The aim of this chapter is to present data on psychiatric care provided to adult South-Verona residents over the 10-year period (1979–88) following the psychiatric reform and the implementation of a new community-based service. These data have been collected using the South-Verona Psychiatric Case Register (PCR), which started operating immediately after the establishment of the new service.

The Italian psychiatric reform has attracted much interest and controversy around the world. While quantitative evidence on its implementation has already been provided (Tansella et al. 1987; de Girolamo, 1989), studies of the effects of the reform on patients are lacking.

There is a well-established tradition in standardized evaluation of the symptomatology and the social performance of psychiatric patients (Wing et al. 1974; WHO, 1983b; Platt, 1983) together with instruments for describing the pattern of contacts with services, like Psychiatric Case Registers (Wing & Hailey, 1972; ten Horn et al. 1986). Interest in a systematic assessment procedure for recording which action should be taken by services in the presence of a problem is more recent. Instruments for these evaluations are still experimental.

The socio-demographic characteristics and the distribution of affective disorders have been investigated in several epidemiological studies. Some of them have been conducted on community samples or in general practice settings, while others have been based on in-patient admissions or on contacts with psychiatric services (case register studies).

It is well known that the great majority of patients presenting psychiatric symptoms are treated by GPs rather than by specialist psychiatric personnel (Shepherd et al. 1966). Goldberg & Huxley (1980) have proposed a model to describe psychiatric disorders and their care, consisting of five levels and four filters. Level 1 refers to psychiatric and emotional disorders in the community as a whole, and filter 1 represents the decision to, and act of, consulting a GP. Level 2 consists of all psychiatric morbidity that presents to GPs, although a proportion is not recognized as such (the hidden psychiatric morbidity – HPM). Filter 2 is thus the process of identification, and level 3 refers to the morbidity so identified (the conspicuous psychiatric morbidity – CPM). Filter 3 is the process of referral to the specialist psychiatric services, the patients of which are designated as level 4. A proportion of patients at this level will be admitted to hospital (i.e. will pass through filter 4) and reach level 5 (psychiatric in-patients).

‘That over-used word community’ (Acheson, 1985, p. 3) has tended to degenerate into a slogan, losing its meaning and becoming a generic expression to label different, not homogeneous functions and institutions. The numerous definitions of community psychiatric services and community care as well as their implications have been discussed elsewhere (Tansella, 1986).