Psilogos Vol.06 Nº2 e Vol. 07 Nºs 1 e 2 (Dez 2008 e Jun/Dez 2009)
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Browsing Psilogos Vol.06 Nº2 e Vol. 07 Nºs 1 e 2 (Dez 2008 e Jun/Dez 2009) by Subject "Community psychiatry"
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- Development of community mental health services: the case of Emilia‑Romagna italian regionPublication . Fioritti, AItalian psychiatry has gained International attention after its radical reform of 1978, which established the progressive closure of mental hospitals and the establishment of community services throughout the country. However it is technically inappropriate to talk about Italian psychiatry as the devolution process has transferred to the regions all competences about policy, planning and evaluating health services. This explains the variety of “community psychiatries” that can be found along the peninsula and the reasons of interest that can arise from their comparison. The development of community psychiatry in Emilia‑Romagna, a region of 4 million inhabitants in Northern Italy, has proceeded through two partially overlapping phases of deinstitutionalization (1978‑1997) and development of integrated mental health departments (1990‑2008). The analysis of raw data about allocation of resources and professional capital development give way to tentative comparisons with the current Portuguese situation of implementation of a similar reform. In 2006 the regional Council launched a three year project aimed at rethinking the welfare system and the integration of social and health services, considering the dramatic social and demographic changes occurring in the region. This project has implied also a three year process of redrafting mental health policy finalised in the Emilia‑Romagna Mental Health Action Plan 2009‑2011 approved by the council in March 2009. It basically follows two strategies: integration of health and social services and further qualification of health services. The former is pursued through a reshaping of the planning and commissioning bodies of both health and social services, previously separated and now merging. They are taking responsibility on many issues related to mental health care, such as prevention, mental health promotion, supported employment, supported housing, subsidies, self‑help. The improvement of community services is an objective to be achieved through formal accreditation and quality assurance mechanisms and through a widespread system of participation of users and carers to all levels of planning and monitoring.
- Modern community care: what do we know that is effective?Publication . Burns, TCommunity care has been seen a remarkable expansion in research in the last thirty years. Such research is beset with difficulties including fixing models long enough to get clear comparisons, the absence of consistency in description (particularly of comparator services) and the inevitable contamination from the ‘Pioneer’ effect of highly motivated teams. Assertive Community Treatment (ACT) teams are the most intensively researched but the evidence is contradictory. ACT is a complex intervention and a meta‑regression analysis is reported here that distinguished between the studies in terms of their component parts to identify effective and redundant ingredients. This analysis clarified the overwhelming impact of variation in comparator services. It also confirmed that the core ingredients in traditional generic CMHTs (multidisciplinary working, home‑based care and combined health and social care) ensured an equally effective outcome to the more intensively staffed and carefully prescribed ACT teams. Community mental health services need not follow one prescriptive model. Developing local services should be guided by the research into how effective aspects of care can be incorporated into locally meaningful structures rather than importing complex systems from other health care cultures