This paper reviews trends in Italian mental health services after the implementation of the 1978 Mental Health Act. Data available at the national level on public and private inpatient services, community mental health centres, residential and day care facilities are presented and discussed. Findings from two case-register areas, where comprehensive community services according to the Mental Health Act have been implemented, are discussed. Public mental hospitals are no longer used for psychiatric treatment, except for a small number of long stay patients. General hospital psychiatric units are the only setting in the public sector where psychiatric patients can be admitted. In private mental hospitals, the number of residents has decreased, while admissions have remained stable. However, community services are unevenly distributed and residential facilities are generally lacking. Little is known about quality of care provided, although data from some pilot studies are encouraging. Stable admission rates to forensic mental hospitals suggest that the criminalization of mentally ill has not increased. The effect of changing patterns of mental health care on suicide rates are discussed.
References
1.
MosherLRadical deinstitutionalization: the Italian experience.Int J Mental Health1983; 11: 129–136.
2.
TansellaM, WilliamsPThe Italian experience and its implications.Psychol Med1987; 17: 283–289.
3.
MosherLItaly's revolutionary mental health law: an assessment.Am J Psychiatry1982; 139: 199–203.
4.
WilliamsP, De SalviaD, TansellaMSuicide and the Italian psychiatric reform: an appraisal of two data collection systems.Eur Arch Psychiatry Neurol Sci1987; 236: 237–240.
De SalviaDÉvolution de l'assistance psychiatrique après la réforme de 1978.L'information psychiatrique1989; 65(7): 677–689.
7.
BolliniP, MuscettolaG, PiazzaA.Mental health care in Southern Italy: application of case-control methodology for the evaluation of the impact of 1978 psychiatric reform.Psychol Med1986; 16: 701–707.
8.
BolliniP, ReichM, MuscettolaGRevision of the Italian psychiatric reform: north/south differences and future strategies.Soc Sci Med1988; 12: 1327–1335.
9.
BacigalupiM, CecereF, AreaM.La mortalita dei ricoverati negli ospedali psichiatrici della regione Lazio: primi risultati.Epidemiol Prev1988; 35: 11–16.
10.
CrepetPA transition period in psychiatric care in Italy ten years after the reform.Br J Psychiatry1990; 156: 27–36.
11.
MartiniP, CecchiniM, CorlitoG.A model of a single comprehensive mental health service for a catchment area: a community alternative to hospitalisation.Acta Psychiatr Scand1985; 71(Suppl 316): 95–120.
12.
BeckerTPsychiatric reform in Italy: how does it work in Piedmont?Br J Psychiatry1985; 147: 254–260.
13.
TansellaM, De SalviaD, WilliamsPThe Italian psychiatric reform: some quantitative evidence.Soc Psychiatry1987; 22: 37–48.
14.
FrisancoR, Di FranciaC, De SalviaD.Il dopo 180: primo bilancio di una riforma.Roma: Edizioni TER,1989.
15.
BalloneE, ContiniGUn confronto fra Nord, Centro e Mezzogiorno d'Italia sul ricovero psichiatrico.Rivista Sperimentale di Freniatria1986; 110: 543–555.
16.
MassignanRPsychiatric reform in the Veneto region of Italy: the state after five years.Acta Psychiatr Scand1984; 70: 36–43.
17.
MorosiniPL, RepettoF, De SalviaD.Psychiatric hospitalization in Italy before and after 1978.Acta Psychiatr Scand1985; 71(Suppl 316): 27–43.
18.
TansellaM, MiccioloR, BalestrieriM.High and long-term users of mental health services.Soc Psychiatry1986; 21: 96–103.
19.
BolliniP, MollicaRFSurviving without asylum. An overview of the studies on the Italian reform movement.J Nerv Ment Dis1989; 177(10): 607–615.
20.
BorzeckiM, WormithJSThe criminalization of the psychiatrically ill people: a review with a Canadian perspective.Psychiatr J Univ Ottawa1985; 10: 242–247.
21.
JonesK, PolettiAUnderstanding the Italian experience.Br J Psychiatry1985; 146: 341–347.
22.
DagaLAppunti in tema di funzione e funzionamento degli Ospedali Psichiatrici Giudiziari. In: GiannicheddaMG, Ongaro BasagliaF eds. Psichiatria tossicodipendenze perizia.Milano: Franco Angeli, 1987.
23.
Istituto Centrale di Statistica. Dati statistici sui suicidi e tentativi di suicidio, anni 1974–1983.Bollettino Mensile di Statistica1984 (Suppl 18): 1–40.
24.
Annuario di Statistiche Sanitarie.Roma: Edizioni, ISTAT1972–1986.
25.
WilliamsP, De SalviaD, TansellaMSuicide, psychiatric reform and the provision of psychiatric services in Italy.Soc Psychiatry1986; 21: 89–95.
26.
World Health Organization.Changing patterns in suicide behaviour. Euro report 74. Copenhagen: WHO Regional Office for Europe, 1982.
27.
BurtiL, GarzottoN, SicilianiO.South Verona's psychiatric service: an integrated system of community care.Hosp Community Psychiatry1986; 37(8): 809–813.
28.
De SalviaD, TansellaMValutazione comparativa dei servizi di Verona Sud e di Portogruaro mediante il registro psichiatrico dei casi: risultati preliminari.Archivio di Psicologia Neurologia Psichiatria1985; 46: 451–473.
29.
WingL, BramleyC, HaileyA.Camberwell cumulative psychiatric case register. In: Aims and methods.Soc Psychiatry1968; 3: 116–123.
30.
HafnerH, KlugJThe impact of an expanding community mental health service on patterns of bed usage: evaluation of a four-year period of implementation.Psychol Med1982; 12: 177–190.
31.
WingJK, HaileyAMLong-term hospital care for the mentally ill. In: WingJK, HaileyAM eds. Evaluating a community psychiatric service. The Camberwell register 1964–1971.London: Oxford University Press, 1972.
32.
AndreoliAUn regard européen sur la désinstitutionnalisation américaine.L'information psychiatrique1988; 64(10): 1259–1278.
