Reform said or done? The case of Emilia-Romagna within the Italian psychiatric context

OBJECTIVE: The authors sought to evaluate how the services required by the Italian Psychiatric Reform of 1978 were implemented in Emilia- Romagna, a region of 4 million inhabitants in Northern Italy. METHOD: All psychiatric facilities were monitored from 1978 to 1994 to determine the number and rates of admissions, average duration of stay, average intake, and percent of beds occupied at inpatient facilities as well as the number of patients residing in former mental hospitals and the number and rates of first contacts with mental health community centers. RESULTS: Three mental hospitals out of nine were closed during the period, and the number of patients who resided in mental hospitals declined from 4,798 to 655. By 1994, there were 145 community centers, 48 day treatment centers, 12 general hospital psychiatric wards, three university psychiatric clinics, seven private psychiatric clinics, 24 psychiatric residences, and 123 supervised apartments that were operating as alternatives to asylums. The overall rate of inpatient admissions remained stable, but compulsory admissions gradually decreased by 35% throughout the period. First contacts at outpatient centers increased by 17.9% from 1984 to 1991. CONCLUSIONS: The shift from a hospital-based to a community-based psychiatric system of care, as foreseen by the Italian psychiatric reform, seems feasible. Some general political, administrative, and social backup conditions appear crucial to ensure the good outcome of this process.