Assistenza psichiatrica e monitoraggio dei servizi. Il Registro dei casi di Verona-Sud 1987-1990

1992 ◽  
Vol 1 (2) ◽  
pp. 117-132 ◽  
Author(s):  
Matteo Balestrieri ◽  
Giuliano Meneghelli ◽  
Michele Tansella
Keyword(s):  
Catchment Area ◽  
Psychiatric Service ◽  
Incidence Rates ◽  
Prevalence Rates ◽  
Case Register ◽  
Multiple Structures ◽  
One Year ◽  
Community Psychiatric Service ◽  
Made In

RiassuntoSono descritte con la stessa metodologia impiegata in quattro altre aree italiane sedi di Registro Psichiatrico dei Casi (RPC), le caratteristiche della catchment-area, del RPC, della struttura e dei principi del Dipartimento di Psichiatria di Verona-Sud. II monitoraggio della domanda su 4 anni evidenzia tassi di prevalenza un anno (1010/100000 residenti adulti), prevalenza un giorno (306/100000 residenti adulti) e di incidenza (219/100000 residenti adulti) inferiori a quelli dei RPC europei. II RPC di Verona-Sud monitora l'attività svolta in strutture e servizi a differente gradiente assistenziale (residenziale ospedaliera, residenziale non ospedaliera, semiresidenziale, ambulatoriale, domiciliare, ecc), secondo il principio della continuità dell'assistenza fornita ai pazienti. II rapporto tra prevalenza annua non ospedaliera e ospedaliera è nel 1990 di 2,5 a 1. II tasso di lungoassistiti e di 130/100000 adulti. La spesa globale del Dipartimento è aumentata di circa il 25%, con un incremento da parte di tutte le componenti dell'assistenza.Parole chiaveservizi psichiatrici territoriali, registri psichiatrici dei casi, utilizzazione dei servizi.SummaryThe principles, structure, Psychiatric Case Register (PcR) and catchment-area of the Community Psychiatric service of South-Verona are described, using the same methodology employed in 4 other Italian PCRs. The monitoring of the demand over 4 years shows one-year prevalence rates (1010/100000 adult inhabitants), one-day prevalence rates (306/100000 adult inhabitants) and incidence rates (219/100000 adult inhabitants) lower than those of other European PCRs. South-Verona PCR records data of the activities made in a comprehensive psychiatric service, which has multiple structures and services, offering different degrees of care: residential in and outside the hospital, semiresidential, in outpatient clinics, domiciliary, etc. The 1990 ratio between non-hospitalized and hospitalized users is 2.5 to 1. The rate of long-term patients is 130/100000 adult inhabitants. All the components of the treatment contributed to the 25% increment of the costs of the South-Verona Psychiatric Service.

Assistenza psichiatrica e monitoraggio dei servizi. Il Registro dei casi di Portogruaro 1987-1990

1992 ◽  
Vol 1 (2) ◽  
pp. 101-116 ◽  
Author(s):  
Domenico De Salvia ◽  
Diego Rocco
Keyword(s):  
Catchment Area ◽  
Psychiatric Service ◽  
Incidence Rates ◽  
Prevalence Rates ◽  
Case Register ◽  
Community Psychiatric ◽  
Multiple Structures ◽  
One Year ◽  
Community Psychiatric Service

RiassuntoSono descritte, con la stessa metodologia impiegata in quattro altre aree italiane sedi di Registro Psichiatrico dei Casi (RPC), le caratteristiche della catchment-area, del RPC, della struttura e dei principi del Dipartimento di Psichiatria di Portogruaro. II monitoraggio della domanda su 4 anni evidenzia tassi di prevalenza un anno (1045/100000 residenti adulti), di prevalenza un giorno (332/100000 residenti adulti) e di incidenza (250/100000 residenti adulti) inferiori a quelli dei RPC europei. II RPC di Portogruaro monitora l'attività svolta in strutture e servizi a differente gradiente assistenziale (residenziale ospedaliera, residenziale non ospedaliera, semiresidenziale, ambulatoriale, socioambientale, domiciliare, ecc), secondo il principio della continuità dell'assistenza fornita ai pazienti. II rapporto tra prevalenza annua non ospedaliera ed ospedaliera è nel 1990 di 5,5 a 1. II tasso di lungoassistiti è di 161/100000 adulti. La spesa globale del Dipartimento è lievemente diminuita dal 1987 al 1990.Parole chiaveservizi psichiatrici territoriali, registri psichiatrici dei casi, utilizzazione dei servizi.SummaryThe principles, structure, Psychiatric Case Register (PCR) and catchment-area of the Community Psychiatric Service of Portogruaro are described, using the same methodology employed in 4 other Italian PCRs. The monitoring of the demand over 4 years shows one-year prevalence rates (1045/100000 adult inhabitants), one-day prevalence rates (332/100000 adult inhabitants) and incidence rates (250/100000 adult inhabitants) lower than those of other european PCRs. Portogruaro PCR records data of the activities made in a comprehensive psychiatric service, which has multiple structures and services, offering different degrees of care: residential in and outside the hospital, semiresidential, in outpatient clinics, domiciliary, etc. The 1990 ratio between non-hospitalized and hospitalized users is 5.5 to 1. The rate of long-term patients is 161/100000 adult inhabitants. The costs of the Community Psychiatric Service slightly decreased during 1987-90 period.

Assistenza psichiatrica e monitoraggio dei servizi. Il Registro dei casi di Caltagirone 1987–1990

1992 ◽  
Vol 1 (1) ◽  
pp. 45-60 ◽  
Author(s):  
Gaetano Interlandi ◽  
Maria Grazia Sotera
Keyword(s):  
Psychiatric Service ◽  
Similar Rate ◽  
Outpatient Clinics ◽  
Case Register ◽  
Diagnostic Categories ◽  
Community Psychiatric ◽  
Multiple Structures ◽  
Community Psychiatric Service ◽  
Made In

RiassuntoSono descritte, con la stessa metodologia impiegata in altre 4 aree italiane sedi di Registro Psichiatrico dei Casi (RPC), le caratteristiche della catchment-aerea, del RPC, della struttura e dei principi del Dipartimento di Psichiatria di Caltagirone. II monitoraggio della domanda su 4 anni evidenzia che i tassi di prevalenza annua (763/100000 residenti adulti) e un giorno (223/100000 residenti adulti) hanno valori inferiori ai RPC europei. I tassi di incidenza (281/100000 residenti adulti) indicano un afflusso di nuovi casi appartenenti a tutte le categorie diagnostiche. II RPC di Caltagirone monitora l'attività svolta in strutture e servizi a differente gradiente assistenziale: residenziale ospedaliera, residenziale non ospedaliera, semiresidenziale, ambulatoriale, domiciliare, ecc. II rapporto tra prevalenza annua non ospedaliera e ospedaliera è nel 1990 di 4,4 a 1. II tasso di lungoassistiti è di 122/100000 residenti adulti, con una tendenza ad un accumulo per quelli che vivono nel territorio, mentre vi è un calo di quelli che sono in Comunità. II costo del Dipartimento, che è andato riducendosi dal 1987 al 1990, è in buona parte da addebitare alle giornate di assistenza in Comunità.Parole chiaveservizi psichiatrici territoriali, registri psichiatrici dei casi, utilizzazione dei servizi.SummaryThe principles, structure, Psychiatric Case Register (PCR) and catchment-area of the Community Psychiatric Service of Caltagirone are described, using the same methodology employed in 4 other Italian PCRs. The monitoring of the demand over 4 years shows that the year prevalence (763'100000 adult inhabitants) and day prevalence (248'100000 adult inhabitants) rates are lower than those of other European PCRs. Incidence rate (248'100000 adult inhabitants) shows that new patients belong to all diagnostic categories. The PCR records data of the activities made in multiple structures and services, offering different degrees of care: residential in and outside the hospital, semiresidential, care in outpatient clinics, domiciliary care, etc. The ratio between non-hospitalized and hospitalized users is 4.3 to 1. The rate of long-term patients is 122'100000 adult inhabitants; the rate of long-term patients living in the community is increasing over the years, whereas the similar rate of patients living in the sheltered apartments is decreasing. The costs of the Service (which have decrease from 1987 to 1990) have to be attributed mainly to the costs of the treatment in sheltered apartments.

Confronti e prospettive nella utilizzazione dei Registri Psichiatrici dei Casi

1992 ◽  
Vol 1 (2) ◽  
pp. 133-148 ◽  
Author(s):  
Matteo Balestrieri ◽  
Rocco Micciolo ◽  
Domenico De Salvia ◽  
Michele Tansella
Keyword(s):  
Psychiatric Treatment ◽  
Psychiatric Service ◽  
Community Services ◽  
Incidence Rates ◽  
Psychiatric Admissions ◽  
Community Psychiatric ◽  
Urban Rural ◽  
One Year ◽  
Community Psychiatric Service

RiassuntoDopo una breve rassegna sui dati di confronto tra Registri Psichiatrici dei Casi (RPC) disponibili nella letteratura internazionale, vengono analizzati gli indici sociodemografici e i tassi standardizzati (per età e sesso) relativi alle attività assistenziali (anni 1987–90) svolte in cinque aree italiane di RPC. Gli indici socio-anagrafici sono risultati correlati con le caratteristiche urbano-rurali del territorio. In ognuna delle cinque aree di registro esisteva, alia fine del 1990, una rete di servizi considerata adeguata rispetto alle esigenze della popolazione. I tassi totali di prevalenza un giorno sono in lieve aumento in tutte le aree di RPC, mentre quelli di prevalenza un anno e incidenza hanno avuto un andamento piuttosto differenziato nelle varie aree. II ricorso al day-hospital è diventato mediamente piu frequente e l'attività territoriale è aumentata dappertutto. Sono diminuiti parallelamente i ricoveri. II fenomeno della lungodegenza è tuttora presente, anche se in forma ridotta, in alcune aree di RPC. I soggetti lungoospitati in comunità sono aumentati in un'area (Arezzo), diminuiti in un'altra (Caltagirone), mentre sono stabili nelle altre aree. I lungoassistiti sono aumentati in quattro aree e in lieve flessione nella quinta (Arezzo). Non e emersa una relazione tra livelli di assistenza psichiatrica erogata e caratteristiche della popolazione di riferimento. Secondo un punteggio assistenziale ponderato di costo lo sviluppo dell'attività assistenziale ha determinato un aumento dei costi a Verona-Sud e ad Arezzo, una diminuzione a Caltagirone e a Legnano e nessuna variazione a Portogruaro.Parole chiaveservizi psichiatrici territoriali, registri psichiatrici dei casi, utilizzazione dei servizi.SummaryAfter a brief review of the literatur on comparison between Psychiatric Case Registers (PCR), this paper analyzes sociodemografic data and 1987-1990 age/sex standardised rates of psychiatric treatment in five Italian areas with a PCR. There was a correlation between sociodemografic indices and urban-rural characteristics of the areas. At the end of 1990 the comprehensive community psychiatric service of each area was considered able to meet the needs of the population. During the four years of our survey, one-day prevalence rates were consistently slighty increasing, while one-year prevalence and incidence rates showed different trend in the five areas. Overall, there was a development of the community services and a decrease of psychiatric admissions. There were still few hospital long-stay patients in some areas, but what is more evident was the increase of the number of long-term patients (hostel long-stay patients and communiy long-term patients). No correlations were evident between levels of psychiatric treatment and characteristics of the populations in the five areas. The development of a comprehensive network of community services required an increase of the costs in Verona-Sud and Arezzo, a decrease in Caltagirone and Legnano, while there was no variation of costs in Portogruaro.

Assistenza psichiatrica e monitoraggio dei servizi. Il Registro dei casi di Legnano 1987-1990

1992 ◽  
Vol 1 (2) ◽  
pp. 85-99 ◽  
Author(s):  
Antonino Mastroeni ◽  
Maria Grazia Colombo
Keyword(s):  
Catchment Area ◽  
Psychiatric Service ◽  
Similar Rate ◽  
Case Register ◽  
Community Agencies ◽  
Community Psychiatric ◽  
The Mean ◽  
Community Psychiatric Service ◽  
The Cost

RiassuntoSono descritte, con la stessa metodologia impiegata in altre aree italiane sedi di Registro Psichiatrico dei Casi (RPC), le caratteristiche della catchment-area, del RPC, della struttura e dei principi dell'Unità Operativa di Psichiatria di Legnano. II monitoraggio della domanda su 4 anni evidenzia che i tassi di prevalenza annua (530/100000 residenti adulti) e un giorno (226/100000 residenti adulti) hanno valori inferiori ai RCP europei. I tassi di incidenza (152/100000 residenti adulti) sono diminuiti nel corso dei 4 anni considerati, mostrando la difficoltà dei servizi ad accogliere nuovi utenti. II rapporto tra prevalenza annua non ospedaliera ed ospedaliera è, mediamente, di 3,8 a 1. II tasso dei lungoassistiti è di 195/100000 residenti adulti, con un accumulo di quelli che vivono nel territorio, ma non di quelli che sono in Comunita. II costo dei servizi psichiatrici di Legnano è diminuito nella componente ospedaliera e semiresidenziale, mentre è aumentato in quella territoriale.Parole chiaveservizi psichiatrici territoriali, registri psichiatrici dei casi, utilizzazione dei servizi.SummaryThe principles, structure. Psychiatric Case Register (PCR) and catchment-area of the Community Psychiatric Service of Legnano are described, using the same methodology employed in 4 other Italian PCRs. The monitoring of the demand over 4 years shows that the mean year prevalence (530/100000 adult inhabitants) rates are lower than those of other European PCRs. Incidence rate (152/100000 adult inhabitants) have diminished, showing a difficulty of the psychiatric services in accepting new patients. The ratio between non-hospidalized and hospidalized users is 3.8 to 1. The rate of long-term patients is 195/100000 adult inhabitants; the rate of long-term patients living in the community is increasing over the years, whereas the similar rate of patients living in the community is increasing over the years, whereas the similar rate of patients living in the scheltered apartments is stable. The costs of the hospital-based and the semiresidential agencies decreased, while the cost of the community agencies increased.

Episodes of Care for First-Ever Psychiatric Patients a Long-Term Case-Register Evaluation in a Mainly Urban Area

1995 ◽  
Vol 167 (2) ◽  
pp. 220-227 ◽  
Author(s):  
Michele Tansella ◽  
Rocco Micciolo ◽  
Annibale Biggeri ◽  
Giulia Bisoffi ◽  
Matteo Balestrieri
Keyword(s):  
Cox Regression ◽  
Psychiatric Patients ◽  
Psychiatric Service ◽  
Mental Illnesses ◽  
Rank Test ◽  
First Episode ◽  
Case Register ◽  
Episode Of Care ◽  
Episodes Of Care ◽  
Community Psychiatric Service

BackgroundPsychiatric case registers (PCRs) are particularly useful for studying patterns of care over time. Methods of ‘survival analysis’ have rarely been used for assessing such data.MethodA longitudinal study was conducted over 10 years (1 January 1982 to 31 December 1991) on 1423 first-ever psychiatric patients, using the PCR of South Verona, Italy. The product-limit method, the log-rank test, the Cox regression model and the Poisson regression analysis were used to analyse episodes of care and relapses.ResultsThe duration of the episodes of care increased consistently from the first to the fifth episode. The probability of opening a new episode of care after the first one increased consistently from the second to the sixth episode. The only variable significantly associated with the length of the first episode of care was diagnosis (highest probability of having longer episodes for schizophrenic patients), while the length of the breaks following the first episode of care was associated with diagnosis, sex and occupational status (highest probability of opening a second episode of care for schizophrenic subjects and those with alcohol and personality disorders, for males, and for unemployed patients). The probability of opening a new episode of care decreased with time since last contact and increased with number of previous contacts.ConclusionsThe community psychiatric service in South Verona is fulfilling its original aim, that is, to give priority to the continuity of care for patients with chronic and severe mental illnesses. Survival analyses proved to be useful methods for assessing episodes of care.

Deinstitutionalisation for Long-Term Mental Illness: A 2-Year Clinical Evaluation

2000 ◽  
Vol 34 (3) ◽  
pp. 476-483 ◽  
Author(s):  
Coletta Hobbs ◽  
Christopher Tennant ◽  
Alan Rosen ◽  
Lesley Newton ◽  
Helen M. Lapsley ◽  
...  
Keyword(s):  
Clinical Evaluation ◽  
Social Behaviour ◽  
Rating Scale ◽  
Longitudinal Design ◽  
Psychiatric Service ◽  
Clinical Effectiveness ◽  
Psychotic Symptoms ◽  
Service Support ◽  
Community Psychiatric Service

Objective: The closure of a long-stay psychiatric hospital in Sydney caused the transfer of an initial 40 very long-term patients to four community residences, each with 10 beds, for a continuing process of deinstitutionalisation. Community psychiatric service support and 24-h supervision were provided. This paper describes the residents' clinical progress which was assessed over a 2-year period. Method: This study employed a quasi-experimental longitudinal design. Evaluation commenced prior to discharge and continued for 2 years following community relocation using the Brief Psychiatric Rating Scale, Life Skills Profile, Social Behaviour Scale, Montgomery Asberg Depression Rating Scale and Quality Of Life measures. Readmission, demographic, case history and medication data were also collected. Results: Of the 40 patients initially transferred to the community, seven required long-term readmission to hospital (either prior to or after amalgamation) and one patient died of medical causes. Additional patients transferred from the hospital to the community following the readmissions. Three of these additional patients had achieved a 2-year community tenure during the study period and were included in the clinical evaluation. The 35 residents in total who remained in the community for 2 years, demonstrated a significant improvement in psychotic symptoms, without significant change in the level of neuroleptic medication. Importantly, the 2 years of community living resulted in a significant increase in the residents' life satisfaction. There were no statistically significant changes in residents' living skills, depressive symptoms or social behaviour problems over the 2 years, indicative of the need for supervision and community service support following deinstitutionalisation. Over the 2-year period, some 37% of the residents required temporary readmission. Conclusion: This study demonstrates the clinical effectiveness of deinstitutionalisation, when planned within a mental health system with adequate community resources.

scholarly journals Impact of introducing capacity-based mental health legislation on the use of community treatment orders in Norway: case registry study

BJPsych Open ◽  
2022 ◽  
Vol 8 (1) ◽  
Author(s):  
Georg Høyer ◽  
Olav Nyttingnes ◽  
Jorun Rugkåsa ◽  
Ekaterina Sharashova ◽  
Tone Breines Simonsen ◽  
...  
Keyword(s):  
Mental Health ◽  
Incidence Rates ◽  
Community Treatment ◽  
Prevalence Rates ◽  
Community Treatment Orders ◽  
Retrospective Case ◽  
Case Register ◽  
Mental Health Act ◽  
Catchment Areas ◽  
Involuntary Care

Background In 2017, a capacity-based criterion was added to the Norwegian Mental Health Act, stating that those with capacity to consent to treatment cannot be subjected to involuntary care unless there is risk to themselves or others. This was expected to reduce incidence and prevalence rates, and the duration of episodes of involuntary care, in particular regarding community treatment orders (CTOs). Aims The aim was to investigate whether the capacity-based criterion had the expected impact on the use of CTOs. Method This retrospective case register study included two catchment areas serving 16% of the Norwegian population (aged ≥18). In total, 760 patients subject to 921 CTOs between 1 January 2015 and 31 December 2019 were included to compare the use of CTOs 2 years before and 2 years after the legal reform. Results CTO incidence rates and duration did not change after the reform, whereas prevalence rates were significantly reduced. This was explained by a sharp increase in termination of CTOs in the year of the reform, after which it reduced and settled on a slightly higher leven than before the reform. We found an unexpected significant increase in the use of involuntary treatment orders for patients on CTOs after the reform. Conclusions The expected impact on CTO use of introducing a capacity-based criterion in the Norwegian Mental Health Act was not confirmed by our study. Given the existing challenges related to defining and assessing decision-making capacity, studies examining the validity of capacity assessments and their impact on the use of coercion in clinical practice are urgently needed.

The Effects that Patients Have on their Families in a Community Care and a Control Psychiatric Service—A Two Year Follow-up

1968 ◽  
Vol 114 (508) ◽  
pp. 265-278 ◽  
Author(s):  
Jacqueline Grad ◽  
Peter Sainsbury
Keyword(s):  
Mentally Ill ◽  
Community Care ◽  
Care Service ◽  
Psychiatric Service ◽  
Research Unit ◽  
Admission Rates ◽  
Community Psychiatric ◽  
Community Psychiatric Service ◽  
Made In

The effects that mentally ill people have on their families have been more commented upon than studied. The currently favoured practice of community care has increased the need for a systematic attempt to evaluate the families' problems, and an opportunity to do this occurred when a community psychiatric service was introduced in Chichester in 1958, while the neighbouring Salisbury district continued with a conventional hospital-based service. The Medical Research Council's Clinical Psychiatry Research Unit has been evaluating the new service to find out how it affects referral and admission rates; how it influences social and clinical outcome, and the effect it has on the community itself. As the patient's family is the sector of the community most closely concerned in any extension of the extra-mural care of patients, we began by assessing the effects on them. The present paper therefore describes the assessments we made of the burden the patients' families carried in the Chichester Community Care Service and compares their burden with that experienced by families in Salisbury, where admission to hospital was more commonly practised. The comparison is made in terms of the relief that was afforded the two groups of families over a period of two years.

Patients' Own Contributions to Long-Term Supportive Psychotherapy in Schizophrenic Disorders

1994 ◽  
Vol 164 (S23) ◽  
pp. 84-88 ◽  
Author(s):  
Sidsel Gilbert ◽  
Endre Ugelstad
Keyword(s):  
Catchment Area ◽  
Active Part ◽  
Research Project ◽  
Supportive Psychotherapy ◽  
One Year ◽  
The Relationship

The paper describes a study based on the Nordic multi-centre research project NIPS. In the Norwegian part, based on one-year screening and sampling of all new schizophrenic cases in a catchment area in Oslo, patients and therapists were interviewed after 2–3 years. Some patients seemed to have played a much more active part in establishing and breaking therapeutic contacts and in setting the terms for the relationship than is usually acknowledged. In the interviews at five-year follow-up, many patients produced viewpoints on their psychotherapeutic experiences that seem to be very important in relation to therapy.

scholarly journals The Great East Japan earthquake in 2011; toward sustainable mental health care system

2012 ◽  
Vol 21 (1) ◽  
pp. 7-11 ◽  
Author(s):  
Y. Suzuki ◽  
Y. Kim
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Care ◽  
Nuclear Power ◽  
Psychiatric Service ◽  
Health Impact ◽  
Local Networks ◽  
Long Term Follow Up ◽  
Community Psychiatric Service

In face with a triple disaster of earthquake, tsunami and nuclear power plant accident, the degrees of which are historically hardly preceded, immediate mental health countermeasure was taken by the initiative of the national and local government together with academic and clinical organizations. Based on previous experience of natural disasters, more than 50 mental health care teams have been organized and dispatched to the affected areas, scheduled by the Ministry of Health, Labor and Welfare. When 6 months have passed, the acute and temporal support system should be replaced with more sustainable local networks with aims at promoting resilience, though community psychiatric service should be developed as well. Existing guidelines should be respected but actually it tended to be only partially recognized. In Fukushima prefecture, where nuclear plant accident occurred, its mental health impact is most concerned and long-term follow-up of the residents' health has been being planned.

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