The evolution of Departments of Mental Health's organizational models in Italy

In Italy the psychiatric reform legislation (“Act 180” of 1978) has strongly encouraged community care. The reform led to the creation of Departments of Mental Health (DMHs) across the whole national territory, each being... [ view full abstract ]

In Italy the psychiatric reform legislation (“Act 180” of 1978) has strongly encouraged community care. The reform led to the creation of Departments of Mental Health (DMHs) across the whole national territory, each being responsible for all Mental Health (MH) services in each Local Health Authority (LHA). The aim of the study was to analyse how the DHMs have evolved since the reform of 1978.

The study used a quali-quantitative research strategy, setting up a proactive process, which directly involved the presidents of the Italian Society of Psychiatry (SIP), and the Italian Society of Epidemiology Psychiatric (SIEP), and the directors of 8 DMHs from 8 different regions. For each of these DMHs we developed a case study. 

The areas of activity of the DMHs are defined at regional level. Most of the DMHs has focused its mission exclusively on adult psychiatry. The other DMHs add either the area related to the drug addiction or that to the infantile neuropsychiatry or both. The DMHs have produced two delivery models: direct production and purchase from outside parties. A reduced share of the psychiatric population (3%) is followed by structures outside the DMHs and absorbs a considerable proportion of the resources available. From the onset the MHDs have developed into a sort of isolation within the LHAs. This situation has enabled innovative solutions in the organisation of services. However, the current heterogeneity of the LHAs configurations physiologically undermine perceived fairness and homogeneity of the results achieved. In the current historical phase, the DMHs could represent the sufficiently wide organizational aggregation to make possible the attribution of responsibility for phenomena that do not relate exclusively to production, but which extend to the use of mental health services and in some cases to the outcomes. In the face of the transformations being in the health system, the DMH could be the direction booth for the patient centricity of the person with mental health disorders.

There are two phenomena that force the community of mental health professionals to maintain an elevated level of cohesion. In the first place, it is not easy to define in a static way the territory of the mental health interventions which relate to the broad spectrum of the most general conditions of health and wellbeing of individuals. The second phenomenon is related to the conditions of legitimacy within the LHAs. What is mental health and how it is called to express itself requires specific reflections and paradigms. There are many issues that lead to interpreting the relationship between mental health and LHA as a valuable opportunity for the valorisation of the mission for the first and for the achievement of the institutional ends for the second. On one hand, the dynamics of transformation of LHAs can represent important thrusts to overcome the isolation that characterized the DMHs. On the other hand, in the LHA, the instances promoted by professionals and patients who call for the assistance directed to the person and family of the patients are increasingly pressing.