De Salvia D, Barbato A
Department of Psychiatry, Health District No. 14, Veneto Region, Portogruaro VE, Italy.
Can J Psychiatry. 1993 Apr;38(3):195-202. doi: 10.1177/070674379303800308.
This paper reviews trends in Italian mental health services after the implementation of the 1978 Mental Health Act. Data available at the national level on public and private inpatient services, community mental health centres, residential and day care facilities are presented and discussed. Findings from two case-register areas, where comprehensive community services according to the Mental Health Act have been implemented, are discussed. Public mental hospitals are no longer used for psychiatric treatment, except for a small number of long stay patients. General hospital psychiatric units are the only setting in the public sector where psychiatric patients can be admitted. In private mental hospitals, the number of residents has decreased, while admissions have remained stable. However, community services are unevenly distributed and residential facilities are generally lacking. Little is known about quality of care provided, although data from some pilot studies are encouraging. Stable admission rates to forensic mental hospitals suggest that the criminalization of mentally ill has not increased. The effect of changing patterns of mental health care on suicide rates are discussed.
本文回顾了1978年《精神卫生法》实施后意大利精神卫生服务的发展趋势。文中展示并讨论了国家层面有关公立和私立住院服务、社区精神卫生中心、寄宿及日间护理设施的可用数据。还讨论了两个案例登记地区的调查结果，在这两个地区已根据《精神卫生法》实施了全面的社区服务。除了少数长期住院患者外，公立精神病院不再用于精神科治疗。综合医院精神科是公共部门中唯一可收治精神科患者的场所。在私立精神病院，住院人数有所减少，而入院人数保持稳定。然而，社区服务分布不均，寄宿设施普遍匮乏。尽管一些试点研究的数据令人鼓舞，但对所提供护理质量的了解仍然很少。法医精神病院稳定的入院率表明，精神疾病的刑事定罪并未增加。文中还讨论了精神卫生保健模式变化对自杀率的影响。
