The psychiatric care reform law is still very unequally applied. Striking differences exist between geographic areas in the amount and type of services provided.

Trends in time

During the first year after this reform, about 10000in-patients were discharged from mental hospitals. This represented a major acceleration of an already current tendency.

The decrease in psychiatric in-patients was greater in southern than in northern Italy and was rather small in areas where the deinstitutionalization process was already developed. This result was facilitated by the fact that in the mental hospitals there weremany ‘inmates’ whowere not psychiatric cases sensu stricto. However, episodes of neglect and abandonment were not rare; some people were discharged or sent to their areas of origin without the families being helped or before community services had been set up. How many such cases there were, we do not know. In the following years, discharges decreased to about 3000-4000 per year.

New services

The small units in the general hospital (Diagnosis and Treatment Services, DTS) were fairly rapidly organized; the norm, in most areas of northern and central Italy, being 15 beds per 100000 of the population. There have been long delays in the development of community services, especially of sheltered accommodation, group homes, social centres and sheltered work. No real relationship can be discerned between the discharge rate and the development of new services; on the contrary, the general impression given is the greater the number of discharges, the poorer the new services. Lack of rational planning is apparent.

Local variability

There are striking differences not only from region to region in Italy (the region, as an administrative unit, can legislate in health matters), but also among Local Health Units and within big cities. The main causes are political and cultural more than structural or financial. This large variability is likely to continue; 40% of the Italian provinces have not fully implemented even the 1904 law.

Patterns of care

It is possible to distinguish between three basic patterns of care.

Psychiatric hospitals plus Diagnosis and Treatment Services

New community services have not been developed. Only the emergency units (DTS) in general hospitals have been opened. There is practically no follow-up care for patients discharged from the psychiatric hospitals (PH). DTSs play a role of pure sedation, because of heavy pressure from unfiltered demand. Turnover rate is very high; psychotropic drugs are used almost exclusively.