Italian Psychiatric Reform Research Articles

Long-stay and long-term psychiatric patients in an area with a community-based system of care. A register follow-up study.

In South-Verona, where a community-based system of care consonant with the provisions of the Italian psychiatric reform has been operating since 1978, case-register data show that Long-stay inpatient rates are decreasing, while rates of patients treated long-term outside the mental hospital (i.e. those in "continuous care for one year, receiving treatment in the community by the various out-patient and day-patient facilities and in some cases short spells of inpatient care") show a recent increasing trend. Long-stay inpatients on 31.12.1982 have been compared with long-term community patients on the same date. The two cohorts were similar in terms of basic sociodemographic variables and contained a similar proportion of psychotic patients. However, while 88% of the long-stay inpatients were still long-stay after two years, only 45% of the long-term patients in the community remained in long-term treatment over the same period. Using a log-linear model, diagnosis was found to be the variable with the highest association in the long-term cohort with subsequent pattern of use of mental health services.

The implementation of the Italian psychiatric reform in a large conurbation.

The implementation of the Italian psychiatric reform in a large conurbation.

Suicide and the Italian psychiatric reform: an appraisal of two data collection systems.

The reliability of Italian suicide data derived from returns made by the Police and Carabinieri was examined by comparing regional suicide data from that source with those based on medically certified cause of death for the years 1973-1980. Rates of medically certified suicide were found to be higher than those derived from the Police/Carabinieri returns, a difference which increased steadily over the years of study. The between-region within-year correlations (between the suicide rates derived from the two sources) were very high, but tended to decrease with time. The between-year within-region correlations were +0.700 or above for 12 of the 19 Italian regions and between +0.500 and +0.700 for a further 3. The correlation between the rates of suicide derived from the two sources was poor for the remaining 4 regions. A previous analysis of the influence on suicide of the Italian psychiatric reform used Police/Carabinieri data (Williams et al. 1986): this was repeated excluding data from these 4 regions, and the previous results were confirmed. Indeed, the negative correlation between suicide and the provision of general hospital psychiatric beds was stronger than that previously reported.

The Italian psychiatric reform: some quantitative evidence.

The “Italian experience” of providing psychiatric care with comprehensive and integrated community services while blocking admissions to mental hospitals needs evaluation on the basis of quantitative evidence as well as opinion. In this paper, national statistics and local case-register data pertaining to this issue are reported. Questions referring to the structure of the services (whether or not the prescribed reorganisation has actually taken place) as well as to function (the way in which the reorganised services, were they have been provided, actually operate) are examined. The available data show that there is a marked regional variation in service provision, as well as a globally inadequate provision of alternative structures. However, the evidence suggests that where adequate community psychiatric services have been provided, they function successfully without the availability of “backup” from the mental hospitals. The results suggest that a national coordination of regional and local policy is urgently necessary, together with an increase of the resources devoted to psychiatric care and a shift of expenditure from the declining mental hospitals to the progressively more overburdened community services.

Community psychiatry without mental hospitals--the Italian experience: a review.

Keywords community psychiatry, Italian psychiatric reform, national statistics, pattern of psychiatric care, psychiatric case register

The general practitioner and the psychiatric health service in Italy after the reform: opinions and experiences in an urban district.

This paper presents an analysis of the impact of the psychiatric reform in Italy on health care delivery by the general practitioner. In an urban district of the Veneto region a survey was made on the opinions and assessments of the general practitioner about the new status of psychiatric care, on the psychiatric cases identified, and the correspondence between these opinions and assessments and the real delivery of psychiatric care. The pessimism about the psychiatric reform that emerges among some general practitioners seems to have more to do with the slow progress in creating intermediary facilities between hospital and region rather than an a priori opposition to the reform.

Suicide, psychiatric reform, and the provision of psychiatric services in Italy.

An ecological approach has been adopted to study the effect on suicide of the 1978 psychiatric reform in Italy. Using regional data, the trend in suicide during the pre-reform quinquennium (1973–1977) is compared with that during the postreform quinquennium (1979–1983). The results show that the suicide rate in Italy as a whole has increased consistently over the past 10–15 years and that the increase is largely confined to the north-central parts of the country. No clear time trend emerged with respect to the proportion of suicides classified as being due to mental illness. The difference between the two 5-year trends (1973–1977 and 1979–1983) was positive (i.e., an increase in the suicide rate) for 10 of the 19 regions in Italy. This difference correlated negatively with the provision of general hospital psychiatric beds, a finding which persisted when controlled for the pre-reform trend in suicide. The post-reform regional provision of mental hospital beds (which have declined considerably in recent years) was not related to changes in the suicide rate. The usefulness of comparing trends in rates, rather than averaged rates, in the investigation of the effect of a new service on suicide is stressed.

Psychiatric reform in Italy--how does it work in Piedmont?

Psychiatric reform in Piedmont following new mental health legislation in Italy (1978) is described. The process of reform is characterised by a drastic reduction in psychiatric hospital populations and the setting-up of a new system of community-based services. The number of hospital admissions remains stable, but the character of inpatient care has changed. The reform involves problems of care for chronic patients.

From Antonio Gramsci to Franco Basaglia: The Theory and Practice of the Italian Psychiatric Reform

Cursory summaries of the intellectual and philosophical context of the Italian psychiatric reform movement have overemphasized its practical limitations while understating its conceptual framework. Emphasis on either theory or practice, not on theory and practice, has kept mental health policy stuck within Gertrude Stein's witty aphorism What history teaches is that history teaches. Modern psychiatric practice seems particularly prone to chronic repetition of the question What did we do this time that failed? This paper presents the sociopolitical concepts and psychiatric strategies underlying Western Europe's most radical psychiatric reform movement, Psichiatria Democratica. Little attention has been given to the important influence of Italy's major political theorist of this century, Antonio Gramsci, on the Italian reformers and their leader, Franco Basaglia. Understanding Gramsci's theory and the practices of Italian psychiatry can help us to evaluate and improve public mental health services in both Italy and elsewhere.

Psychiatric reform in the Veneto region of Italy: the state after five years.

The state of the psychiatric reform in Italy since 1978 is now examined. The reform has faced many difficulties due to the economic crisis, political instability and inadequate implementation of regional facilities stipulated by law. However, it has had some positive effects and has awakened public opinion to the problem of the mentally ill. The study area chosen is the Veneto region of Italy. It is a widespread belief that with some modifications, particularly regarding the problem of long-term patients, the psychiatric reform can be carried out with success. The principles which have inspired it are worthy but its application is not easy as we are dealing more with a cultural reform than with a new organization of services; this will require more time.