Evaluation of Mental Health Services in Italy on the Basis of Case Register Studies

Abstract

Since the end of World War II, there has been a widespread opinion that it would be better to transfer the functions of mental hospitals to psychiatric units in general hospitals and to local non residential or semiresidential services. Many efforts have been carried out towards this goal, but no legislator ever considered the possibility of prohibiting admissions to the traditional mental hospital. In Italy, this prohibition has been operating since 1978. During the last 15 years, in Italy there have been many changes in the pattern of psychiatric patient care. At the beginning of the seventies, policy was oriented towards deinstitutionalization and resettlement of patients in the community. Until 1975, the possibilities were realistic: the average duration of hospital stay for new patients shortened and many long-stay patients were rehabilitated to their homes or, frequently, the elderly were cast into nursing homes. A large number of discharges were merely transfers to other institutions without a break in continuous care. After 1975, providing alternative allocations for the remaining long-stay inpatients became more and more difficult, and the decrease in total inpatient population slowed down. In May, 1978, a new law was enacted; the essential features of the new organization are: since the date of the new act, no “first ever” has been admitted as inpatient; since July, 1980, readmissions have also been prohibited; all residential treatments, both compulsory and voluntary, have been undertaken in small psychiatric units attached to general hospitals; the units have been established with an approximative ratio of 0.15 per 1,000 population; it has been suggested that the greater part of care should be assigned to outpatient services.