Community-based psychiatry: long-term patterns of care in South-Verona

Community-based psychiatry has attracted a wide interest in the last 20 years. However, the evidence in the literature on monitoring and evaluating community psychiatric services for a long period of time is scanty. The aim of this monograph is to present the results of a number of evaluative studies, covering a ten-year period, conducted in South-Verona, an area of 75,000 inhabitants in Northern Italy, where a new community-based system of care, the South-Verona Community Psychiatric Service (CPS), has operated since 1978. This system, which is based on the provisions of the Italian psychiatric reform, is alternative to the old hospital-centred system of care, and provides care and support to all types of patients, without back-up from the mental hospital, where only a few old long-stay in-patients continue to reside. In the first part of the monograph, trends in the provision of psychiatric care in the period 1979-1988 are presented, using the South-Verona Psychiatric Case Register (PCR). Both one-day and one-year prevalence figures and incidence rates are lower than in other register areas outside Italy, partly because of the smaller number of specialized out-patient services available in South-Verona and partly because of less use of in-patient care in our area. Moreover, there is a tendency in Italy to care for elderly patients in geriatric institutions outside the psychiatric system. Most of the patients seen in any year are treated without in-patient care. This applies to all diagnostic groups, except affective psychosis. Rates of compulsory admission dropped dramatically after the reform. The total number of admissions to all in-patient psychiatric facilities (including private hospitals) in 1988 is only 8.4% lower than that found in 1977 (one year prior to the reform), while the mean number of occupied beds in 1988 was 47% lower than in 1977. In South-Verona point-prevalence of long-stay in-patients has slowly decreased over the years and there is a negligible build-up of new long-stay in-patients. The South-Verona CPS is now taking care of most psychiatric patients who, before the reform, would have been admitted to the mental hospital and become long-stay. These patients, who may be defined as long-term patients in the community, have consistently accumulated since 1981 and are making high use of psychiatric community services.(ABSTRACT TRUNCATED AT 400 WORDS)