Aims — Monitoring of a community mental health service is presented, aimed at describing patients' demographic and clinical characteristics, pathways to care and decision—making process for the first contacts, distribution of interventions according to diagnoses, patterns of service utilization, and finally variables associated with intensity and duration of care, testing the hypothesis that high and long—term users are the most disadvantaged patients with regard to social and clinical variables. Design — Observational study, based upon first year implementation of the local informative system. Setting — Community Mental Health Service, San Giorgio di Piano, Bologna, Italy. Main outcome measures — The relative risk of being a high long—term user was computed for some socio—demographic and clinical variables against the reference category, i.e. the most favoured group. Confounding effects between social and clinical variables were controlled using stratified analysis. Results — Crude rates are presented for one—day prevalence (635.4/100.000 adult inhabitants) and one—year prevalence (1314.1/100.000). Among patients in contact with service at census day schizophrenic— type psychoses are prevailing, while patients coming for treatment in 1993 have more frequently organic psychoses and neurotic disorders. After the first contact 50% of patients are not taken in care; decision seems to be based on diagnosis and not connected with past psychiatric history or socio—demographic characteristics. Forty—nine per cent of outpatient care is delivered to 20% schizophrenic—type psychoses; moreover, this group of patients is seen to receive a wider range of interventions. Inpatient care is rare even for the most serious diagnoses; the global ratio between nonhospitalized and hospitalized users is 12.5 to 1. Factors significantly associated with long-term high user outcome are: being under 55 years old, unmarried status, living alone or without family, having functional psychosis, and having been long-term patient in 1992. Conclusions ‖ Consistently with the local guidelines for mental health care, service's resources are mainly devoted to most seriously ill patients. Evidence is shown for a strong community tenure and for a higher proportion of long-term users than in other Italian services. The hypothesis that high and long-term users are more disadvantaged is confirmed, even if no significant outcome difference is seen according to sex, educational level and occupational status.

Objective – The QUALYOP study has three objectives: 1) To describe both structural resources and organizational procedures of the 12 Psychiatric Hospitals and to assess the rate of decline in the number of in-patients; 2) to assess the quality of structures, organizational procedures and activities delivered by the hospitals; 3) to describe the socio-demographic, clinical and disability characteristics of the in-patient population. Data regarding this third objective will be presented in a future paper. Design – A transectional design has been adopted. The 12 Psychiatric Hospitals have been visited between July and November 1994. Administrative informations have been collected using an ‘Hospital Form’, filled up by the director of each Hospital; an ‘Hospital Ward Form’, filled up by a group of trained researchers, was adopted to evaluate the quality of each Hospital Ward. A reportage of the structural aspects of the hospitals has also been performed by a professional photographer. Setting – The 12 former Psychiatric Hospitals of Regione Lombardia (Bergamo, Brescia, Castiglione delle Stiviere, Codogno, Como, Cremona, Limbiate, Mantova, Milano, Sondrio, Varese, Voghera). Main outcome measures ‖ We utilized a set of indicators to evaluate the following three dimensions: human and logistic resources, organizational procedures, psychosocial rehabilitation activities. The quality of care has been judged in comparison with explicit reference criteria. Results ‖ 2752 patients are sheltered in the 12 Psychiatric Hospitals of Regione Lombardia. The quality assessment phase of the study has revealed that structures are inadequate in the majority of the wards (70%). In addition, in more than 70% of the wards procedures and rehabilitation activities aiming at decreasing the disability of patients have not been activated. Conclusions ‖ A low degree of consistency between avaliable structures and quality standards has been evidentiated. In addition, soft indicators have documented the inadequacy of organization procedures and activities. These results demonstrated that the dehospitalization policies are often inadequate and that educational policies are warranted to train and motivate mental health professionals. It has been also demonstrated the feasibility of Quality Assurance studies which use a system of reference criteria derived from reliable clinical studies, ethical values, experience, definition of ‘not admissible events’ and common sense.

Objective To compare the prevalence of psychological discomfort in four groups of young people of different social status (metalworkers exposed and not exposed to mental health occupational risks, individuals unemployed or seeking their first job and full-time students). The study also evaluates among the same groups, six years after, the changes in status and in the rates of psychological discomfort. Design – The subjects, selected through an appropriate random procedure, are males, aged between twenty and twenty-nine, resident in the same geographical area for at least 10 years and still living with their families. 157 young men were involved, divided into the following four groups: metalworkers exposed to mental health occupational risks (n° = 30); metalworkers «not exposed» (n° = 57); unemployed (n° = 40); full-time students (n° = 30).

The prevalence of psychological discomfort has been compared in the four groups; six years after, within 116 subjects participating in the follow-up study, the changes in status and in psychological discomfort have been examinated. Setting – The survey was conducted in Cento (Ferrara, Northern Italy), an area with a healthy local economy and a comparatively low unemployment rate. In 1987 and in 1993 all young men were interviewed at home, after telephone contact, by the same psychologist. Main outcome measures - In the 1987 survey, to each subject were administered a «Social Position and Health Schedule» (SPH) and a previously validated questionnaire, to determine the index of psychological discomfort (IDP).

Through the «Occupational Risk Questionnaire» (ORQ) the metalworkers were also divided into two groups (exposed and not exposed to mental health occupational risks).

In 1993 the participants in the follow-up completed the same «IDP-Questionnaire» and a «Social and Occupational Position Schedule» (SOP) to give detailed informations on both labour turn-over and/or shifts in social status over the six years period. Results – In the 1987 survey significantly higher frequencies and averages were found in the group of metalworkers exposed to mental health risks, while no statistically significant results were noted in the other groups, including the group of unemployed. The main finding of the follow-up study relates to those metalworkers who, in the follow-up period, have changed their manual job to another type of employment and whose score visa-vis psychological discomfort was better than the rest of the group. Our findings indicate also that those young men seeking their first job who had found employment during the follow-up period, experienced an increase in psychological discomfort. Conclusion The most interesting aspect of our survey seems to concern the relationships between occupational prospects and mental health among young men living in an area characterized by a healthy local economy. Further studies on the students and the unemployed (and their possible occupational outcomes) are however needed.