Packages of care in the Departments of Mental Health in Lombardy

Abstract

Four packages of care ("community care only", "hospital care plus community care", "hospital care only" "community care plus day centre care") represented 95% of the patients. Three quarter of the patients were treated only in the community setting, without hospital, residential and day centre contacts in the year. Heavier patients (patients with more than 5000 care weight) represent only 4%. Residential care is the heavier setting (36% of the total weight), while schizophrenia is the diagnosis with mayor impact on the community services (59% of the total weight). Of the patients treated only in the community setting one third receives only psychological and psychiatric visits, while two thirds integrated community care. Conclusions in community care the mixed packages represent the exception not the rule. More complex or heavier packages are addressed to severe mental illness patients.

Estimating the Prevalence of Severe Mental Illness in Mental Health Services in Lombardy (Italy)

“…Particularly the community care criterion (six-month of psychiatric community care involving more than one health worker over the past five years) could overestimate the need for care. The cut off in number of contacts (more than fourinterventions in CMHCs or more than four attendances in Day-care Centre) derived from a previous analysis of the packages of care provided in Lombardy (Lora et al, 2002), where a similar cut off was used to differentiate consultations from short ambulatory treatments.…”

“…This classification of the treatment patterns was used in HoNOS 2 survey (Erlicher et al,2003), while the definition of community and clinical treatment patterns was drawn from an analysis of the packages of care delivered in Lombardy in 1999 (Lora et al, 2002).…”

A predictive model to allocate frequent service users of community-based Mental Health Services to different packages of care

“…A package includes the characteristics of the patient, the type of treatment and the intensity of the care provided. Packages of care can be described as 'the mix of treatments provided to an individual patient within a specific timeframe involving different settings' e.g., CMHCs, day-care facilities, general hospital wards, community residential facilities (Lora et al, 2002;2007;Patel et al, 2007). The aims of this study (Ipsycost) is to analyse, in five Italian CMHSs, located in five different regions, three in the northern, one in the central and one in southern Italy, the possibility to predict, after very few contacts with a service, on the basis of their clinical and socio-demographic characteristics, whether a patient will be a frequent user of the services and, for the frequent service users only, to identify different possible packages of care.…”

Psychiatric Units in general hospitals. Problems and perspectives in Europe

“…It is even more difficult to interpret dynamically the often complex integration between GHPUs (and other inpatient facilities, such as University Psychiatric Clinics and private facilities) and community services; often this integration is poor, as shown by the results of a study carried out in the entire Lombardy Region, among all firstever admitted patients in the year 2000, who had no history of previous contacts with public services: in this sample, only 1 in 6 was in contact with public mental health services in the following year (Lora et al, 2002).…”

“…Piu difficile risulta interpretare in maniera dinamica la spesso complessa integrazione funzionale tra i SPDC (e le altre strutture di ricovero, quali le Cliniche Psichiatriche Universitarie e le case di cura) ed i servizi territoriali: spesso tale integrazione e debole e marcata da problemi, come emerge, ad esempio, dai dati regionali della Lombardia che mettono in evidenza come su 6 persone ricoverate nel corso del 2000 nei SPDC della Lombardia, le quali prima del ricovero acuto non avevano mai avuto contatto con i servizi di salute mentale pubblici (ed e presumibile quindi che un gran numero di questi casi fossero costituiti da episodi psicotici acuti), solo uno era ancora in contatto con i DSM lombardi nell'anno successivo al ricovero (Lora et al, 2002). I dati della Lombardia dimostrano, tra l'altro, come venga sprecata o, comunque, mai utilizzata un'occasione preziosa di contatto prolungato, come quella resa possibile da una degenza, al fine di cementare una presa in carico segnata da un'alleanza terapeutica forte.…”