Thirty-Five Years of Community Psychiatry In Italy

Ferrannini, Luigi; Ghio, Lucio; Gibertoni, Dino; Lora, Antonio; Tibaldi, Giuseppe; Neri, Giovanni; Piazza, Antonella

doi:10.1097/nmd.0000000000000141

Cited by 25 publications

(24 citation statements)

References 17 publications

(20 reference statements)

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“…In 1978, national policy reforms established a network of CMHCs to serve as hubs of psychiatric care for geographically-defined catchment areas between 50 000 and 150 000 inhabitants (Ferrannini et al, 2014 People under the care of the CMHCs had a median age of 51 years, and the mean duration of psychiatric treatment was 6.3 years (SD 6.6).…”

Section: Settingmentioning

confidence: 99%

Early intervention service for first episode psychosis in Modena, Northern Italy: The first hundred cases

Ferrara

Tedeschini²,

Baccari³

et al. 2019

Early Intervention Psych

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Aim To report on the development of an early intervention service in Modena, Italy, with information relevant to the first 4 years of implementation. Methods The 2‐year service was offered to people aged 18‐35 with psychotic manifestations, within 2 years from psychosis onset/or naïve to antipsychotics, by teams placed within community mental health Centres, according to a “specialist within generalist” model. Treatment included pharmacological consultation, psychoeducation and social inclusion programs. Health of the Nation Outcome Scale was administered at baseline and every 6 months. Results One hundred cases accepted the treatment from 1 March 2013 to 31 December 2016. Of these, 71% were male with a median age of 23. Ninety percent were diagnosed with non‐affective psychosis, yielding an estimated treated incidence of 19.1/105. General practitioners (GPs)represented the most frequent referrers to the program (38%), followed by referrals from acute general and psychiatric hospital units (22%) and self‐referrals (14%). Meaningful clinical improvement was observed, 6 months after enrolment. Conclusions An early intervention service for psychosis was successfully implemented within existing community outpatient services. GPs represented the main referrals, providing some validation of the “specialist within generalist” model of care. A promising clinical improvement and trend of reduction in duration of untreated psychosis was found, supporting the variety of early detection efforts in the community. The high median age and lack of information about pathways to care underline possible barriers to access for younger patients. These findings will inform refinement of treatments and service models for the Region.

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Section: Settingmentioning

confidence: 99%

Early intervention service for first episode psychosis in Modena, Northern Italy: The first hundred cases

Ferrara

Tedeschini²,

Baccari³

et al. 2019

Early Intervention Psych

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“…Nationally, there were, and still are, considerable heterogeneity and differences for programming in the field of public health and mental health services (composition of the Mental Health Department [MHD], organization of Inpatients Psychiatric wards, RFs and much more) [3,5].…”

Section: Future Perspectivesmentioning

confidence: 99%

“…As a result, the transition from a hospital-based care system to a community-based model was neither linear nor uniform across the country. Thus, the effective closure of all Italian mental hospitals was not successfully completed until the end of 1999 [2,3,7].…”

Section: Introductionmentioning

confidence: 97%

“…This neglect was essentially due to the fact that Law 180 was basically a framework, and Italy's 20 regions had to draft detailed norms, methods, and timetables for translation of the law's general principles [3,5]. The law itself neither provided standards for staff and service provision nor allocated funding for implementation of services.…”

Section: Introductionmentioning

confidence: 99%

“…As a result of the Reform, a community-based model of mental health care was developed and the first nonhospital residential facilities were implemented, following specific principles which had been formulated for therapeutic communities [2][3][4][5][6].…”

Section: Introductionmentioning

confidence: 99%

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Residential Care in Italy: Critical Issues and Future Perspectives

Ghio

Favaretto²,

Rocca

et al. 2016

International Journal of Mental Health

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As a result of law 180/78, a community-based model of mental health care was developed and the first nonhospital residential facilities were implemented, following specific principles that had been formulated for therapeutic communities in Italy. Taking into account the new national guidelines in this field, the purpose of this article is to describe the development over the years of residential facility care in Italy, to address the critical issues that have emerged, and to outline the future developments. The main critical issues that have emerged are: the gradually increasing of the number of facilities from 2000 to present, the low rate of discharge with the consequent risk of institutionalisation, the high variability of resources and interventions provided by facilities, the low adherence to national guidelines, and the poor differentiation of levels of intensity of care offered. In relation to this critical data, a national plan of recommendations was set up by the Ministry of Health in 2013. The aim was to promote a move from the logic of long-term stays to that of individualized and project-based care pathways and to distinguish residential facilities based on the level of rehabilitation intervention and intensity of assistance offered. The new plan should promote an improvement of the quality of care of residential facilities; however, more efforts should be addressed to the understanding of what are the factors related to a successful conclusion of residential treatments.

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