Department of Mental Health, Desio Hospital, via Mazzini 1, Desio, Milan, Italy.
Soc Psychiatry Psychiatr Epidemiol. 2012 Mar;47(3):447-54. doi: 10.1007/s00127-011-0352-1. Epub 2011 Feb 4.
The psychiatric reform in Italy devolved to the regions the responsibility of implementing community psychiatric care. The aim of this paper is to evaluate the mental health system in Lombardy by assessing changes in accessibility and patterns of care occurred between 1999 and 2009.
Data on mental health services were collected through the regional mental health information system and analyzed in terms of treated prevalence, treated incidence, continuity of care and packages of care.
Both treated incidence and treated prevalence in Lombardy increased between 1999 and 2009. There was an increasing access to psychiatric services of people with a better social integration. Incidence of schizophrenic and personality disorders decreased and that of affective and neurotic disorders increased dramatically, while increase in prevalence concerned all diagnostic groups. The percentage of patients in continuous care remained stable and was generally low. The majority of cases, even those with schizophrenia, are cared for on outpatient basis. The percentage of patients receiving integrated multiprofessional care declined. Rates of admission to inpatient services remained low and within the inpatient sector a shift from hospital towards residential care emerged, with decreasing hospital utilization and an increase in size of patient population entering community residences. Treatment gap is still a problem in schizophrenic disorders.
The Lombardy mental health system is strongly based on community care. However, it is reaching a turning point and it needs to be improved in some key areas: the shifting balance towards the care of common mental disorders, in the absence of resource allocations targeted to severely mentally ill, may hinder the system ability to deal with more disabled people. A focus on early intervention and an improvement of continuity of care for people with severe mental disorder, by strengthening community teams, is a priority.
意大利的精神科改革将实施社区精神卫生保健的责任下放给了各个地区。本文的目的是通过评估 1999 年至 2009 年期间可及性和护理模式的变化，来评估伦巴第大区的精神卫生系统。
通过区域精神卫生信息系统收集有关精神卫生服务的数据，并从治疗流行率、治疗发生率、护理连续性和护理套餐方面进行分析。
伦巴第大区的治疗发生率和治疗流行率均在 1999 年至 2009 年间有所增加。社会融合程度较好的人群获得精神卫生服务的机会增加。精神分裂症和人格障碍的发生率下降，而情感性和神经症障碍的发生率则大幅上升，同时流行率的增加涉及所有诊断类别。连续护理的患者比例保持稳定且普遍较低。大多数患者，即使是精神分裂症患者，也接受门诊治疗。接受综合多专业护理的患者比例下降。住院服务的入院率仍然较低，在住院部门，住院治疗向住院护理转变，住院利用率降低，进入社区住所的患者人数增加。精神分裂症的治疗差距仍然是一个问题。
伦巴第大区的精神卫生系统主要基于社区护理。然而，它正处于一个转折点，需要在一些关键领域进行改进：在没有针对严重精神疾病的资源分配的情况下，向常见精神障碍护理的平衡转移可能会阻碍该系统为更多残疾人士提供服务的能力。关注早期干预和严重精神障碍患者护理的连续性的改善，通过加强社区团队，是当务之急。
