The Italian psychiatric reform: some quantitative evidence

Summary The Italian experience of providing psychiatric care with comprehensive and integrated community services while blocking admissions to mental hospitals needs evaluation on the basis of quantitative evidence as well as opinion. In this paper, national statistics and local case-register data pertaining to this issue are reported. Questions referring to the structure of the services (whether or not the prescribed reorganisation has actually taken place) as well as to function (the way in which the reorganised services, were they have been provided, actually operate) are examined. The available data show that there is a marked regional variation in service provision, as well as a globally inadequate provision of alternative structures. However, the evidence suggests that where adequate community psychiatric services have been provided, they function successfully without the availability of backup from the mental hospitals. The results suggest that a national coordination of regional and local policy is urgently necessary, together with an increase of the resources devoted to psychiatric care and a shift of expenditure from the declining mental hospitals to the progressively more overburdened community services.