Integration between general practice and mental health services in Italy: guidelines for consultation-liaison services implementation

Abstract

Purpose: This paper illustrates some guidelines for the implementation of Consultation-liaison services in contexts where GPs work alone. We present some activity data of our experience in the period 1999-2004 and a critical evaluation of what works and what does not work.

Context: In Italy single-sited spontaneous initiatives of co-operation and integration between general practice and psychiatry have been implemented in many regions. Recently, the Italian Health Care Government has begun to encourage integration between primary and secondary care for the management of mental health. The Bologna Consultation-liaison Service opened in 1999 in one area. The service was first located in the Community Mental Health Centre and subsequently in a medical non-psychiatric outpatient service. In 2002, the services were implemented in the overall city area, and the Bologna Consultation-liaison Service had its own office in the centre of the town.

Data source: Data have been collected by reviewing clinical charts. They include clinical (mental status examination, progress notes) and socio-demographic data, assessment scales that measure psychological distress and disability, reports for GPs, and consultation outcome.

Conclusion: A consultation-liaison service like the one proposed in this paper could contribute to an efficient and fully-integrated collaborative management of common psychiatric disorders, reducing the use of mental health services.

Figure 1

Number of first visits of patients with anxiety and depressive disorders (common psychiatric disorders) in Community Mental Health Centres (CMHC) and in the Consultation-liaison Service (data regarding one administrative district of Bologna).