Selection of Patients for a Day-care Center in Reggio Emilia

Abstract

The question of selecting patients most obviously directs our attention to the objectives and functions of a particular operational unit, which are the reference points invoked when the decision is made not to admit every patient. There is, we think, another aspect involved in selection a less explicit, more concealed aspect one that has to do with the selection that others (in particular, the patients) make with regard to the services offered by a day-care center. We believe that the model for our day-care center (indeed, probably for all day-care centers) has been determined largely by the practical needs confronting community services during the first years of reform of Italy's mental health system. The models established have, of course, been influenced by theoretical considerations; but they have also been dictated by the empirical situation and, from case to case, by the problematic contingencies with which we have had to deal. This mixture of elements certainly does not make it easier to describe the model or to compare experiences or, in terms of day-to-day discussion, to provide a precise picture of the mechanisms of patient selection. An analytic and descriptive, plus a historical, approach is called for; but such approaches are not very general and hence not always sufficiently clear and may be somewhat boring. This being the case, we are unableto deal exhaustively with the topic of selection, to present guidelines, precise rules, and thoroughly grounded arguments; we can offer only some disjointed observations from our own personal experience, hoping that they may converge and overlap with the experiences of others.