The status of Italian psychiatric reform: the example of Lombardy in comparison with Switzerland]

In Italy, the worldwide reduction in numbers of psychiatric beds since the fifties had led already by 1971 to a much lower per capita rate of beds than in most European countries. In Northern Italy the psychiatric reform of 1979 speeded up the ongoing reduction of beds, ameliorated conditions for hospitalized patients and built up ambulatory care. A comparison with three Swiss cantons shows that, in Lombardy, the largest and economically most developed Italian Region, the rate of patient contacts with outpatient services has probably reached or surpassed the level found in Switzerland. Contacts by home visits are much more frequent than in Switzerland. The number of psychiatric beds per 1,000 inhabitants is 0.7 in Lombardy and thus has been reduced to one third the Swiss bed-ratio. Comparisons of Italian with Dutch and Danish psychiatric register data show that the Italian psychiatric service as a whole reaches a considerably smaller segment of the severely disordered patients. The Region of Lombardy has recently been trying to increase the psychiatric bed-ratio by agreements with private hospitals. The shortage of beds is not compensated by the ambulatory services and is leading to increasing stress for the families of the severely disordered.