Aims – To describe in a sample of 646 relatives of patients with physical long-term illnesses: a) the relatives' burden of care; b) the relatives' attitudes towards the patients; c) the social and professional support received by the families. Methods – The study has been carried out in 30 Italian geographic areas randomly selected taking into account geographic location and population density. The sample has been consecutively recruited in 139 specialised units for the treatment of chronic heart, brain, diabetes, kidney, and lung diseases. Family burden was evaluated in relation to: a) family's socio-demographic variables and patients' clinical variables; b) relatives' attitudes toward the patient; c) social and professional support; d) geographic area and population density. Outcome measures – Family Problems Questionnaire, physical illness version (QPF-O) and Social Network Questionnaire (QRS). Results – The consequences of caregiving most frequently reported were constraints in social and recreational activities, and feelings of loss. Burden was more marked in relatives of patients with higher physical disabilities, with neurological illnesses, and in relatives with lower support by their social network. Conclusions – These data highlight the need to provide psychological and practical support to caregivers of patients with long-term physical diseases on the basis of the evaluation of their needs for care.

Declaration of Interest: none of the five authors has had any interest or received any form of support, including that from drug companies and honoraria for lectures and consultancies, potentially in conflict with this scientific work, in the last 2 years.

Aims – To explore the current state of Italian social psychiatry research as evidenced by original papers published in peer-reviewed journals 2004-2006. Methods – Electronic databases and hand searches of leading peer-reviewed journals were used to identify original research papers published in 2004-2006, addressing a social psychiatric issue, having at least one Italian author, and reporting data from Italian samples. Results – A total of 174 papers were identified. A substantial proportion reported findings of international collaborative research. Quantitative methods dominated, with 86 papers on cross-sectional surveys. Only 18 papers showed results of intervention trials with pre and post measures. Most common target group were psychiatric patients in community mental health services which featured in 93 papers. Conclusions – There is a critical mass of Italian social psychiatry research, dominated by a few research centres and with considerable amount of international collaboration. The findings of this survey might reflect the relative shortage of national funding for social psychiatry research.

Declaration of Interest: None.

Objective - The aim of the present paper is to assess the supply and demand of psychotherapy in mental health services and to identify the factors predicting the start of psychotherapy, using routine data, including 18 clinic and extraclinic variables, collected at 10 Mental Health Centers. Setting - Ten Mental Health Services of Regione Emilia-Romagna. Design - A prospective longitudinal study regarding all «new» users in 1995 followed for one year after the first visit. Results - The percentage of the new users starting a psychotherapy was 11.5%, corresponding to an overall one-year incidence of 5.6/10000 inhabitans ≥18 years old (range 0.9-14.8 across the 10 centres). The demand of psychotherapy in 1995 was 16.1%, including both the request of the patients and the primary care physicians (range 0.6-33%). The predictive factors for the beginning of the psychotherapy were: the presence of a psychologist at the first encounter, the request of the patient for a psychotherapy, age < 48 years, high educational level, being student, living with the family, the Mental Health Center; the broad diagnostic group of «neurotic» diagnoses resulted to have a twofold probability with respect to controls to start a psychotherapy. The logistic regression analysis of 18 variables coudn't find a predictive model with more than 33% sensitivity. Conclusions - The psychotherapeutic treatment is not predictable in the 10 Centers we studied, because of extreme differences in psychotherapy supply among Centers and probably because of uncertainty of therapeutic recommendations for psychotherapies.

World Psychiatry, the official journal of the World Psychiatric Association (WPA), is now published in five languages (English, Spanish, Chinese, Russian and French) and reaches more than 33,000 psychiatrists in 121 countries. It received recently its first impact factor, 3.896. The publication of the journal has two objectives. The first is to reach as many psychiatrists of the various countries of the world as possible, disseminating information on recent significant clinical, service and research developments in a language that can be assimilated by the vast majority of them. The second is to give voice to psychiatrists of all regions of the world, encouraging submission of research papers, commentaries and reports on innovative service modalities. Related to this second objective has been the establishment by the WPA of a task force aiming to promote dissemination of psychiatric research conducted in low and middle income countries. Among the objectives of this task force is to advise and support the editors of high quality journals produced in those countries in their efforts to achieve indexation.

Declaration of Interest: None.

Objective - The aim of this article is to explain the current status of deinstitutionalisation and of community care development in the UK. Design — Literature review of articles and reports on deinstitutionalisation. Setting — Articles included in the review related either to the whole of the UK, to England and Wales, or to a specific area such as London. Main outcome measures — The review was carried out pertaining to the question of the extent to which community care can or should take over the functions of the asylum, with particular reference to those at risk of behaving violently. These functions include those that are manifest, or explicit, and those that are latent, or unintended but implicit (Bachrach, 1976). Results — The example of patients at risk of violent behaviour is one that highlights the continuing relevance of both these sets of functions, which are argued to be exerting a powerful influence on the processes of asylum closure and community care development. This influence is seen in delayed asylum closure, transinstitutionalisation (the shift of some patients from asylums to other institutions), and the institutionalisation of aspects of community care. Conclusions — Both the manifest and the latent functions of asylums must be acknowledged by those involved in planning community care; where it is felt desirable that community care does not take over certain functions, the consequences of this must be anticipated so that they can be prevented or dealt with in other ways.

Objective - The present paper represents the second part of a larger review on the studies assessing needs for care in mental health field. In the first part, studies assessing needs for services in the general population were reviewed. In this second part studies assessing needs on individual level were reviewed and the role played by the assessment of individual needs in planning mental health care was discussed. Methods - Studies published in international literature from January 1980 to June 1999 were reviewed. The studies were located through a computerised search of the databases MEDLINE and PsycLit; in addition, the reference lists of the studies located through the computerised search and the content of main international psychiatric journals were manually scanned in order to avoid possible omissions. Studies assessing needs in the general population and in psychiatric patients were reviewed separately. The latter were reviewed on the basis of the diagnostic category (psychotic and non psychotic patients) and setting of care (outpatients and inpatients). Studies on particular categories, such as homeless, children and adolescents, elderly and patients with aggressive behaviour, have been also reviewed. Results - Psychotic patients show a wide range of both clinical and social needs. Patients followed by community-based mental health services show similar number of clinical and social needs, while inpatients (with the exception of acute patients) show more social needs. For both community-based mental health patients and inpatients, social needs are most frequently unmet and psychopharmacological treatments are used more frequently than psychotherapeutic or rehabilitative interventions. Non psychotic patients show lower number of needs than psychotic patients; these needs are both clinical and social, with a higher total number of clinical needs, but a higher number of unmet social needs. Conclusions - Studies on needs for care provide an interesting perspective on people suffering from mental illness. In the routine clinical practice needs assessment could be a valuable tool for providing specific, individualised and effective mental health care.

Objective — To describe requests of admissions to eight General Hospital Psychiatric Wards (SPDC) in Lombardy, Italy, during November 1995. Design — Descriptive prospective multicenter study. Setting — SPDCs of Busto Arsizio (VA), Calcinate (BG), Desio (MI), Magenta (MI), Merate (LC), Milano San Paolo I, Pavia, Treviglio (BG). The global catchment area sums up to 11% of the whole regional area, and to 18% of the population. Main outcome measures — We used a previously developed flowchart with two major key points: who decided to go to the hospital? Did a doctor confirm this initiative? Main sociodemographic characteristics, ICD10 diagnosis and previous psychiatric admissions were collected for each admission. Results — Admissions were 315, patients 246. In 9.5% of cases patients asked for admission without any medical advice. In one third of cases the ward psychiatrist was the first doctor to visit the patient. Compulsive admissions (TSO) were 45 (14.3%), although patient's initiative lacked in 55.6% of cases. A referral from Outpatient Departments (CPS) was present in 28.2%. First-ever admitted were 63 (25.6%): 20.7% sent by CPS, 16% by GPs, 11% by other non psychiatric wards. Conclusions — Although Goldberg & Huxley's model described General Hospital Psychiatric Wards as the last level of intervention, our data show that Italian SPDCs work as «front line» services: less than one admission out of two were referred by a psychiatrist. Problems raised by «self-referred» patients are conspicuous and an evaluation of the filtering function of CPSs seems necessary. In this regard, a comparison with different modalities of Department organization could be useful.

Aims — In this article the author – board-member of the European Network of (ex-) Users and Survivors of Psychiatry (ENUSP) -explains, what is needed to guarantee a minimal level of involvement of users and survivors of psychiatry into issues relating to psychiatric drugs. Methods – He reflects demands of their organisations, and compares these demands with the current involvement level. Considering the concrete circumstances in psychiatry, he reflects the risks and dangers of the administered drugs -especially the widely used neuroleptics –for example enhanced breast cancer risk in women, suicidal effects, receptor changes, tardive dyskinesia and other toxic reactions. Results – Considering the unique situation of psychiatric patients to receive treatment in general without informed consent and in a violent way or through bullying and threat, he argues for to provide their involvement in all aspects of psychiatric drug issues -especially registration and monitoring, for example by their involvement in creating and running a suicide register. And he argues for involvement in ethics committees, licensing processes and providing guidelines and decision making about effectiveness and reimbursement of costs. Conclusions – As first steps towards these aims he proposes independent and user-controlled research, independent and user-controlled education and independent and user-controlled information about the effects of psychiatric drugs.

Declaration of Interest: the Author did not receive any grants and financial support for the study; any forms of financing (included pharmaceutical company support and any honoraria for consultancies or interventions in the last two years); any other involvements that might be considered a conflict of interest in connection with the submitted article.

Objective – The aim of this paper is to analyse long-term care in an area (Portogruaro) monitorized with a Psychiatric Case Register. Design – A cohort composed by patients included in 1987 prevalence was followed in 1992. Three hypothesis have been tested: a) long-term patients (LT) have a better prognosis than long-stay patients; b) clinical and socio-demographical characteristics of LT are significantly different from those of non-LT patients included in the cohort; c) clinical and socio-demographical characteristics of LT that are also high-users are different from those LT that are not high-users. Main outcome measures – Analysis was performed using generalised linear models; principal clinical and socio-demographical characteristics were considered. Results – The results confirm the first hypothesis, and show that two variables (previous psychiatric contact and employment) were associated with patterns of care in 1992. Highly significant is the correlation between patterns of contacts in 1987 and 1992, showing that particularly long-term and high-user patients tend to confirm their pattern over the years. Conclusions – These results underline the necessity for psychiatric services to commit themselves to the care of this group of patients, that constitute the «new chronicity».

Objective - The present study was conducted to determine the excess of mortality in long-term psychiatric inpatients. Setting - Psychiatric hospital, Bologna, Italy. Design – Retrospective study on a cohort of 264 chronic psychiatric inpatients, followed up for ten years since January 1981. Mortality measures were computed by psychiatric diagnosis, length of stay and «still resident at follow-up/discharged» condition. Main measures – Standardized mortality ratios were computed with reference to the mortality by age of the population resident in Bologna in the years 1981- 1991. Presence in the cohort was expressed in person/years. Results – The excess of deaths in the cohort was 2.89 (CI 95%: 2.12-3.86) for males and 2.38 (CI: 1.66-3.31) for females. A remarkable excess of deaths for both sexes was observed in the class of age 15/44 (18.33 for males, CI 9.14-32.81; 60 for females, CI: 21.91-130.6 ) and in association with a diagnosis of personality disorder/alcohol abuse (11.25 for males, CI: 5.13-21.36; 5 for females, CI: 1.35-12.8). Length of stay and age of patients were inversely associated with SMRs. Conclusion – The present study confirms that the excess of mortality is high in psychiatric long-term inpatients and that it may be concentrated in younger classes of age, first years after admission and in subjects with diagnoses of personality disorder/alcohol abuse.

Objective - To discuss the ethical and legal basis of ECT use in Italy, one year after the regulation set up by the Minister of Health. Methods - Literature review and presentation of authors' personal opinions. Results - Despite being the oldest somatic therapy still practised in psychiatry, ECT effectiveness has been systematically evaluated only during the last 20 years, and its clinical indications have become progressively restricted. Yet there are wide variations between countries and within each individual country about the extension, the modalities and the indications for its use. ECT seems to be practised mainly in large scale public psychiatric hospitals and in private clinics, but its use in systems following a community approach is very limited. Wide variations exist also with reference to the severity of regulations imposed by governments or suggested by professional associations. The extent of education and auditing by university centres varies considerably, but is generally considered unsatisfactory. There are still some reports about possible political and repressive use of ECT in some countries, especially developing ones. Conclusion - The authors consider that every national system of care should have a clear policy and clear regulations about ECT. The provisions set up by the Italian Minister of Health seem to be consistent with Italian health policies and psychiatric community care.