title: Patterns of mental health service utilisation in Italy and Spain--an investigation using the European Service Mapping Schedule.
abstract: BACKGROUND
  Methods for comparing local mental health service systems are needed to allow identification of different patterns of service provision and of inequities within and between countries.
  
  
  OBJECTIVE
  The aim of this study was to describe and compare mental health service systems in 13 catchment areas in Spain and Italy. Within each country, a range of area characteristics was represented.
  
  
  METHODS
  The European Service Mapping Schedule (ESMS) and European Socio-Demographic Schedule (ESDS) were used to describe: (i) socio-demographic and geographical area characteristics; (ii) services provided; and (iii) service utilisation in each area.
  
  
  RESULTS
  Great differences emerged in patterns of service provision and use between and within countries. In contrast to Northern Europe, high unemployment rates were not associated with high service utilisation rates, but areas with large numbers of single-person households tended to have high service use. Most service utilisation rates were substantially below those reported from Northern European studies. Spanish centres tended to have low rates of hospital service utilisation despite limited development of community-based services. Trieste, where there has been a strong emphasis on developing innovative community services, showed a distinctive pattern with low hospital bed use and high rates of day service use and of contacts in the community.
  
  
  CONCLUSIONS
  This methodology yielded useful data, which raise significant questions regarding equity and the implementation of mental health policy. The very large variations indicate that underlying local patterns of service provision must be investigated and taken into account in the interpretation of research evaluations of interventions.
authors.affiliation: RIRAG/PSICOST Research Network, Jerez, Spain.
authors.forename: Luis
authors.initials: L
authors.lastname: Salvador-Carulla
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Tibaldi
authors.forename: Sonia
authors.initials: S
authors.lastname: Johnson
authors.forename: Elena
authors.initials: E
authors.lastname: Scala
authors.forename: Cristina
authors.initials: C
authors.lastname: Romero
authors.forename: Carmine
authors.initials: C
authors.lastname: Munizza
mesh_terms: D003431:Cross-Cultural Comparison; D003710:Demography; D006801:Humans; D007558:Italy; D001523:Mental Disorders / Q000628:therapy*; D008605:Mental Health Services / Q000458:organization & administration / Q000706:statistics & numerical data*; D013030:Spain