Process of Care in General Hospital Psychiatric Units: National Survey In Italy

• Published in: Australian and New Zealand journal of psychiatry Vol. 41; no. 6; pp. 509 - 518
• Main Authors: Gigantesco, Antonella, Miglio, Rossella, Santone, Giovanni, de Girolamo, Giovanni, Bracco, Renata, Morosini, Pierluigi, Norcio, Bruno, Picardi, Angelo
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01-06-2007; Informa
• Subjects: Adult; Biological and medical sciences; Cognitive Therapy; Female; Hospital Bed Capacity - statistics & numerical data; Hospitalization - statistics & numerical data; Hospitals, General; Humans; Italy - epidemiology; Length of Stay - statistics & numerical data; Male; Medical sciences; Mental Disorders - epidemiology; Mental Disorders - rehabilitation; Mental Disorders - therapy; Mental Health Services - organization & administration; Mental Health Services - statistics & numerical data; Psychiatric Department, Hospital - organization & administration; Psychiatric Department, Hospital - statistics & numerical data; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Surveys and Questionnaires; Italy; Europe; process of care; acute inpatients; general hospital psychiatric unit; Human; Psychiatric hospital; General hospital; Acute; Hospital ward; Public inquiry; Psychiatry
• ISSN: 0004-8674; 1440-1614
• DOI: 10.1080/00048670701341921

Objective: To investigate the process of care in Italian public acute inpatient facilities.
Method: Each facility's head psychiatrist (in all Italian regions except Sicily) completed a structured interview concerning provision of treatment and facility rules.
Results: Twenty-three university psychiatric clinics with 399 beds (mean=17.3 beds), 16 24 h community mental health centers with 98 beds (mean=6.1 beds), and 262 general hospital psychiatric units with 3431 beds (mean=13.1 beds) were surveyed. Mean length of stay was 18.5±7.1 days, 37.0±55.3 days and 12.0±3.4 days, respectively. Pharmacotherapy was ubiquitous. Approximately 80% of facilities held regular clinical evaluations, supportive talks, and counselling. Dynamic focused psychotherapy was available in 29% of the facilities; 24% provided cognitive behavioural therapy; 32% family therapy; and 39% structured rehabilitative intervention. Vocational training and activities targeted at helping patient integration into their local communities were uncommon. Most facilities did not allow the possession of cutting utensils (96%), personally possessed medication (96%), or lighters (72%), and most had locked doors (75%). Fewer facilities (37%) prohibited the use of mobile phones (32%) and metal knives during mealtimes (37%). Frequency of physical restraint was associated with number of internal rules. Delivery of psychotherapy was associated with nurst provision.
Conclusions: The process of psychiatric inpatient care in Italy shows considerable variability. Future clinical practice guidelines should address the currently limited provision of evidence-based psychosocial intervention in these facilities. Efforts should also be devoted to improving the effectiveness of the hospital–community mental health service interface.