Community residential facilities in mental health services: A ten-year comparison in Lombardy.

Residential mental health services grew steadily since 2000 in Italy. A reorganisation of residential facilities was implemented in 2007 in Lombardy, introducing supported housing in addition to staffed facilities. We compare the provision and characteristics of residential facilities in the 2007 and 2016. In 2007 there were 3462 beds (35.9/100,000 population) in 276 facilities. In 2016 beds were 4783 (47.8/100,000) in 520 facilities. The increase were unevenly distributed in the public and private sector, and the overall increase was due to a higher increase in the private sector. 72% of beds were in highly supervised facilities in 2007 and 66% in 2016. The public sector managed more facilities with a rehabilitation goal, while the private sector more for long-term accommodation. Mean numbers of beds were higher in facilities managed by the private sector in both years. The 2007 reorganisation and the stop to opening new facilities in the last years were not enough to correct the imbalance between highly supervised and flexible solutions. A wider and more diverse offer might have triggered off an increased demand, rather than a more rational use. Given the costs of highly staffed facilities, and the risk of reproducing custodial models, close evaluation of the use of residential facilities should inform policies.

Ethnic differences in the utilization of mental health services in Lombardy (Italy): an epidemiological analysis.

PURPOSE: To analyze the differences in mental health service utilization by immigrant and native populations of Lombardy, an Italian region that hosts one-fourth of the immigrants living in Italy. METHOD: The data are drawn from the regional mental health information system (based on the case register model), which supplies information on the users and mental health activities of the Departments of Mental Health, Lombardy, a region of about 10 million people; 139,775 adult users were treated in mental health services in 2010. RESULTS: Mental health services are used by 11.3 immigrant users out of 1,000 immigrants (with marked differences depending on country of origin) compared with 17.0 native users. Acute mental health services are used more frequently by immigrant patients; the types of intervention provided to immigrants differ from those provided to the native population (mainly as far as psychotherapeutic interventions is concerned), while gender differences are substantial. CONCLUSIONS: The number of immigrant users using mental health services has increased notably in recent years, and in Lombardy it has been observed that the use of such services differs from service unit to service unit. This raises the problem of how to increase the cultural awareness of mental health professionals dealing with the mental health needs of the immigrant population. On the whole, immigrants use community mental health services less than the native population; however, immigrants tend to be more frequently admitted to general hospital psychiatric units during acute phases and both the utilization rates and gender differ greatly, depending on the country of origin.

Discharges of patients from public psychiatric hospitals in Italy between 1994 and 2000.

BACKGROUND: Psychiatric hospitals in Italy had to be closed under a law dated 1994. AIMS: To investigate the discharge of patients from public psychiatric hospitals. METHODS: A total of 4492 patients from 22 psychiatric hospitals were described at recruitment and followed during the period 1994-2000. Their characteristics were investigated as determinants of discharge to community residential facilities for psychiatric patients versus other settings. RESULTS: All 22 psychiatric hospitals closed between 1994 and 2000; 678 patients had died, and the remainder were discharged. Of these, 39% went to nursing homes, 29% to community residential facilities for psychiatric patients, 2% joined their family, less than 1% were settled in private independent accommodation, and 29% remained in the psychiatric hospital, although defined as discharged. Ten patients were recorded as missing when still in the psychiatric hospitals, none after discharge. Younger, more educated patients and patients from two of the four regions studied were more likely to be discharged to community residential facilities. CONCLUSIONS: The majority of patients were discharged to highly supervised settings. The potential risk of abandonment due to deinstitutionalization was not observed in this population. The wide use of highly supervised settings can be explained by the patients' old age, but different local policies may have affected the discharge process.