This paper argues within the mental health services that people who are most disabled by mental illness, the severely mentally ill (SMI), should be afforded the highest priority, and that services should be provided in relation to need. For this to occur the priority groups need first to be defined. Second, if a service wishes to provide for all prevalent cases of people suffering from severe mental illness, then a systematic method of recording local information about these people is required, and this may draw upon information about patients who are in contact with health services, social services, family health services and who contact voluntary sector and other agencies. One approach to estimating the need for services for people with SMI is by using indicative norms for service requirements. Finally, managerial methods are proposed to monitor how far targeting services to the SMI occurs in clinical practice.

Objective - The aim of our research is to evaluate the prevalence of psychiatric illnesses by means of data collected at the Florence municipality community mental health services encompassing all hospital and extramural activities, providing the same kind of information given by Psychiatric Case Register (PCR) covered areas. Design - It has been carried out a one week prevalence assessment through a cross-sectional analysis of clinical records gathered by psychiatric services of the submitted area. Population studied - The inquiry has considered the area of USL (Administative Local Authority of National Health Service) 10/A, 10/B, 10/C and 10/D, which constituite togheter with USL 10/E, the Florence municipality area. Results - Total and specific rates for diagnostic categories, sex and age reveal a large variability among the four considered USLs confirmed by standardized rates: the 10/A and 10/B USLs, that include the historic centre of Florence, present the highest standardized rates (10/A 207/100.000, 10/B 189/100.000), especially for the most severe disorders (Schizophrenia: 10/A 110/100.000, 10/B 87/100.000; Major Affective Disorders: 10/A 32/100.000, 10/B 38/100.000; Organic Psichosys: 10/A 6/100.000, 10/B 9/100.000). Conclusion - In the present study, the prevalence rate for all diagnoses for the whole area considered, is about 150.6/100.000, quite close to the estimate calculated in Verona-Sud (200/100.000). As to the different rates among USLs we have to bear in mind the development of the delivery care system, and the available clinical settings (on day hospital and residentials activities for long-term patients).

Objective - This study aims to improve the economic knowledge of major depression. It reports the investigation methodology and some preliminary indications on direct and indirect costs associated to this illness. Setting - Centro Psicosociale (CPS) USSL 72, Magenta (Mi) Italy. Design - We enrolled 10 patients (7F and 3M) with age between 34 and 65 (average 49.2 + 10.2 SD) at the first contact with CPS for an episode of major depression and we followed them up for 3 months. Main Measure Outcomes - At each visit we perform a clinical evaluation (HRS-D, CGI, DOTES) and we administered an interview to collect data in order to quantify social costs (direct and indirect) related to the observation period. Results - At the end of the 3 month period, all patients showed an improvement of the simptomatolgy as expressed by HRS-D (final score at least 50% below the initial one). Our accounting model estimated that the full cost of a psychiatric visit (on average lasting 47.8 minutes) is 107.537 Italian Liras. For the 10 patients under observation direct costs amounted to 9.402.000 It. Liras; psychiatric visits represented 70% of these costs. According to a conservative approach, indirect costs (value of labor time lost) amounted to 13.254.000 It. Liras if patients and relatives are considered and to 11.044.000 It. Liras if only patients time is evaluated. Conclusion - The paper presents a methodological proposal aimed to assess social costs of major depression. It also reports a first attempt to measure these costs in a prospective study performed in a public psychiatric centre. Our results have to be considered in the light of the limited sample of patients under observation and have to be regarded as strictly dependent on the specific context both in terms of the organizational settings and the characteristics of patients.

Aims - Evaluating socio-demographic characteristics of a sample of 102 schizophrenic patients and their relatives which got in touch with a facility with different psychoeducational treatments. Checking differential characteristics among subsamples according to the engaging to different treatment programs. Longitudinally evaluating both patient's psychosocial course and relative's perception 1 year after the end of such a treatment. Design - Assessment of patients and relatives sociodemographic characteristics, according to engaging in 2 different psychoeducative groups (informative and support) or not engaging (early drop-outs), matching Vs. an external control sample of «no-treated» families. One year follow-up study on patients and relatives both for «objective» and «subjective» conditions. Setting -A private social organization of voluntary psychiatrists, the Association for Research on Schizophrenia in Milan. Main outcome measures - Survey on characteristics of patients and relatives in different stage of treatment collected by standardized records and contrasted with those of comparison groups. Follow-up study by structured questionary. Student's two tailed t tests were used to compare some socio-demographic data. Chi-square analyses were used to compare nominal data. Mc Nemar test is used to follow significative changes. Results - Some preliminar differences in sociodemographic features, between different groups, are to be confirmed by increasing sample while there are interesting evidences for different course and outcome in a group following a particular kind of treatment (informative group) for both patient's objective performance and family subjective well-being. Conclusions - Psychoeducational family treatment shows good prospects for families interested to coping with schizophrenia and which are able to look for information and support. Longitudinal evaluation shows interesting changes in the relationship with public facilities and in the occupational status overall in the informative group. It proves its importance for «acute» schizophrenia, while a supportive treatment retains an usefulness in chronic ilnesses reducing the burden of care.