Am J Psychiatry 1997; 154:94-98
Copyright © 1997 by American Psychiatric Association
Reform said or done? The case of Emilia-Romagna within the Italian psychiatric context
A Fioritti, L Lo Russo and V Melega
Mental Health Service, Azienda USL Citta di Bologna, Italy.
OBJECTIVE: The authors sought to evaluate how the services required by the
Italian Psychiatric Reform of 1978 were implemented in Emilia- Romagna, a
region of 4 million inhabitants in Northern Italy. METHOD: All psychiatric
facilities were monitored from 1978 to 1994 to determine the number and
rates of admissions, average duration of stay, average intake, and percent
of beds occupied at inpatient facilities as well as the number of patients
residing in former mental hospitals and the number and rates of first
contacts with mental health community centers. RESULTS: Three mental
hospitals out of nine were closed during the period, and the number of
patients who resided in mental hospitals declined from 4,798 to 655. By
1994, there were 145 community centers, 48 day treatment centers, 12
general hospital psychiatric wards, three university psychiatric clinics,
seven private psychiatric clinics, 24 psychiatric residences, and 123
supervised apartments that were operating as alternatives to asylums. The
overall rate of inpatient admissions remained stable, but compulsory
admissions gradually decreased by 35% throughout the period. First contacts
at outpatient centers increased by 17.9% from 1984 to 1991. CONCLUSIONS:
The shift from a hospital-based to a community-based psychiatric system of
care, as foreseen by the Italian psychiatric reform, seems feasible. Some
general political, administrative, and social backup conditions appear
crucial to ensure the good outcome of this process.
