[Packages of care in the departments of mental health in Lombardy]

Abstract

Objective: The analysis aims to study the packages of care in the public Departments of Mental Health by diagnosis and service utilisation intensity.

Design: Data on community, hospital and residential contacts were provided by the Regional Psychiatric Information System. The sample has been composed by 55,518 patients residents in Lombardy and treated in public Departments of Mental Health.

Setting: The public Departments of Mental Health in Lombardy.

Main outcome measures: Fifteen packages of care were defined according to researchers' experience; the package "community care only" has been divided in five sub-packages; for every package the care weight has been attached.

Results: Four packages of care ("community care only", "hospital care plus community care", "hospital care only" "community care plus day centre care") represented 95% of the patients. Three quarter of the patients were treated only in the community setting, without hospital, residential and day centre contacts in the year. Heavier patients (patients with more than 5000 care weight) represent only 4%. Residential care is the heavier setting (36% of the total weight), while schizophrenia is the diagnosis with mayor impact on the community services (59% of the total weight). Of the patients treated only in the community setting one third receives only psychological and psychiatric visits, while two thirds integrated community care. Conclusions in community care the mixed packages represent the exception not the rule. More complex or heavier packages are addressed to severe mental illness patients.