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Elisa F, Davide T, Luisa SM, Martina M, Tommaso B, Luis SC, Barbara D, Morena F, Giulio C. Outcome analysis on individual health budgets in mental Health: finding from the Friuli Venezia Giulia Region, Italy. J Ment Health 2024; 33:159-168. [PMID: 37177819 DOI: 10.1080/09638237.2023.2210657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 04/12/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Individual Health Budget (IHB) is used for social and health integration and to facilitate processes of resource reorientation in healthcare. Despite its increased use in mental health settings, few studies investigated its effectiveness in severe mental disorders. METHODS 383 IHB beneficiaries were recruited among Mental Health Departments users of the Italian region Friuli Venezia Giulia. Data involved sociodemographic and clinical variables, IHB type and scores of Health of the Nation Outcome Scale (HoNOS) at admission to IHB programme (T0), after 12 months (T1), and after 24 months (T2). RESULTS The length and the mean number of hospitalisations and healthcare interventions decreased at T1. A significant scores' reduction from T0 to T1 evaluation was found in HoNOS total score (T-test (P) < 0.05) and in most of its items. An improvement throughout the whole evaluation period (T0 vs. T2) was found in 36% of the IHB beneficiaries, while more than 60% of them remained in the same HoNOS severity category. CONCLUSIONS Our results support the use of IHB in patients with severe mental problems, since it may contribute to an improvement in social and clinical functioning, consequently lowering the burden on MHDs.
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Affiliation(s)
- Fontecedro Elisa
- Mental Health Department, Health University Agency of Udine, Udine, 33100, Italy
| | - Tossut Davide
- Welfare Area, Friuli Venezia Giulia Region, Palmanova (UD), Italy
| | - Scattoni Maria Luisa
- Research Coordination and Support Service, Istituto Superiore di Sanità, Rome, Italy
| | - Micai Martina
- Research Coordination and Support Service, Istituto Superiore di Sanità, Rome, Italy
| | - Bonavigo Tommaso
- Mental Health Department, Health University Agency of Trieste, Trieste, Italy
| | - Salvador-Carulla Luis
- Health Research Institute, Faculty of Health, University of Canberra, Bruce Campus Canberra, Australia
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Camperdown, Sydney
| | | | - Furlan Morena
- Central Health Directorate, Friuli Venezia Giulia Region, Trieste, Italy
| | - Castelpietra Giulio
- Central Health Directorate, Friuli Venezia Giulia Region, Trieste, Italy
- Dipartimento Universitario Clinico di Scienze Mediche Chirurgiche e della Salute, Università degli Studi di Trieste, Trieste, Italy
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Robinson M, Blaise M, Weber G, Suhrcke M. The Effects and Costs of Personalized Budgets for People with Disabilities: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16225. [PMID: 36498302 PMCID: PMC9739011 DOI: 10.3390/ijerph192316225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 11/30/2022] [Accepted: 12/01/2022] [Indexed: 06/17/2023]
Abstract
This article reviews the peer-reviewed and grey literature published from January 1985 to November 2022 that has quantitatively evaluated the effects of personalized budgets for people with disabilities (PwDs), in terms of a range of benefit and cost outcomes. Benefit metrics of interest comprised measures of well-being, service satisfaction and use, quality of life, health, and unmet needs. A search was conducted using the PsycINFO, MEDLINE, CINAHL, ASSIA, and Social Care Online databases. Based on inclusion criteria and a quality assessment using the Downs and Black Checklist, a final count of 23 studies were identified for in-depth review. Given the heterogeneous nature of the studies, a narrative synthesis, rather than a formal meta-analysis, was undertaken. Taking the relatively scarce and often methodologically limited evidence base at face value, the findings suggest that-overall-personalized budget users tend to benefit in terms of well-being and service satisfaction outcomes, with the exception of mixed effects for people with mental health conditions. Only a minority of studies have investigated the cost-effectiveness or costs-only of personalized budgets, finding mixed results. Two out of the three cost-effectiveness studies find personal budgets to be more cost-effective than alternative options, meaning that the possibly higher costs of personalized budgets may be more than outweighed by additional benefits. Some evidence looking at service use and/or costs only also points to significant reductions in certain service use areas, which at least hints at the potential that personalized budgeting may-in some cases-entail reduced costs. Further research is needed to explore the generalizability of these conclusions and to better capture and understand the factors driving the observed heterogeneity in some of the results.
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Affiliation(s)
- Marguerite Robinson
- Luxembourg Institute of Socio-Economic Research (LISER), 4366 Esch-sur-Alzette, Luxembourg
| | - Marie Blaise
- Luxembourg Institute of Socio-Economic Research (LISER), 4366 Esch-sur-Alzette, Luxembourg
| | - Germain Weber
- Faculty of Psychology, University of Vienna, 1010 Vienna, Austria
| | - Marc Suhrcke
- Luxembourg Institute of Socio-Economic Research (LISER), 4366 Esch-sur-Alzette, Luxembourg
- Centre for Health Economics, University of York, York YO10 5DD, UK
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Leuci E, Pelizza L, Landi G, Quattrone E, Maestri D, Azzali S, Pelosi A, Ceroni P, Soncini C, Daolio MC, Paulillo G, Raballo A, Pellegrini P. Personal health budget in patients with first episode psychosis: A new rehabilitation model based on a community care system in Italy. Early Interv Psychiatry 2022; 16:221-230. [PMID: 33754490 DOI: 10.1111/eip.13145] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Revised: 02/02/2021] [Accepted: 03/12/2021] [Indexed: 02/06/2023]
Abstract
AIM Recently, there has been increasing interest in providing Personal Health Budgets (PHBs) to patients with severe mental illness. However, information on implementing PHB initiatives is still limited. Aim of this observational study was to evaluate the applicability of a PHB intervention model in a sample of Italian adults with first-episode psychosis (FEP) across a 2-year follow-up period. METHODS Participants (n = 104; 18-50 years) were recruited within the 'Parma-Early Psychosis' program and completed the brief psychiatric rating scale (BPRS), the health of nation outcome scale (HoNOS) and the global assessment of functioning (GAF). Mixed-design analysis of variance (ANOVA) and Kaplan-Maier survival analysis (as drop-out measure) were performed. RESULTS A significant effect of time on all BPRS, HoNOS and GAF scores along the follow-up was observed in both the FEP subgroups (i.e., with [n = 49] and without [n = 55] PHB intervention). Mixed-design ANOVA results showed a significant 'time x group' interaction effects on BPRS 'Disorganization', HoNOS 'Psychiatric Symptoms' and GAF scores in FEP participants with PHB. Kaplan-Meyer survival analysis showed a longer survival mean for FEP patients with PHB. CONCLUSIONS Our results support the applicability of a PHB model within an 'Early Intervention in Psychosis' program in public community mental health services.
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Affiliation(s)
- Emanuela Leuci
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Parma, Italy
| | - Lorenzo Pelizza
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Parma, Italy
| | - Giulia Landi
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Parma, Italy.,Department of Mental Health and Pathological Addiction, Azienda USL di Modena, Modena, Italy
| | - Emanuela Quattrone
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Parma, Italy
| | - Davide Maestri
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Parma, Italy
| | - Silvia Azzali
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Annalisa Pelosi
- Department of Medicine and Surgery, Parma University Hospital, University of Parma, Parma, Italy
| | - Patrizia Ceroni
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Parma, Italy
| | - Caterina Soncini
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Parma, Italy
| | - Maria Cristina Daolio
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Parma, Italy
| | - Giuseppina Paulillo
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Parma, Italy
| | - Andrea Raballo
- Division of Psychiatry, Department of Medicine, University of Perugia, Perugia, Italy.,Center for Translational, Phenomenological and Developmental Psychopathology, Perugia University Hospital, Perugia, Italy
| | - Pietro Pellegrini
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Parma, Italy
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Views of Mental Health Professionals on Positive Changes in Service Practices and Staff-User Relationships After One Year of Covid-19 Pandemic in Italy. JOURNAL OF PSYCHOSOCIAL REHABILITATION AND MENTAL HEALTH 2022; 9:239-249. [PMID: 35075406 PMCID: PMC8771651 DOI: 10.1007/s40737-022-00259-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 01/04/2022] [Indexed: 01/26/2023]
Abstract
This study explored views of mental health services (MHS) professionals regarding positive changes in service practices and organizations, and staff-user relationships after one year of COVID-19 in Italy. Professionals from a community-oriented MHS completed online the Questionnaire on MHS Transformations during the COVID-19 pandemic, a 30-item tool developed by a participatory approach and validated. Of the 184 participants, 91.8% felt it was “true/definitely true” that during the pandemic they had informed users on procedures to reduce contagion risks, and 82.1% stated that they had increased telephone contact with users. Sixty-nine percent of professionals reported that staff revised treatment plans according to new needs of care and 78.6% stated that they had been able to mediate between user needs and safe working procedures. Moreover, 79.4% of respondents stated that they had rediscovered the importance of gestures and habits, and 65% that they had gained strength among colleagues to face fear. Fifty-four percent of participants admitted that they had discovered unexpected personal resources in users. Overall, 59.6% of participants stated that they found some positives in the COVID-19 experience. Perceived positive changes was greater among professionals from community facilities vs. those from hospital and residential facilities. In community-oriented MHS, the pandemic offered an opportunity to change practices and rethink the meaning of relationships between people. This data may be useful in generating a more balanced understanding of COVID-19's impact on MHS and for MHS planning in the pandemic era.
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Micai M, Gila L, Caruso A, Fulceri F, Fontecedro E, Castelpietra G, Romano G, Ferri M, Scattoni ML. Benefits and challenges of a personal budget for people with mental health conditions or intellectual disability: A systematic review. Front Psychiatry 2022; 13:974621. [PMID: 35990078 PMCID: PMC9386381 DOI: 10.3389/fpsyt.2022.974621] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 07/14/2022] [Indexed: 01/04/2023] Open
Abstract
UNLABELLED Personal budgets (PBs) may improve the lives of people with mental health conditions and people with intellectual disability (ID). However, a clear definition of PB, benefits, and challenges is still faded. This work aims to systematically review evidence on PB use in mental health and ID contexts, from both a qualitative and quantitative perspective, and summarize the recent research on interventions, outcomes, and cost-effectiveness of PBs in beneficiaries with mental health conditions and/or ID. The present systematic review is an update of the existing literature analyzed since 2013. We performed a systematic search strategy of articles using the bibliographic databases PubMed and PsycINFO. Six blinded authors screened the works for inclusion/exclusion criteria, and two blinded authors extracted the data. We performed a formal narrative synthesis of the findings from the selected works. A total of 9,800 publications were screened, and 29 were included. Improvement in responsibility and awareness, quality of life, independent living, paid work, clinical, psychological, and social domains, and everyday aspects of the users' and their carers' life have been observed in people with mental health conditions and/or ID. However, the PBs need to be less stressful and burdensome in their management for users, carers, and professionals. In addition, more quantitative research is needed to inform PBs' policymakers. SYSTEMATIC REVIEW REGISTRATION [www.crd.york.ac.uk/prospero/], identifier [CRD42020172607].
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Affiliation(s)
- Martina Micai
- Research Coordination and Support Service, Istituto Superiore di Sanità, Rome, Italy
| | - Letizia Gila
- Research Coordination and Support Service, Istituto Superiore di Sanità, Rome, Italy
| | - Angela Caruso
- Research Coordination and Support Service, Istituto Superiore di Sanità, Rome, Italy
| | - Francesca Fulceri
- Research Coordination and Support Service, Istituto Superiore di Sanità, Rome, Italy
| | - Elisa Fontecedro
- Department of Mental Health, Friuli Centrale Healthcare Agency, Udine, Italy
| | | | - Giovanna Romano
- Directorate General of Health Prevention, Ministry of Health, Rome, Italy
| | | | - Maria Luisa Scattoni
- Research Coordination and Support Service, Istituto Superiore di Sanità, Rome, Italy
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Castelpietra G, Guadagno S, Pischiutta L, Tossut D, Maso E, Albert U, Balestrieri M. Are patients improving during and after a psychiatric hospitalisation? Continuity of care outcomes of compulsory and voluntary admissions to an Italian psychiatric ward. J Public Health Res 2021; 11. [PMID: 34355553 PMCID: PMC8847955 DOI: 10.4081/jphr.2021.2382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 06/22/2021] [Indexed: 11/23/2022] Open
Abstract
Background: To compare the characteristics of compulsory admissions (CAs) and voluntary admissions (VAs) in a General Hospital Psychiatric Unit (GHPU), and to assess whether CA and VA patients’ outcomes improved during hospitalisation and followup in mental health services (MHS) based on community continuity of care. Design and methods: Observational longitudinal study comparing 19 CAs and 83 VAs consecutively admitted to GHPU of Udine, Italy, and followed-up for six-months by MHS. Five psychometric scales assessed psychosocial and clinical characteristics for each patient at admission (T0), discharge (T1) and follow-up (T2). Statistical analyses were performed using: multivariate logistic regression for comparing CA and VA; Friedman χ2 and Mann-Whitney tests for outcomes’ improvement. Results: Being hospitalised for a psychotic crisis was the most significant predictor of CA (OR = 5.07). An outcomes’ improvement was observed from T0 to T1 in almost all psychometric tests, while from T1 to T2 only for PSP-A (useful social activities), CGI-S (severity of illness) and CGI-EI (drug’s efficacy related to side effects). CA was associated to lower performances in all scales at T0, in GAF and CGI-S at T1, while no difference with VA was observed at T2. Conclusions: CA and VA patients improved to a same extent during hospitalisation and follow-up, particularly in relation to social functioning. This fosters the hypothesis that communitybased MHS using a longitudinal continuity of care model might achieve recovery in a long-term perspective. Future research may benefit by considering patients’ subjective experiences and assessing long-term improvement in those who received personcentred interventions. Significance for public health This study demonstrates that patients voluntarily or involuntarily admitted to an inpatient psychiatric service improve to a same extent during hospitalisation, and this improvement is maintained during a six-month follow-up by outpatient mental health services. Moreover, the greatest improvement after discharge from hospital is observed in social functioning. To our knowledge, this is also the first study analysing psychiatric patients’ outcomes in a longitudinal continuity of care model, allowing preliminary scientific evidences valuable for mental health policy. The study also shed a light on the hypothesis that a mental health system strongly community-based and applying a whole-system continuity of care approach might achieve recovery in a long-term perspective, particularly with regard to psychosocial outcomes in more severely-ill patients.
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Affiliation(s)
- Giulio Castelpietra
- Outpatient and Inpatient Care Service, Central Health Directorate, Friuli Venezia Giulia Region, Trieste.
| | - Silvia Guadagno
- Udine Nord Community Mental Health Centre, Mental Health Department, Friuli Centrale Healthcare Agency, Udine.
| | - Livia Pischiutta
- Department of Medicine, Surgery and Health Sciences, University of Trieste.
| | - Davide Tossut
- Welfare Area, Giuliano Isontina Healthcare Agency, Palmanova (UD).
| | - Elisa Maso
- Psychiatric Unit, Mental Health Department, Friuli Centrale Healthcare Agency, Udine.
| | - Umberto Albert
- Department of Medicine, Surgery and Health Sciences, University of Trieste.
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Motrico E, Salinas-Perez JA, Rodero-Cosano ML, Conejo-Cerón S. Editors' Comments on the Special Issue "Social Determinants of Mental Health". INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18083957. [PMID: 33918698 PMCID: PMC8070115 DOI: 10.3390/ijerph18083957] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 04/06/2021] [Indexed: 01/04/2023]
Abstract
Mental disorders are one of the greatest public health concerns of our time, and they are affected by social factors. To reduce the considerable burden of mental disorders, more global and systematic knowledge of the social determinants of mental health is necessary. This paper presents the results of the 27 studies included in the International Journal of Environmental Research and Public Health Special Issue, “Social Determinants of Mental Health”. The studies are grouped into four broad categories: social inclusion and mental health, young people’s mental health, mental health at work, and mental health service users. The results cover different countries, age populations, settings, and methodologies. Finally, the main findings on the relationship between social determinants and mental health are presented and summarized.
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Affiliation(s)
- Emma Motrico
- Department of Psychology, Universidad Loyola Andalucía, 41704 Sevilla, Spain
- Prevention and Health Promotion Research Network (redIAPP), 08007 Barcelona, Spain
- Correspondence: (E.M.); (J.A.S.-P.); (M.L.R.-C.); (S.C.-C.)
| | - Jose A. Salinas-Perez
- Department of Quantitative Methods, Universidad Loyola Andalucía, 41704 Sevilla, Spain
- Centre for Mental Health Research, Australian National University, Canberra, ACT 2601, Australia
- Correspondence: (E.M.); (J.A.S.-P.); (M.L.R.-C.); (S.C.-C.)
| | - Maria Luisa Rodero-Cosano
- Department of Quantitative Methods, Universidad Loyola Andalucía, 41704 Sevilla, Spain
- Correspondence: (E.M.); (J.A.S.-P.); (M.L.R.-C.); (S.C.-C.)
| | - Sonia Conejo-Cerón
- Prevention and Health Promotion Research Network (redIAPP), 08007 Barcelona, Spain
- Biomedical Research Institute of Malaga (IBIMA), 29009 Málaga, Spain
- Correspondence: (E.M.); (J.A.S.-P.); (M.L.R.-C.); (S.C.-C.)
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Castelpietra G, Colli C, Tossut D, Furlan M, Balestrieri M, Starace F, Beghi M, Barbone F, Perulli A, Salvador-Carulla L. The impact of Covid-19 pandemic on community-oriented mental health services: The experience of Friuli Venezia Giulia region, Italy. HEALTH POLICY AND TECHNOLOGY 2021; 10:143-150. [PMID: 33520636 PMCID: PMC7833105 DOI: 10.1016/j.hlpt.2020.12.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES to assess the changes in prevalence, incidence and hospitalisation rates during the first four months of 2020, compared to the same period of 2019, in Friuli Venezia Giulia Mental Health Departments (MHDs); to analyse the features of MHDs patients tested for Sars-Cov-2, and to monitor whether MHDs applied and adhered to regional recommendations. METHODS Observational study using MHDs' administrative data and individual data on suspected and positive cases of Sars-Cov-2. Adherence to recommentations was assessed using 21 indicators. Changes in rates were calculated by Poisson regression analysis, while the Fisher exact test was used for assessing differences between suspected and positive cases. RESULTS The decrease in voluntary admission rates on 100,000 inhabitants in hospital services was significantly larger from January to April 2020, compared to the same period of 2019 (P<0.001), while no other data showed a significant decrease. Among the 82 cases tested for Sars-Cov-2, five were positive, and they significantly differ from suspected cases only in that they were at home or in supported housing facilities prior to the test. The MHDs mostly complied with the indicators in the month after the publication of recommendations. CONCLUSIONS Outpatient services continued to work normally during the emergency, while hospital services decreased their activities. A low number of positive cases was found among MHDs' users, which might be linked to a rapid reconversion of services, with an extensive use of home visits and telepsychiatry. These preliminary data should be interpreted with caution, due to the small size and the limited period of observation.
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Affiliation(s)
- Giulio Castelpietra
- Central Health Directorate, Friuli Venezia Giulia Region, Riva Nazario Sauro 8, 34100, Trieste, Italy
- Department of Medicine (DAME), University of Udine, Ple Santa Maria della Misericordia 15, 33100, Udine, Italy
| | - Chiara Colli
- Department of Medicine (DAME), University of Udine, Ple Santa Maria della Misericordia 15, 33100, Udine, Italy
| | - Davide Tossut
- Welfare Area, Friuli Venezia Giulia Region, Borgo Aquileia 2, 33057 Palmanova (UD), Italy
| | - Morena Furlan
- Central Health Directorate, Friuli Venezia Giulia Region, Riva Nazario Sauro 8, 34100, Trieste, Italy
| | - Matteo Balestrieri
- Department of Medicine (DAME), University of Udine, Ple Santa Maria della Misericordia 15, 33100, Udine, Italy
| | - Fabrizio Starace
- Department of Mental Health & Drug Abuse, AUSL Modena, Vle Ludovico Antonio Muratori 201, 41124, Modena, Italy
| | - Massimiliano Beghi
- Department of Mental Health, AUSL Romagna, pzle Giommi, 47521, Cesena, Italy
| | - Fabio Barbone
- Central Health Directorate, Friuli Venezia Giulia Region, Riva Nazario Sauro 8, 34100, Trieste, Italy
| | - Alfredo Perulli
- Central Health Directorate, Friuli Venezia Giulia Region, Riva Nazario Sauro 8, 34100, Trieste, Italy
| | - Luis Salvador-Carulla
- Centre for Mental Health Research, Research School of Population Health, ANU College of Health and Medicine, Australian National University, 63 Eggleston Rd Acton ACT 2601, Canberra, Australia
- Menzies Centre for Health Policy, Faculty of Medicine and Health, University of Sydney, Charles Perkins Centre, The University of Sydney, NSW, 2006, Sydney, Australia
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