An urban Italian study on emergency room utilisation by immigrants suffering from mental disorders in Rome, 2000-2004.

PURPOSE: To compare Emergency Room (ER) utilisation by subjects diagnosed as suffering from a mental disorder, who were born in Strong Migratory Pressure Countries (SMPC) or in Italy. To evaluate the predictors of admission to psychiatric and to non-psychiatric wards. METHOD: Data collected from Information System of Emergency Rooms were analysed. ER contacts in the years 2000-2004 pertaining to subjects who received a psychiatric diagnosis (ICD9-CM codes), and who were born in SMPC or in Italy were examined. "Contacts" included a total of 68,867 assessments made in the ER of all general hospitals in Rome having an acute psychiatric ward. Gender, age and clinical information on SMPC-born and Italian-born patients were compared. A multinomial logistic regression analysis was performed in order to determine risk factors for admission to a psychiatric or to a non-psychiatric ward. RESULTS: At the end of follow-up, 11.7% of ER contacts concerned patients born in SMPC. Compared to the Italian-born group, these patients were younger and received more frequently a diagnosis of "Alcohol and substance abuse and dependencies", while admissions to a psychiatric ward were significantly less common. CONCLUSION: Monitoring health service utilisation may provide relevant information for the delivery of culturally sensitive mental health services.

Mental health care in Rome.

AIM: To describe principles and characteristics of mental health care in Rome. METHOD: Based on existing data, service provision, number of professionals working in services, funding arrangements, pathways to care, user/carer involvement and specific issues are reported. RESULTS: After the Italian psychiatric reform of 1978, an extensive network of community-based services has been set up in Rome providing prevention, care and rehabilitation in mental health. A number of small public acute/emergency inpatient units inside general hospitals was created (median length of stay in 2002 = 8 days) to accomplish the shift from a hospital-based to a community-based psychiatric system of care. Some private structures provide inpatient assistance for less acute conditions (median length of stay in 2002 = 28 days), whilst the large Roman psychiatric hospital was closed in 1999. DISCUSSION: Whilst various issues of mental health care in Rome overlap with those in other European capitals, there also are some specific problems and features. During the last two decades, the mental health system in Rome has been successfully converted to a community-based one. Present issues concern a qualitative approach, with an increasing need to foresee adequate evaluation, especially considering mental health patients' satisfaction with services and economic outcomes.