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Amerio A, Vai E, Bruno E, Costanza A, Escelsior A, Odone A, De Berardis D, Aguglia A, Serafini G, Amore M, Ghaemi SN. COVID-19 Impact on the Italian Community-based System of Mental Health Care: Reflections and Lessons Learned for the Future. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE : THE OFFICIAL SCIENTIFIC JOURNAL OF THE KOREAN COLLEGE OF NEUROPSYCHOPHARMACOLOGY 2023; 21:2-9. [PMID: 36700307 PMCID: PMC9889896 DOI: 10.9758/cpn.2023.21.1.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 10/04/2022] [Indexed: 01/27/2023]
Abstract
Despite the unprecedented wave of research and publications sparked by the recent pandemic, only few studies have investigated the impact of COVID-19 on the Italian community-based system of mental health care. We aimed to summarize the available evidence from the literature also considering what we have learned from our daily clinical practice. As hospital care was restricted by COVID-19, although reducing their opening hours and activities, Community Mental Health Centers promoted continuity of care for at-risk populations, supporting them to cope with loneliness and hopelessness during quarantine and self-isolation. Ensuring continuity of care also remotely, via teleconsultation, lowered the risk of psychopathological decompensation and consequent need of hospitalization for mental health patients, with satisfaction expressed both by patients and mental health workers. Considering what we have learned from the pandemic, the organization and the activity of the Italian community-based system of mental health care would need to be implemented through 1) the promotion of a "territorial epidemiology" that makes mental health needs visible in terms of health care workers involved, 2) the increase of mental health resources in line with the other European high-income countries, 3) the formalization of structured initiatives of primary care and mental health cooperation, 4) the creation of youth mental health services following a multidimensional and multidisciplinary approach and encouraging family participation, 5) the promotion of day centers, to build competence and self-identity within a more participatory life, and programs geared to employment as valid models of recovery-oriented rehabilitation.
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Affiliation(s)
- Andrea Amerio
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy,IRCCS Ospedale Policlinico San Martino, Genoa, Italy,Address for correspondence: Andrea Amerio Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, IRCCS San Martino, L.go R. Benzi 10, 16100, Genova, Italy, E-mail: , ORCID: https://orcid.org/0000-0002-3439-340X
| | - Eleonora Vai
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Edoardo Bruno
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Alessandra Costanza
- Department of Psychiatry, Faculty of Medicine, University of Geneva (UNIGE), Geneva, Switzerland,Department of Psychiatry, Faculty of Biomedical Sciences, University of Italian Switzerland (USI), Lugano, Switzerland
| | - Andrea Escelsior
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Anna Odone
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Domenico De Berardis
- NHS, Department of Mental Health, Psychiatric Service for Diagnosis and Treatment, Hospital, “G. Mazzini”, ASL 4, Teramo, Italy
| | - Andrea Aguglia
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Gianluca Serafini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Mario Amore
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Seyyed Nassir Ghaemi
- Department of Psychiatry, Tufts University School of Medicine, MA, USA,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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Martinelli A, Bonetto C, Bonora F, Cristofalo D, Killaspy H, Ruggeri M. Supported employment for people with severe mental illness: a pilot study of an Italian social enterprise with a special ingredient. BMC Psychiatry 2022; 22:296. [PMID: 35473634 PMCID: PMC9040313 DOI: 10.1186/s12888-022-03881-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 02/03/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND People with mental disorders are far more likely to be unemployed than the general population. Two internationally recognized, evidence-based models of interventions for employment for people with severe mental health problems are Individual Placement Support and the Clubhouse. In Italy, a common model is the 'social enterprise' (SE), which is a programme run by non-profit organisations that help individuals with disabilities to be employed. Despite SEs spread and relevance in Italy, there are no studies about Italian samples. This paper reports on a pilot evaluation of psychosocial and work outcomes of a SE based in Verona, Italy. The study aims to investigate if people with SMI involved in SE job placements may achieve personal recovery and better outcomes over time, and in comparison with a comparable group of users. METHODS This is a pilot descriptive study with three components. A longitudinal design that comprised a functioning description of 33 SE members with a psychiatric disability in two time-points (when they joined the SE-on average 5 years before the study recruitment, and at the study recruitment-year 2018); and a repeated collection of job details of the 33 members in three time points: 2 years before the recruitment,-year 2016; 1 year before the recruitment - year 2017; and at the recruitment-year 2018. An assessment at the recruitment time-year 2018, of SE users' satisfaction with the job placement, symptoms, functioning, and quality of life (QoL). A cross-sectional study that compared the 33 SE members at the recruitment time-year 2018, with a matched group of people with the following criteria: living in local supported accommodations, being unemployed and not SE members. The two groups were compared on ratings of psychopathology, functioning, and QoL. Descriptive analyses were done. RESULTS At the recruitment time - year 2018, all SE participants showed a significant better functioning (p < 0.001) than when they joined the SE-when they had been employed for an average of 5 years. In comparison to the matched group, SE members had significantly better functioning (p = 0.001), psychopathology (p = 0.007), and QoL (p = 0.034). According to their SE membership status, participants comprised trainees (21.2%) and employee members (78.8%). Trainees compared to employees had lower autonomies, functioning, QoL and more severe psychopathology. Over the two years prior to study recruitment, trainees showed stable poor autonomies, while employee members showed a variation from average autonomies in the 2 years before the recruitment time - year 2016, to good ones at the recruitment time - year 2018. Over the two years, all SE members set increasing numbers of objectives in all three domains. All SE participants reported high levels of satisfaction with all aspects of the job placement. CONCLUSIONS SE that provides tailored support to assist people to gain employment skills may be an effective component in helping recovery from SMI.
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Affiliation(s)
- Alessandra Martinelli
- grid.5611.30000 0004 1763 1124Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Piazzale L.A. Scuro 10, 37134 Verona, Italy ,grid.419422.8Unit of Clinical Psychiatry, IRCCS Istituto Centro San Giovanni Di Dio Fatebenefratelli, Via Pilastroni, 4, 25125 Brescia, BS Italy
| | - Chiara Bonetto
- grid.5611.30000 0004 1763 1124Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Piazzale L.A. Scuro 10, 37134 Verona, Italy
| | - Federica Bonora
- grid.5611.30000 0004 1763 1124Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Piazzale L.A. Scuro 10, 37134 Verona, Italy
| | - Doriana Cristofalo
- grid.5611.30000 0004 1763 1124Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Piazzale L.A. Scuro 10, 37134 Verona, Italy
| | - Helen Killaspy
- grid.83440.3b0000000121901201Division of Psychiatry, University College London, London, UK
| | - Mirella Ruggeri
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy. .,Section of Psychiatry, Verona Hospital Trust, AOUI, Verona, Italy.
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Mattei G, Venturi G, Alfieri S, Colombini N, Ferrari S, Rigatelli M, Starace F, Galeazzi GM. Clinical and Socio-demographic Variables Associated with the Outcome of Vocational Rehabilitation Programs: A Community-Based Italian Study. Community Ment Health J 2020; 56:1380-1390. [PMID: 32086675 DOI: 10.1007/s10597-020-00577-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 02/11/2020] [Indexed: 10/25/2022]
Abstract
This study aims to identify clinical and socio-demographic variables associated with the outcome of vocational rehabilitation programs (VRPs). All users of an Italian Community Mental Health Centre (CMHC) included in VRPs delivered according to the model of Supported Employment in years 2011-2016 were retrospectively enrolled. Fifty users who ended the program with employment were compared with fifty users who dropped out, with respect to clinical and socio-demographic variables. VRPs lasting less than 6 months and oriented toward the competitive labor market had a higher probability of employment. Among users who successfully ended the VRP, the median of health interventions significantly decreased after employment. In the same group of users, less non-health interventions strictly linked to the VRP were required, when compared with users who dropped out. We conclude that employment is associated with improvement of users' clinical conditions and reduced workload for the CMHC.
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Affiliation(s)
- G Mattei
- Department of Biomedical, Metabolic and Neural Sciences, Section of Clinical Neurosciences, University of Modena and Reggio Emilia, Modena, Italy. .,Ph.D. School in Labor, Development and Innovation, "Marco Biagi" Department of Economics & Marco Biagi Foundation, University of Modena and Reggio Emilia, Modena, Italy. .,Association for Research in Psychiatry, Castelnuovo Rangone, Modena, Italy.
| | - G Venturi
- Department of Biomedical, Metabolic and Neural Sciences, Section of Clinical Neurosciences, University of Modena and Reggio Emilia, Modena, Italy
| | - S Alfieri
- Department of Mental Health & Drug Abuse, AUSL Modena, Modena, Italy
| | - N Colombini
- Department of Mental Health & Drug Abuse, AUSL Modena, Modena, Italy
| | - S Ferrari
- Department of Biomedical, Metabolic and Neural Sciences, Section of Clinical Neurosciences, University of Modena and Reggio Emilia, Modena, Italy.,Department of Mental Health & Drug Abuse, AUSL Modena, Modena, Italy
| | - M Rigatelli
- Department of Biomedical, Metabolic and Neural Sciences, Section of Clinical Neurosciences, University of Modena and Reggio Emilia, Modena, Italy
| | - F Starace
- Department of Mental Health & Drug Abuse, AUSL Modena, Modena, Italy
| | - G M Galeazzi
- Department of Biomedical, Metabolic and Neural Sciences, Section of Clinical Neurosciences, University of Modena and Reggio Emilia, Modena, Italy.,Department of Mental Health & Drug Abuse, AUSL Modena, Modena, Italy
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Pelizza L, Ficarelli ML, Vignali E, Artoni S, Franzini MC, Montanaro S, Andreoli MV, Marangoni S, Ciampà E, Erlicher D, Troisi E, Pupo S, Fioritti A. Implementation of Individual Placement and Support in Italy: The Reggio Emilia Experience. Community Ment Health J 2020; 56:1128-1138. [PMID: 32157515 DOI: 10.1007/s10597-020-00603-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 03/06/2020] [Indexed: 01/26/2023]
Abstract
Individual placement and support (IPS) is an evidence-based intervention helping people with mental illness to obtain competitive jobs. In the last decade, European mental health leaders were interested on its implementation. Aim of the study was to assess the IPS feasibility in Italian patients with moderate-to-severe mental illness. To date, no evaluation of IPS has been conducted exclusively in Italy. Participants (n = 95) were clients of community mental health centers of the Reggio Emilia Department of Mental Health. In addition to drop-out rates, we calculated job acquisition, job duration, and total hours per week worked. A crude competitive employment rate of 41.1% and a crude drop-out rate of 30.5% were found over 42-month follow-up period. Using a Kaplan-Meyer survival analysis, the cumulative employment rate increased up to 44% at 12 months and 61% both at 24 and 42 months. This study documents the feasibility of an implementation strategy for introducing the IPS model in the public mental health care system in Italy.
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Affiliation(s)
- Lorenzo Pelizza
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS Di Reggio Emilia, Via Amendola n.2, 42100, Reggio Emilia, RE, Italy. .,Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Centro "Santi", Via Vasari n.13, 43100, Parma, PR, Italy.
| | - Maria Lorena Ficarelli
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS Di Reggio Emilia, Via Amendola n.2, 42100, Reggio Emilia, RE, Italy
| | - Elisabetta Vignali
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS Di Reggio Emilia, Via Amendola n.2, 42100, Reggio Emilia, RE, Italy
| | - Simona Artoni
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS Di Reggio Emilia, Via Amendola n.2, 42100, Reggio Emilia, RE, Italy
| | - Maria Cristina Franzini
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS Di Reggio Emilia, Via Amendola n.2, 42100, Reggio Emilia, RE, Italy
| | - Serenella Montanaro
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS Di Reggio Emilia, Via Amendola n.2, 42100, Reggio Emilia, RE, Italy
| | - Maria Vittoria Andreoli
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS Di Reggio Emilia, Via Amendola n.2, 42100, Reggio Emilia, RE, Italy
| | - Sara Marangoni
- E.N.A.I.P. Foundation, Via D'Arezzo n. 14, 42123, Reggio Emilia, RE, Italy
| | - Elizabeth Ciampà
- E.N.A.I.P. Foundation, Via D'Arezzo n. 14, 42123, Reggio Emilia, RE, Italy
| | - Diana Erlicher
- E.N.A.I.P. Foundation, Via D'Arezzo n. 14, 42123, Reggio Emilia, RE, Italy
| | - Elisa Troisi
- School of Psychiatric Rehabilitation Techniques, University of Modena and Reggio Emilia, Via Università n.4, 44121, Modena, MO, Italy
| | - Simona Pupo
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS Di Reggio Emilia, Via Amendola n.2, 42100, Reggio Emilia, RE, Italy
| | - Angelo Fioritti
- Department of Mental Health and Pathological Addiction, Azienda USL di Bologna, Via Castiglione n.29, 40124, Bologna, BO, Italy
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Mezzina R. Forty years of the Law 180: the aspirations of a great reform, its successes and continuing need. Epidemiol Psychiatr Sci 2018; 27:336-345. [PMID: 29506591 PMCID: PMC6998886 DOI: 10.1017/s2045796018000070] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Accepted: 01/30/2018] [Indexed: 11/07/2022] Open
Abstract
AIM Italy pioneered deinstitutionalisation over the past 60 years and enforced a famous mental health (MH) reform law in 1978. Deinstitutionalisation has been completed with the very closure of all psychiatric hospitals over two decades. METHODS After 40 years of implementation, this article presents the main achievements and challenges of the Italian MH reform law, including its long-term effect and impact in Italy and abroad. RESULTS The Legislation of 1978 was based on the discovery of rights as a key tool in mental healthcare. At the climax of crisis of psychiatric hospitals as total institutions in this country, through the new community-based system of care, it has fostered the lowest rate of involuntary care and gave back the full citizenship to people with MH disorders. This act was also part of a social movement for expanding civil and social rights, and a promise of a true paradigm shift not only in psychiatry, but also in the way of providing an adequate welfare community for all citizens. According to the WHO, the Italian city of Trieste, together with its region, is a practical example of how the Italian movement achieved deinstitutionalisation, intended as a complex process resulting in the gradual relocation of the economic and human resources and subsequent creation of 24 h services together with the development of social inclusion programmes. CONCLUSIONS Even if the great principles of the Italian reform law were anticipatory (e.g., the UN Convention on Rights of Persons with Disabilities - CRPD), the law application has been poorly provided with resources and did not follow those avant-garde experiences as models. Limitations are evident today especially at the organisational levels, such as services capable to take up the challenge and transforming the field, left free from the imprint of total institutions. These endemic critical aspects concerning to implementation policies, together with the financial crisis of the Italian healthcare system, must be taken into consideration for a re-launch of this historical law. The rights-based approach opened by the Law 180 should now take into consideration the new legal situation caused by the CRPD worldwide in the area of individuals' human rights, especially about the issue of legal capacity and related involuntary care.
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Affiliation(s)
- R. Mezzina
- Dipartimento di Salute Mentale, ASUI Trieste, WHO Collaborating Centre for Research and Training, Trieste, Friuli-Venezia Giulia, Italy
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Group-apartments for recovery of people with psychosis in Italy: Democratic therapeutic communities in post-modern social communities. THERAPEUTIC COMMUNITIES 2016. [DOI: 10.1108/tc-03-2016-0008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The purpose of this paper is to present a model of democratic therapeutic community (DTC) for people with a diagnosis of schizophrenia and psychotic disorder, namely the Group-Apartment (GA). The authors will describe it in more detail, discussing the ideas which lie behind it, considering the relative cost of treating people in larger residential DTCs and in GAs, outlining findings from the first data gathered on a GA and looking at the usefulness of this model in post-modern societies, with particular reference to Sicily.
Design/methodology/approach
In brief a GA is a flat, located in an urban apartment building, inhabited by a small group of people. In this paper the authors consider an apartment inhabited by a group of three or four patients with the presence of clinical social workers who work in shifts for several hours a day on all or most days of the week (Barone et al., 2009, 2010). GA is also inspired by the pioneering work of Pullen (1999, 2003), in the UK tradition of the apartment post TC for psychosis.
Findings
GAs in Italy have become one of the main methods of support housing in recovery-oriented treatment, because it allows the empowerment of the users and fights against the stigma of mental illness (Barone et al., 2014; Bruschetta et al., 2014). The main therapeutic activities provided in the GA depend on the type of recovery route being supported, on the level of autonomy being developed and on the level of participation in the democratic life of the local community.
Originality/value
GAs appear better, cheaper and a more appropriate treatment for mental problems in the current financial and social climate than larger institutions. Where they have been tried out, they have been found to be effective, by users and by stakeholders. They exemplify the advantages of the DTC for encouraging recovery, but cost less to run. In accordance with DTC principles, the social democratic process is used not only to evaluate the clinical effectiveness of GAs, but also to build a network to support the development of innovative mental health services and new enabling environments (Haigh et al., 2012).
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Cognitive and Social Functioning Correlates of Employment Among People with Severe Mental Illness. Community Ment Health J 2016; 52:851-8. [PMID: 25895854 DOI: 10.1007/s10597-015-9874-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Accepted: 04/09/2015] [Indexed: 10/23/2022]
Abstract
We assess how social and cognitive functioning is associated to gaining employment for 213 people diagnosed with severe mental illness taking part in employment programs in Andalusia (Spain). We used the Repeatable Battery for the Assessment of Neuropsychological Status and the Social Functioning Scale and conducted two binary logistical regression analyses. Response variables were: having a job or not, in ordinary companies (OCs) and social enterprises, and working in an OC or not. There were two variables with significant adjusted odds ratios for having a job: "attention" and "Educational level". There were five variables with significant odds ratios for having a job in an OC: "Sex", "Educational level", "Attention", "Communication", and "Independence-competence". The study looks at the possible benefits of combining employment with support and social enterprises in employment programs for these people and underlines how both social and cognitive functioning are central to developing employment models.
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Fioritti A, Peloso PF, Percudani M. “We Can Work It Out”: The Place of Work in Italian Psychosocial Rehabilitation. INTERNATIONAL JOURNAL OF MENTAL HEALTH 2016. [DOI: 10.1080/00207411.2015.1129841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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