Process of Care in General Hospital Psychiatric Units: National Survey In Italy

Abstract

To investigate the process of care in Italian public acute inpatient facilities. Each facility's head psychiatrist (in all Italian regions except Sicily) completed a structured interview concerning provision of treatment and facility rules. Twenty-three university psychiatric clinics with 399 beds (mean=17.3 beds), 16 24 h community mental health centers with 98 beds (mean=6.1 beds), and 262 general hospital psychiatric units with 3431 beds (mean=13.1 beds) were surveyed. Mean length of stay was 18.5+/-7.1 days, 37.0+/-55.3 days and 12.0+/-3.4 days, respectively. Pharmacotherapy was ubiquitous. Approximately 80% of facilities held regular clinical evaluations, supportive talks, and counselling. Dynamic focused psychotherapy was available in 29% of the facilities; 24% provided cognitive behavioural therapy; 32% family therapy; and 39% structured rehabilitative intervention. Vocational training and activities targeted at helping patient integration into their local communities were uncommon. Most facilities did not allow the possession of cutting utensils (96%), personally possessed medication (96%), or lighters (72%), and most had locked doors (75%). Fewer facilities (37%) prohibited the use of mobile phones (32%) and metal knives during meal times (37%). Frequency of physical restraint was associated with number of internal rules. Delivery of psychotherapy was associated with nurse provision. The process of psychiatric inpatient care in Italy shows considerable variability. Future clinical practice guidelines should address the currently limited provision of evidence-based psychosocial intervention in these facilities. Efforts should also be devoted to improving the effectiveness of the hospital-community mental health service interface.