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.

Aims – The aims of the SIEP-DIRECT'S Project (DIscrepancy betweenRoutine practice andEvidence in psychiatricCommunityTreatments onSchizophrenia) are: 1) To evaluate the appropriateness of the NICE guidelines for schizophrenia in Italian Departments of Mental Health; 2) to develop and to test a set of SIEP indicators, based on the NICE recommendations, useful to evaluate their real application in mental health services. Methods – Based on the NICE recommendations, 103 indicators have been developed, some of them qualitative and the rest quantitative. These indicators investigate five different areas: 14 indicators concern the common elements in all phases of mental health care; 11 the treatment of first episode; 24 the crisis treatment; 41 the recovery promotion; 13 the urgency, including management of violent behaviours and fast soothing. After a pilot study conducted in 2 community mental health services, the indicators were tested in 19 Italian Departments of Mental Health, to obtain a self-evaluation of the quality of care and to verify the application of NICE recommendations in the clinical routine of these Services. Data for the self-evaluation have been obtained from the DSM'ls psychiatric informative system and from the Direction of the local health authorities or of the DSM. Moreover, for some indicators, information has been gathered from the clinical records, and by means of questionnaires administered to a sample of patients and relatives. Finally, “multidisciplinary” (i.e. involving different types of professionals) or “specialized” (i.e. involving only psychiatrists) focus groups have assessed the degree of similarity between practice and recommendation for 33 indicators. Finally, the focus group methodology has been applied in all services with the aim to judge the appropriateness of each NICE recommendation in the context of the Italian Departments of Mental Health. Results and Conclusions – Most NICE recommendations have been considered useful and appropriated to measure quality of care in the context of the Italian services. The SIEP indicators have been easily used by the services participating in the DIRECT's Project. The self-evaluation process has provided several data of great relevance to improve the quality of care for schizophrenia and implement clinical guidelines in Italy.

Declaration of Interest: None.

Aims – The aim of this work is to present the main discrepancies, as evidenced by the SIEP-DIRECT's Project, between the evidence-based NICE guidelines for schizophrenia and the usual practices of the Italian mental health services in order to promote the recovery of patients with schizophrenia. Methods – Starting from the main NICE recommendations on recovery promotion, 41 indicators were developed. These were experimented in 19 participating Italian Mental Health Departments (MHD) or Psychiatric Services through self-evaluation of the activities carried out to promote patient recovery with the aim of assessing the level of adherence to the recommendations. The data required by most of the indicators were obtained from the psychiatric informative system or from the Direction of the MHD. Moreover, specific research was carried out on the clinical records and on representative patient samples. Furthermore, for 14 indicators, there was requested an assessment by the part of “multidisciplinary” or “specialistic” focus groups who then attributed a score according to a defined “ad hoc” scale. Results – According to the data obtained, although the mental health services seem to care about the physical condition of their patients, they do not routinely examine principle parameters such as blood pressure, glycaemia etc., and collaboration with general practitioners is often complex or not uniformly practiced. Most psychiatrists and psychologists possess the basic communication skills but not enough competences in cognitive-behavioural treatments; such treatments, and every other form of structured individual psychotherapy, are seldom carried out and seem to have become marginal activities within the Services. Also family psycho-educational interventions are under-used. The Services are very active in the care of multi-problem schizophrenia patients, who make up a large percentage (almost a quarter, on average) of the patients in their care. These patients are offered specific and integrated treatment plans with the involvement of other health services and social agencies operating in the territory. The strategies adopted by the services for the pharmacological treatment in the prevention of relapses and for patients with frequent crises or with treatment-resistant schizophrenia are all in line with the NICE recommendations. Finally, the Services promote activities of vocational training and supported employment, but the outcomes of these are often unsatisfactory. Conclusions – The results of the study show a picture of the Italian mental health services with bright yet also dark areas as regards recovery promotion activities. The Services seem to guarantee adequate pharmacological evidence-based treatments, an integrated assistance and good management of multi-problem patients. They have difficulty, however, with respect to the monitoring of the physical health of the patients, psychotherapeutic activities, including those for families, and the promotion of supported employment. Moreover, they still show problems regarding the structuring and formalizing of care processes. To improve this situation, they should make greater use of professional guidelines, protocols and written procedures.

Declaration of Interest: None.