Objective — The analysis aims to study patterns of care of patients in contact with 5 Psychiatric Services in Lombardy. Four patterns have been identified :long term-high users, non long term-high users, long term-non high users, non long term- non high users. Design — Data were provided by the regional Psychiatric Information System. The cohort of patients have been composed by 5,670 patients included in 1994 one year prevalence. Setting — Five Psychiatric Services (Merate, Treviglio, Crema, Desio, Castano Primo) with a total population of 610,184 inhabitants aged over 14. Main utilised measures — Some sociodemographic and clinical variables have been taken into consideration for a descriptive analysis; a multinomial logistic regression model was used to identify the characteristics of patients associated with different patterns. Results — Long term-high users were 5.3%, i.e. a mean rate of 4.9/10,000 residents over 14, and absorbed 60% of resources; the absence of a partner was associated in regression analysis with this pattern. Non long term-high users were 1.2%, i.e. a mean rate of 1.1/10,000 residents over 14, and absorbed 7.8% of resources; age below 45, unemployment, absence of a partner, severe mental illness and first contact with Psychiatric Services in the period 1985-1989 were predictive variables. Long term-non high users were 23.4%, i.e. a mean rate of 21.6/10,000 residents over 14, and absorbed 18.1% of resources; age below 45, unemployment, living alone, absence of a partner, severe mental illness and first contact with Psychiatric Services before 1990 were predictive variables. Non long term-non high users were 70.1%, i.e. a mean rate of 64.8/10,000 residents over 14 and, and absorbed 18.1% of resources. Conclusions — Data show that on the whole the activity of Psychiatric Services is addressed to most serious patients, though considerable differences between Psychiatric Services utilisation may be found. This study highlights the importance of a regional Psychiatric Information System, that allows the monitoring in time and in the regional territory of patterns of care.

Objective - The aim of this article is to explain the current status of deinstitutionalisation and of community care development in the UK. Design — Literature review of articles and reports on deinstitutionalisation. Setting — Articles included in the review related either to the whole of the UK, to England and Wales, or to a specific area such as London. Main outcome measures — The review was carried out pertaining to the question of the extent to which community care can or should take over the functions of the asylum, with particular reference to those at risk of behaving violently. These functions include those that are manifest, or explicit, and those that are latent, or unintended but implicit (Bachrach, 1976). Results — The example of patients at risk of violent behaviour is one that highlights the continuing relevance of both these sets of functions, which are argued to be exerting a powerful influence on the processes of asylum closure and community care development. This influence is seen in delayed asylum closure, transinstitutionalisation (the shift of some patients from asylums to other institutions), and the institutionalisation of aspects of community care. Conclusions — Both the manifest and the latent functions of asylums must be acknowledged by those involved in planning community care; where it is felt desirable that community care does not take over certain functions, the consequences of this must be anticipated so that they can be prevented or dealt with in other ways.

Objective - The objective of the paper is to explore the capacity of mental health systems of Eastern Europe to engage in genuine mental health reforms. Methods – Proceeding from assumptions introduced by the School of Group Relations the propensity of organisations to abandon declared primary tasks under ideological, political and other context-related influences is adopted. The mental health scene of Eastern Europe is discussed from this perspective. Results - Change and progress are found to be impeded by rules prohibiting curiosity and challenge of routine practices. Conclusions - The emergence of networks of reform minded professionals in Eastern Europe is found to be a healthy sign. A major task ahead is the substitution of defunct structures of mental health (services, research, training) with new ones. The challenge of the inherited establishment is inevitable. The role of collaborative works with the West is of utmost importance.

Objective — This work proposes a series of indicators, based on routine data collection system adopted in the Emilia Romagna Region, with the aim of describing the quality and quantity of psychiatric care and the connections of psychiatric structures. We are bearing in mind the Plan aimed to Mental Health Care 1994-1996 and the Efficiency and quality indicators of National Health System (SSN) devised by the Department of Health of national government. Method — A working group has been instituted by the regional authority to define the indicators (definition of meaning, formula, danger level, finality, level od utilisation, data source and frequency of survey, congruent with the regional information system. Results — We present 105 indicators grouped according to the psychiatric structure they are aimed at (comunity centers, acute admissions wards, semiresidential and residential facilities, former mental hospitals, district mental health department) and according to code in three lists: 1) general indicators; 2) probing indicators; 3) outcome indicators. Conclusions — This set of indicators though created for local usage is aimed on objetives defined by the national Department of Health and can therefore be of interest for other Italian regions. Modular costruction permits flexible application ad adaptation to less complex information systems. Part of this system is since 1977 part of routine information flux in Emilia Romagna.

Objective — The medical interview has important diagnostic and therapeutic functions and requires the integration of doctor-centred and patient-centred interviewing techniques to collect accurate and complete biopsychosocial data from the patient. Analysis of the interaction between patient and doctors which occur during the medical interview allow to evaluate physicians' interview techniques and to eventually improve them. Objective — 1. To review different Interaction Analysis Systems (IAS) used to describe doctor-patient communication in terms of clinical relevance, observational strategy, reliability and behavioural and verbal contents. 2. To critically evaluate these IASs on the basis of their relevant research outcomes. Method — Previous reviews on interaction and keywords for Medline research (HealthGate) listed above were utilised to collect the relevant literature. Results — Seventeen classification systems were identified and ten were discussed in a chronological order. Starting from a general sociological or psycholinguistic approach, the IASs over the years have became more specific and detailed, focusing more and more on the medical interview and on specific topics, such as cancer or hospital medical consultations. Conclusions — When studying interactions in general practice medicine, it is important to define the significant units of interaction which allow to identify a «patient-centred approach», since this is relevant not only for obtaining reliable and complete medical and social data, but also for the recognition of patients with emotional disorders and their correct diagnosis. Listening to the patient and facilitating the expression of emotions is an important aspect of patient education too, as patients learn that talking about psychological problems to their physician is appropriate and may be therapeutic.

Objective Description of burden, attitudes and received professional support in a sample of relatives of patients with schizophrenia, recruited in 8 Italian Mental Health Sservices (MHS), stratified by geographic areas and population density.Design - Cross-sectional study on key-relatives of clinically stable patients with a DSM-IV diagnosis of schizophrenia. Evaluation of: a) relationships of family burden with patient's clinical characteristics, family's sociodempgraphic variables, relative's attitudes toward the patient, professional and social support received by the family; b) differences in the levels of burden, attitudes and support received by the family with respect to geographical area and population density.Setting - 8 Italian MHS stratified by geographic areas (Northern, Central, Southern Italy) and population density (urban vs. rural areas).Main outcome measures - Patient's clinical status and social functioning: BPRS and ADC. Family burden, attitudes and support received by the family: FPQ.Results - Data on 144 patients and their key-relatives were collected. Higher levels of burden were found among relatives referring to Southern MHS. The burden was found positively correlated with the levels of patients' BPRS positive and manic/hostility symptoms and disability, and with the number of daily hours spent by the relative in contact with the patient, and negatively correlated with the levels of professional support received by the family. Conclusions - The results of this study highlight the need to provide rehabilitative programmes for patients with schizophrenia as well as informative and psychoeducational interventions for their families.