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Becker T, Schomerus G, Speerforck S. [Understanding Change Helps Conceptualise Current Action: History of Mental Health Reform in Great Britain and Italy]. PSYCHIATRISCHE PRAXIS 2023; 50:326-332. [PMID: 36455600 DOI: 10.1055/a-1969-9670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Mental health reform processes in Great Britain and Italy have been discussed. Recent publications permit a comparative reflection. In England, the reform started earlier and ran continuously, with its focus changing from deinstitutionalisation and community care to (also) user involvement, managerialism, evidence-based medicine, guidelines and budget cuts. Government policies can be identified. In Italy, the reform process started later and was more disruptive. It was influenced by Basaglia und the political-historical context. The reform process has been continuous, deficits are discussed, it has stood the test of time. Similarities and differences (GB vs I) are highlighted, a social history framework is proposed to understand mental health reform processes as one aspect of societal development. This research process could help identify and shape alliances for further reforms of mental health care.
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Affiliation(s)
- Thomas Becker
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Georg Schomerus
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Sven Speerforck
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Leipzig, Leipzig, Germany
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Meneghelli A, Ciancaglini P, Di Domenico M, Mazzola A, Ghio L, Preti A. Implementation of early intervention clinical services within the National Health System in Italy: Third wave survey with focus on structures, resources, and fidelity to the evidence-based model. Early Interv Psychiatry 2023; 17:884-892. [PMID: 36682817 DOI: 10.1111/eip.13380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 08/23/2022] [Accepted: 01/02/2023] [Indexed: 01/24/2023]
Abstract
BACKGROUND Early intervention in psychosis (EIP) is a well-established approach aimed at detecting and treating early signs and symptoms of psychosis to prevent its long-term consequences. The present study aimed at detailing the current status of EIP services in Italy, covering all the Departments of Mental Health (DMHs) operating in 2018. METHODS All directors of public DMHs operating in Italy in 2018 (n = 127) were invited to fill in a Census form about EIP structure and activities. The first episode psychosis services fidelity scale (FEPS-FS) was used to investigate fidelity to the EIP model of the centre. RESULTS An active EIP service was reported by 41 DMHs (32% of the total DMHs; 56% of those who took part in the survey). Most EIP services had an autonomous team. The large majority of the Italian EIP centres provided psychosocial interventions to their patients, principally psychotherapy, family support, and psychoeducation. Among those with an active EIP, 29 DMHs filled in the FEPS-FS. Internal consistency was good when based on the replies of the respondents, but reliability was weak when measured on the basis of an independent evaluation (Cohen's kappa = 0.571). The fidelity to the guidelines for early intervention was uneven, with some criteria met by most centres, especially those peculiar to the Italian community psychiatry. CONCLUSION A further spreading of the early intervention model across the Italian DMHs was found. A lack of resources might limit the use of specific psychosocial treatments, such as cognitive-behavioural therapy or manualized family support.
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Affiliation(s)
- Anna Meneghelli
- Associazione Italiana per la Prevenzione e l'Intervento Precoce nella Salute Mentale, Milan, Italy
| | - Panfilo Ciancaglini
- Associazione Italiana per la Prevenzione e l'Intervento Precoce nella Salute Mentale, Milan, Italy
| | - Marina Di Domenico
- Associazione Italiana per la Prevenzione e l'Intervento Precoce nella Salute Mentale, Milan, Italy
| | - Andrea Mazzola
- Associazione Italiana per la Prevenzione e l'Intervento Precoce nella Salute Mentale, Milan, Italy
| | - Lucio Ghio
- Department of Mental Health and Addiction, Azienda Sanitaria Locale 3 (ASL3) Genova, Genoa, Italy
| | - Antonio Preti
- Associazione Italiana per la Prevenzione e l'Intervento Precoce nella Salute Mentale, Milan, Italy
- Department of Neuroscience, University of Turin, Turin, Italy
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3
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Angelozzi A. La necessità del cambiamento. PSICOTERAPIA E SCIENZE UMANE 2022. [DOI: 10.3280/pu2022-004002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
La introduzione al dibattito sull'attuale crisi della assistenza psichiatrica in Italia è l'occasione per sintetizzare come questa crisi, le sue cause e le sue prospettive sono descritte da chi indica solo ritardi e incompletezze nell'attuazione della Riforma nata dalla Legge 180/1978 e chi invece individua deficit strutturali proprio nella legge di riforma. Vengono passate in rassegna le varie criticità: dal rischio di nuovi manicomi al fragile inserimento dei reparti nell'ospedale generale; dai limiti del trattamento sanitario obbligatorio (TSO) al riproporsi della pericolosità; dalle rigidità dei Dipartimento di Salute Mentale all'aspetto immutato dello stigma; dalla ambiguità circa l'evidence-based medicine (EBM) alle trasformazioni prodotte dai mutamenti legislativi in Italia. Il tutto in una logica dove la carenza di risorse e di proposte innovative si intrecciano. La proposta è quella di un cambiamento che restituisca alla salute mentale una sua specificità lontana dalle banalizzazioni della psichiatria popolare, definisca l'ambito di riferimento della salute mentale, disegni un nuovo progetto e un modello chiaro, fortemente ancorato ai modelli scientifici, chiarisca le risorse necessarie e lo vincoli limitando la discrezionalità locale.
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Carpiniello B, Vita A. Impact of COVID-19 on the Italian Mental Health System: A Narrative Review. SCHIZOPHRENIA BULLETIN OPEN 2022; 3:sgac038. [PMCID: PMC9619790 DOI: 10.1093/schizbullopen/sgac038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Italy has been severely affected by the COVID-19 pandemic, consequently producing a heavy burden on the Italian National Health Service. From February 2020 until the end of the same year, the Italian Mental Health System (MHS), comprising an extensive network of community services, was subjected to a significant decrease in standards of care followed at the beginning of 2021 by a slow return to usual levels of activity. Data reported in the present article highlight how the Italian MHS – as was the case in the majority of countries—was largely unprepared for this emergency, suggesting an impelling need to develop appropriate supplementary national plans with the aim of preventing similar situations from developing in the future. The upheaval caused by the pandemic has highlighted the need to reinforce, both at a local and national level, the organization and standards of care of the Italian MHS in order to protect and support the mental health of patients with severe mental disorders, health workers, and the general population, thus preventing a potential “pandemic” of mental disorders.
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Affiliation(s)
- Bernardo Carpiniello
- Department of Medical Sciences and Public Health, University of Cagliari , Cagliari , Italy
| | - Antonio Vita
- Department of Clinical and Experimental Sciences, University of Brescia , Brescia , Italy
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Grassi L, Stivanello E, Belvederi Murri M, Perlangeli V, Pandolfi P, Carnevali F, Caruso R, Saponaro A, Ferri M, Sanza M, Fioritti A, Meggiolaro E, Ruffilli F, Nanni MG, Ferrara M, Carozza P, Zerbinati L, Toffanin T, Menchetti M, Berardi D. Mortality from cancer in people with severe mental disorders in Emilia Romagna Region, Italy. Psychooncology 2021; 30:2039-2051. [PMID: 34499790 PMCID: PMC9290959 DOI: 10.1002/pon.5805] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 08/17/2021] [Accepted: 08/20/2021] [Indexed: 11/11/2022]
Abstract
Objective To examine cancer‐related mortality in patients with severe mental disorders (SMI) in the Emilia Romagna (ER) Region, Northern Italy, during the period 2008–2017 and compare it with the regional population. Methods We used the ER Regional Mental Health Registry identifying all patients aged ≥18 years who had received an ICD‐9CM system diagnosis of SMI (i.e., schizophrenia or other functional psychosis, mania, or bipolar affective disorders) during a 10‐year period (2008–2017). Information on deaths (date and causes of death) were retrieved through the Regional Cause of Death Registry. Comparisons were made with the deaths and cause of deaths of the regional population over the same period. Results Amongst 12,385 patients suffering from SMI (64.1% schizophrenia spectrum and 36.9% bipolar spectrum disorders), 24% (range 21%–29%) died of cancer. In comparison with the general regional population, the mortality for cancer was about 50% higher among patients with SMI, irrespective if affected by schizophrenia or bipolar disorders. As for the site‐specific cancers, significant excesses were reported for stomach, central nervous system, respiratory, and pancreas cancer with a variability according to psychiatric diagnosis and gender. Conclusions Patients suffering from SMI had higher mortality risk than the regional population with some differences according to cancer type, gender, and psychiatric diagnosis. Proper cancer preventive and treatment interventions, including more effective risk modification strategies (e.g., smoking cessation, dietary habits) and screening for cancer, should be part of the agenda of all mental health departments in conjunction with other health care organizations, including psycho‐oncology.
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Affiliation(s)
- Luigi Grassi
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy
| | - Elisa Stivanello
- Department of Public Health, Local Health Trust of Bologna, Bologna, Italy
| | - Martino Belvederi Murri
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy
| | | | - Paolo Pandolfi
- Department of Public Health, Local Health Trust of Bologna, Bologna, Italy
| | - Fabio Carnevali
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy
| | - Rosangela Caruso
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy
| | - Alessio Saponaro
- General Directorate of Health and Social Policies, Bologna, Italy
| | - Mila Ferri
- General Directorate of Health and Social Policies, Bologna, Italy
| | - Michele Sanza
- Department of Mental Health and Substance Abuse, Local Health Trust of Romagna, Cesena, Italy
| | - Angelo Fioritti
- Department of Mental Health and Substance Abuse, Local Health Trust of Bologna, Bologna, Italy
| | - Elena Meggiolaro
- Psycho-Oncology Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Federica Ruffilli
- Psycho-Oncology Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Maria Giulia Nanni
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy
| | - Maria Ferrara
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy.,Department of Psychiatry, Yale University, School of Medicine, New Haven, Connecticut, USA.,Program for Specialized Treatment Early in Psychosis (STEP), Connecticut Mental Health Center, New Haven, Connecticut, USA
| | - Paola Carozza
- Integrated Department of Mental Health and Pathological Addictions, Local Health Trust of Ferrara, Ferrara, Italy
| | - Luigi Zerbinati
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy
| | - Tommaso Toffanin
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy
| | - Marco Menchetti
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Domenico Berardi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
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Carpiniello B, Tusconi M, Zanalda E, Di Sciascio G, Di Giannantonio M. Psychiatry during the Covid-19 pandemic: a survey on mental health departments in Italy. BMC Psychiatry 2020; 20:593. [PMID: 33327940 PMCID: PMC7739792 DOI: 10.1186/s12888-020-02997-z] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 12/03/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND To date, very few nationwide studies addressing the way in which mental health services are addressing the current pandemics have been published. The present paper reports data obtained from a survey relating to the Italian mental health system conducted during the first phase of the Covid-19 epidemic. METHODS Two online questionnaires regarding Community Mental Health Centres (CMHC) and General Hospital Psychiatric Wards (GHPW), respectively, were sent to the Heads of all Italian Mental Health Departments (MHDs). Statistical analysis was carried out by means of Chi Square test with Yates correction or the Fisher Exact test, as needed. RESULTS Seventy-one (52.9%) of the 134 MHDs and 107 (32.6%) of the 318 GHPWs returned completed questionnaires. Less than 20% of CMHCs were closed and approx. 25% had introduced restricted access hours. A substantial change in the standard mode of operation in CMHCs was reported with only urgent psychiatric interventions, compulsory treatments and consultations for imprisoned people continuing unchanged. All other activities had been reduced to some extent. Remote contacts with users had been set up in about 75% of cases. Cases of COVID positivity were reported for both staff members (approx. 50% of CHMCs) and service users (52% of CHMCs). 20% of CMHCs reported cases of increased aggressiveness or violence among community patients, although only 8.6% relating to severe cases. Significant problems emerged with regard to the availability of personal protective equipment (PPE) for staff members. A reduced number of GHPWs (- 12%), beds (approx.-30%) and admissions were registered (87% of GHPWs). An increase in compulsory admissions and the rate of violence towards self or others among inpatients was reported by 8% of GHPWs. Patient swabs were carried out in 50% of GHPWs. 60% of GHPWs registered the admission to general COVID-19 Units of symptomatic COVID+ non-severe psychiatric patients whilst COVID+ severe psychiatric patients who were non-collaborative were admitted to specifically set up "COVID-19" GHPWs or to isolated areas of the wards purposely adapted for the scope. CONCLUSIONS The pandemic has led to a drastic reduction in levels of care, which may produce a severe impact on the mental health of the population in relation to the consequences of the expected economic crisis and of the second ongoing wave of the pandemic.
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Affiliation(s)
- Bernardo Carpiniello
- Department of Medical Sciences and Public Health-Unit of Psychiatry, University of Cagliari, Cagliari, Italy.
| | - Massimo Tusconi
- Department of Medical Sciences and Public Health-Unit of Psychiatry, University of Cagliari, Cagliari, Italy
| | | | | | - Massimo Di Giannantonio
- Department of Neurosciences, Imaging and Clinical Sciences, University of Chieti, Chieti, Italy
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Ostinelli EG, Cavallotti S, Fanti V, Demartini B, Gambini O, D'Agostino A. The reMAP project: A retrospective, 15-year register study on inpatient care for youth with mental disorders. Early Interv Psychiatry 2020; 14:705-713. [PMID: 31769192 DOI: 10.1111/eip.12899] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Revised: 08/21/2019] [Accepted: 10/20/2019] [Indexed: 12/30/2022]
Abstract
AIM We aimed to characterize youth hospitalization trends in a psychiatric inpatient unit from a large, public university hospital with a broad catchment area in Milan, Italy. METHODS Hospitalization data of patients with an age at admission ≤ 35 were retrospectively retrieved over a time span of 15 years. The sample was comprised of 1982 admissions to a psychiatric ward, aggregated into ICD-10 diagnostic clusters and then analysed. We investigated the epidemiological trends with a focus on age at admission, gender, nationality and hospitalization rates, length of stay and "revolving door" readmissions within a year. RESULTS Hospitalization rates increased for eating Disorders and decreased for non-affective psychotic disorders; median length of stay generally decreased; hospitalization rates for foreign youth increased, in particular for those diagnosed with non-affective psychotic disorders, personality disorders, and substance-related and addictive disorders. The revolving door phenomenon was also associated with non-affective psychoses and neurodevelopmental disorders, while found to increase for eating disorders. CONCLUSIONS Hospitalization patterns reflect the general increase of foreign youth in the suburban tissue of a large metropolitan area like Milan. However, our data might underestimate the constant growth of mental health problems in foreign youth due to a generally lower access to services. Novel pharmacological treatments and early intervention programs might explain the decrease of hospitalization duration and hospitalization rate for youth with non-affective psychoses. The observed increase in hospitalization for young patients with eating disorders sustains the development of adequate policies tailored towards specialty wards.
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Affiliation(s)
- Edoardo G Ostinelli
- Department of Health Sciences, Università degli Studi di Milano, Milan, Italy.,Department of Mental Health, ASST Santi Paolo e Carlo, Milan, Italy
| | | | - Valentina Fanti
- Department of Health Sciences, Università degli Studi di Milano, Milan, Italy.,Department of Mental Health, ASST Santi Paolo e Carlo, Milan, Italy
| | - Benedetta Demartini
- Department of Health Sciences, Università degli Studi di Milano, Milan, Italy.,Department of Mental Health, ASST Santi Paolo e Carlo, Milan, Italy
| | - Orsola Gambini
- Department of Health Sciences, Università degli Studi di Milano, Milan, Italy.,Department of Mental Health, ASST Santi Paolo e Carlo, Milan, Italy
| | - Armando D'Agostino
- Department of Health Sciences, Università degli Studi di Milano, Milan, Italy.,Department of Mental Health, ASST Santi Paolo e Carlo, Milan, Italy
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Angelozzi A. Dibattiti. Senza scienza e senza cultura. Riflessioni sulle riforme in salute mentale. PSICOTERAPIA E SCIENZE UMANE 2019. [DOI: 10.3280/pu2019-001006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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