Regional Planning for improved mental health care: Defining quality, evaluating intervention and ini

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Regional Planning for improved mental health
careDefining quality, evaluating intervention
and initiatives to promote active inclusion

• Gerardo Favaretto Andrea Angelozzi
• Prague, 22nd June 2009

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The 1978 Italian Mental Health Actfrom mental
hospitals to community-care

• Closure of Mental Health Hospitals
• A few beds for acute psychiatric emergencies in
  general hospitals
• Establishment of a wide range of community-based
  services
• Strict rules for compulsory treatment

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• Premises of the 1978 Act
• Hospitalization worses chronicity in mental
  illness instead of treating, or, at least
  improving it
• Emphasis is on treatment, not on danger to
  society
• The advent of neuroleptics
• A holistic (bio-psycho-social) approach to mental
  illness
• A politically and ideologically favourable climate

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A few data on the implementation of the Mental
Health Reform in the Veneto Region

• 805 beds for acute psychiatric emergencies in 40
  general hospitals
• 337 community-based services, 111 of which are
  residential
• ¾ of community-based services are run by LHAs
• 3.000 staff (80 work for LHAs) 47 nurses, 24
  care givers, 13 psychiatrists, 6 educators, 3
  psychologists, 3 social workers (ie. 1 1500
  inhabitants)

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• 64.700 (16,3 per 1.000 inhabitants) mentally ill
  people treated in 2007, of whom 11.680 (3,0/000)
  admitted to general hospitals and 59.800
  (15,1/000) in community-based services
• Note estimated prevalence of mental illness in
  Italian population 8
• ? 368.000 in Veneto region
• (ie. most treated by G.P.s)
• Overall costs 250 million (ie. 3,5 of LHAs
  budget)
• Note the objective is 5

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De-istitutionalization works were supported by a
wide range of community-based services the case
of Verona
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The OrganizationMental Health Department

• Responsable for planning and coordinating all
  mental health services in a specific area
• Both hospital and community-based services
  integration between social and health services
• One for each of 21 Veneto region LHAs
• Run by a Director, supported by a Committee, with
  an Assembly
• In cooperation with NGOs and Patients and
  Families Associations

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All relevant stakeholders are involved in the
development of community-based services

• All stakeholders are involved for recommendations
  and proposal
• to Regional Govt.
• The REGIONAL COMMITTEE on Mental Health
• Steering group established in 2005 that meets
  regularly (1 time/month)
• Analysis of reality of Services and their
  troubles, and of reality of people request about
  Mental Health
• Recommendations and proposal about Regional Plans
  on M.H.
• Representatives of
• Local Mental Health Departments
• Scientific Societies
• Municipalities
• LHAs
• University
• NGOs
• Patients and Families Associations

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All relevant stakeholders are involved in the
development of community-based services

• All stakeholders are involved from the beginning
  in elaboration of Act of Regional Govt. about
  Mental Health
• Stages for Regional ACT on Rules and standards
  for Accreditation of M.H.
• 1) A Working team (experts from Regional Govt.,
  Local Mental Health Departments, NGOs, Families
  Associations) write a starting document
• 2) Analyzed with REGIONAL COMMITTEE on Mental
  Health
• 3) Analyzed with Scientific Societies
• 4) Analyzed with COMMITTEE of Directors of Local
  Mental Health Departments and University
  Departments
• 5) Analyzed with NGOs
• 6) Analyzed with Regional Govt. Departments
  Social Services and Hospital Services
• 7) Published on WEB site of Regional Govt.
• All critical observations and proposal have been
  analyzed in the original Working Team and the
  final document has been presented to REGIONAL
  COMMITTEE on Mental Health for approval.
• Then Regional Service for Mental Health has
  deliberated the ACT 1616 for Rules and standards
  for Accreditation of M.H.
• The Working Team ( with all stakeholders ) has
  to monitor troubles and stages of application of
  ACT 1616

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The new Regional Planning of community-based
services in Mental Health

• All stakeholders are involved from the beginning
  in elaboration
• Stages for New Regional Planning (the old was
  edited in year 2000).
• 1) 4 Working teams (experts from Regional Govt.,
  Local Mental Health Departments, NGOs, Families
  Associations) write starting document on these 4
  items
• Identity, structures and rules of M.H.
  Departments
• Relationship of M.H. Departments with hospital
  and sommunity realities
• Therapeutic and rehabilitative paths in mental
  health
• Mental health in childreen and adolescence.
• 1 Working team elaborates one document
• 2) Analyzed with REGIONAL COMMITTEE on Mental
  Health
• 3) Analyzed with Scientific Societies
• 4) Analyzed with COMMITTEE of Directors of Local
  Mental Health Departments and University
  Departments
• 5) Analyzed with NGOs
• 6) Analyzed with Regional Govt. Departments
  Social Services and Hospital Services
• 7) Published on WEB site of Regional Govt.
• All critical observations and proposal ll be
  analyzed in the original Working Team and the
  final document ll be presented to REGIONAL
  COMMITTEE on Mental Health for approval.
• Then Regional Service for Mental Health will
  deliberate one document that has to be analyzed
  by political levels of Regional Govt.

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New Conceptual grounds in the new planning

• Customer oriented services (emphasis is on
  Costumers needs not on structured services)
• An adequate network of community-based services,
  including all comunity resources
• High quality standards Accountability
• Inclusion of customers in planning of treatment
• Inclusion of customer and stakeholders in
  planning of services
• Evaluation of services and outcome

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How to overcome the fear and stigma?

• A favourable political and cultural climate
• The role of mass-media and the political agenda
• Normalization of treatment within General
  Hospitals and Local Health Districts
• Social integration the case of no-profit social
  co-operatives
• Opening the doors