Measuring the treatment environment of a psychiatric ward and a community mental health center after the Italian reform

DAily time use, Physical Activity, quality of care and interpersonal relationships in patients with Schizophrenia spectrum disorders (DiAPASon): an Italian multicentre study

BACKGROUND

Schizophrenia spectrum disorders (SSD) are ranked among the leading causes of disabilities worldwide. Many people with SSD spend most of their daily time being inactive, and this is related to the severity of negative symptoms. Here, we present the 3-year DiAPAson project aimed at (1) evaluating the daily time use among patients with SSD living in Residential Facilities (RFs) compared to outpatients with SSD and to the general population (Study 1); (2) evaluating the quality of staff-patient relationships, its association with specific patient outcomes and the quality of care provided in RFs (Study 2); and (3) assessing daily activity patterns in residential patients, outpatients with SSD and healthy controls using real-time methodologies (Study 3).

METHODS

Study 1 will include 300 patients with SSD living in RFs and 300 outpatients; data obtained in these clinical populations will be compared with normative data obtained by the National Institute of Statistics (ISTAT) in the national survey on daily time use. Time use assessments will consist of daily diaries asking participants to retrospectively report time spent in different activities. In Study 2, a series of questionnaires will be administered to 300 residential patients (recruited for Study 1) to evaluate the quality of care and staff-patient relationships, level of well-being and burnout of RFs' staff, and quality of RFs using a European standardized questionnaire (QuIRC-SA). In Study 3, the daily time use will be evaluated in a subgroup of 50 residential patients, 50 outpatients and 50 healthy controls using the Experience Sampling Method approach (participants will complete a brief questionnaire -about time use, mood and perceived energy- on a smartphone 8 times a day for 1 week) to compare retrospective and real-time reports. Moreover, their level of physical activity, sleep patterns, and energy expenditure will be monitored through a multi-sensor device.

DISCUSSION

This project is highly innovative because it combines different types of assessments (i.e., retrospective and real-time reports; multi-sensor monitoring) to trace an accurate picture of daily time use and levels of physical activity that will help identify the best therapeutic options promoting daily activities and physical exercise in patients with SSD.

TRIAL REGISTRATION

ISRCTN registry ID ISRCTN21141466.

A suggested revision of the Community Oriented Program Environmental Scale (COPES) for measuring the psychosocial environment of supported housing facilities for persons with psychiatric disabilities

The aim of the present study is to address issues of construct validity and reliability of a revised short version of the COPES instrument to measure the psychosocial environment of supported housing facilities for persons with psychiatric disabilities. The results revealed that the division into subscales is not sufficiently reliable for use in measuring the psychosocial environment, although the three higher order dimensions can possibly be used for the descriptive and comparative purposes. A factor analysis based on the revised short version generated new factor solutions, differing from the COPES subscales, but with sufficient psychometric properties.

Ward atmosphere - the Scarlet Pimpernel of psychiatric settings?

Patients and staff in a forensic psychiatric setting were requested to name three distinguishing characteristics of the ward atmosphere. The manifest content analysis of the responses revealed the following categories: interpersonal relations and pre-conditions for interpersonal relations; organization; staff; treatment; daily activities; physical environment; and feeling good and secure. The patients appeared to have a peripheral role as contributors to the ward atmosphere in the views of the respondents. The easily administered single question format provided valuable information about an intangible element of psychiatric settings - the ward atmosphere.

Influencias y hegemonías en la orientación de la investigación de las reformas de salud

Analizamos la evolución de las publicaciones, incluidas en MEDLINE, LILACS y Sociological Abstracts, sobre las Reformas de Salud en el mundo y las influencias que determinan su orientación y distribución en el período de 1990-2004. En total se seleccionaron 8.729 publicaciones. Los principios de "Sostenibilidad" y "Calidad y Efectividad" son los más atendidos, existiendo distintos patrones de atención, dependiendo de regiones y países. De 199 países, el 61% tiene referencia sobre sus procesos de reforma, siendo Estados Unidos y Gran Bretaña los que agrupan la mayor cantidad. Se observó que existen fuertes influencias para el estudio de las Reformas de Salud, provenientes de los patrones Británico y Norteamericano de atención a los Principios de Reforma. Esto puede estar limitando la visibilidad científica de cuestiones como la equidad, participación y eficiencia.

[Request for psychiatric admission: data from eight general hospital psychiatric wards in Lombardy]

OBJECTIVE

To describe requests of admissions to eight General Hospital Psychiatric Wards (SPDC) in Lombardy, Italy, during November 1995.

DESIGN

Descriptive prospective multicenter study.

SETTING

SPDCs of Busto Arsizio (VA), Calcinate (BG), Desio (MI), Magenta (MI), Merate (LC), Milano San Paolo I, Pavia, Treviglio (BG). The global catchment area sums up to 11% of the whole regional area, and to 18% of the population.

MAIN OUTCOME MEASURES

We used a previously developed flow chart with two major key points: who decided to go to the hospital? Did a doctor confirm this initiative? Main sociodemographic characteristics, ICD10 diagnosis and previous psychiatric admissions were collected for each admission.

RESULTS

Admissions were 315, patients 246. In 9.5% of cases patients asked for admission without any medical advice. In one third of cases the ward psychiatrist was the first doctor to visit the patient. Compulsive admissions (TSO) were 45 (14.3%), although patient's initiative lacked in 55.6% of cases. A referral from Outpatient Departments (CPS) was present in 28.2%. First-ever admitted were 63 (25.6%): 20.7% sent by CPS, 16% by GPs, 11% by other non psychiatric wards.

CONCLUSIONS

Although Goldberg & Huxley's model described General Hospital Psychiatric Wards as the last level of intervention, our data show that Italian SPDCs work as "front lines" services: less than one admission out of two were referred by a psychiatrist. Problems raised by "self-referred" patients are conspicuous and an evaluation of the filtering function of CPSs seems necessary. In this regard, a comparison with different modalities of Department organization could be useful.

The deinstitutionalization movement in Italy. Ideological thrust to cultural error

The Basaglia movement in Italian psychiatry is described and analyzed in several contexts: the historical, the cultural, and the "practical" in terms of outcomes. Those who began the movement of democratic psychiatry grasped interesting elements of "critical theory": the definitions of madness, power structures, and medical discourse itself. A backward look at the sea change, however, reveals states and rates of dysfunction that disappoint and indicate that political ideology divorced from cultural awareness can often harden the opposition.

The cost of fragmented mental health financing: is it worth it?

Three major aspects of mental health systems--the way they are financed, the configuration of services, and the outcome of services--are discussed. Problems of resource consumption, fragmentation of goals, and deleterious impacts due to financing systems, per se, are described. Levels of staff involvement in the financing system (as distinct from direct services) influence staff attitudes toward financing, services, and clients. Financing schemes appear to both influence the effectiveness of mental health systems and provide the dubious "advantage" of costing more. Studies are suggested that will compare comprehensive systems with an eye toward reform.

Improving treatment for the severely mentally ill: implications of the decade-long Italian psychiatric reform

Recent reviews of the results of the important Italian Psychiatric Reform have been unusual in that they have ranged from very enthusiastic to very negative. No recent report has focused on extrapolating from the Italian experience the pluses and minuses that might be applicable to the U.S. system of delivery of mental health services so as to improve the care of the seriously mentally ill. In this paper I will summarize my observations and clinical research during 6 months in Italy, emphasizing what has not been reported by others; I will analyze the impact of the Italian changes on Italian practice and try to identify in a balanced way any inferences that can be drawn from the Italian experience that add to ideas now current in the United States about treatment of the severely mentally ill.