haro JM, Karam EG, Kessler RC, Kovess V, Lane MC, Lee S, Levinson D, Ono Y, Petukhova M, Posada-Villa J, Seedat S, Wells JE (2007) Use of mental health services for anxiety, mood and substance disorders in 17 countries in the WHO world mental health surveys. JAMA 370:841–850

    Google Scholar 

  15. Brown P, Pirkis J (2009) Mental health quality and outcome measurement and improvement in Australia. Curr Opin Psychiatry 22:610–618

    Article  PubMed  Google Scholar 

  16. Salvador-Carulla L, Haro JM, Ayuso-Mateos JL (2006) A framework for evidence-based mental health carer and policy. Acta Psychiatr Scand Suppl 432:5–11

    Article  PubMed  Google Scholar 

  17. Saz-Parkinson Z, Medel A, Cediel Garcia P, Castellote J, Bouza C, Amante JM (2010) Trends on schizophrenia admission during the deinstitutionalisation process in Spain (1980–2004). Soc Psychiatry Psychiatr Epidemiol. doi:10.1007/s00127-010-0289-9

  18. Suvisaari JM, Haukka JK, Tanskanen AJ, Lönnqvist JK (1999) Decline in the incidence of schizophrenia in Finnish cohorts born from 1954 to 1965. Arch Gen Psychiatry 56:733–740

    Article  PubMed  CAS  Google Scholar 

  19. Kirkbride JB, Croudace T, Brewin J, Donoghue K, Mason P, Glazebrook C, Medley I, Harrison G, Cooper JE, Doody GA, Jones PB (2009) Is the incidence of psychotic disorder in decline? Epidemiological evidence from two decades of research. Int J Epidemiol 38:1255–1264

    Article  PubMed  CAS  Google Scholar 

  20. Kohn R, Saxena S, Levav I, Saraceno B (2004) The treatment gap in mental health care. Bull World Health Organ 82:858–866

    PubMed  Google Scholar 

  21. Saha S, Chant D, Welham J, McGrath J (2005) A systematic review of the prevalence of schizophrenia. PLoS Med 2:e141

    Article  PubMed  Google Scholar 

  22. World Health Organization (2008) The global burden of disease: 2004 update. Geneva, World Health Organization. http://www.who.int/healthinfo/global_burden_disease/estimates_regional/en/index.html. Accessed 27 November 2010

  23. Kovess-Masféty V, Alonso J, Brugha TS, Angermeyer MC, Haro JM, Sevilla-Dedieu C (2007) Differences in lifetime use of services for mental health problems in six European countries. Psychiatr Serv 58:213–220

    Article  PubMed  Google Scholar 

  24. de Girolamo G, Polidori G, Morosini P, Scarpino V, Reda V, Serra G, Mazzi F, Alonso J, Vilagut G, Visonà G, Falsirollo F, Rossi A, Warner R (2006) Prevalence of common mental disorders in Italy. Results from the European Study of the Epidemiology of Mental Disorders (ESEMeD). Soc Psychiatry Psychiatr Epidemiol 41:853–861

    Article  PubMed  Google Scholar 

  25. Salvador-Carulla L, Haro JM, Ayuso-Mateos JL (2006) Framework for evidence-based mental health care and policy. Acta Psychiatr Scand Suppl (432):5–11

  26. Fattore G, Percudani M, Pugnoli C, Contini A, Beecham J (2000) Mental health care in Italy: organisational structure, routine clinical activity and costs of a community psychiatric service in Lombardy region. Int J Soc Psychiatry 46:250–265

    Article  PubMed  CAS  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Mental Health, Desio Hospital, via Mazzini 1, Desio (Milan), Italy

    Antonio Lora

  2. Epidemiology and Social Psychiatric Unit, Mario Negri Institute for Pharmacological Research, Milan, Italy

    Angelo Barbato

  3. Department of Mental Health, Legnano Hospital, Milan, Italy

    Giorgio Cerati

  4. Department of Mental Health, Niguarda Ca’ Granda Hospital, Milan, Italy

    Arcadio Erlicher

  5. Department of Mental Health, Guido Salvini Hospital Garbagnate Milanese, Milan, Italy

    Mauro Percudani

Authors
  1. Antonio Lora
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  2. Angelo Barbato
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  3. Giorgio Cerati
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  4. Arcadio Erlicher
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  5. Mauro Percudani
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Corresponding author

Correspondence to Antonio Lora.

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Lora, A., Barbato, A., Cerati, G. et al. The mental health system in Lombardy, Italy: access to services and patterns of care. Soc Psychiatry Psychiatr Epidemiol 47, 447–454 (2012). https://doi.org/10.1007/s00127-011-0352-1

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  • DOI: https://doi.org/10.1007/s00127-011-0352-1

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