title: [Promoting recovery of schizophrenic patients: discrepancy between routine practice and evidence. The SIEP-DIRECT'S Project].
abstract: OBJECTIVE
  The aim of this work is to present the main discrepancies, as evidenced by the SIEP-DIRECT'S Project, between the evidence-based NICE guidelines for schizophrenia and the usual practices of the Italian mental health services in order to promote the recovery of patients with schizophrenia.
  
  
  METHODS
  Starting from the main NICE recommendations on recovery promotion, 41 indicators were developed. These were experimented in 19 participating Italian Mental Health Departments (MHD) or Psychiatric Services through self-evaluation of the activities carried out to promote patient recovery with the aim of assessing the level of adherence to the recommendations. The data required by most of the indicators were obtained from the psychiatric informative system or from the Direction of the MHD. Moreover, specific research was carried out on the clinical records and on representative patient samples. Furthermore, for 14 indicators, there was requested an assessment by the part of "multidisciplinary" or "specialistic" focus groups who then attributed a score according to a defined "ad hoc" scale.
  
  
  RESULTS
  According to the data obtained, although the mental health services seem to care about the physical condition of their patients, they do not routinely examine principle parameters such as blood pressure, glycaemia etc., and collaboration with general practitioners is often complex or not uniformly practiced. Most psychiatrists and psychologists possess the basic communication skills but not enough competences in cognitive-behavioural treatments; such treatments, and every other form of structured individual psychotherapy, are seldom carried out and seem to have become marginal activities within the Services. Also family psycho-educational interventions are under-used. The Services are very active in the care of multi-problem schizophrenia patients, who make up a large percentage (almost a quarter, on average) of the patients in their care. These patients are offered specific and integrated treatment plans with the involvement of other health services and social agencies operating in the territory. The strategies adopted by the services for the pharmacological treatment in the prevention of relapses and for patients with frequent crises or with treatment-resistant schizophrenia are all in line with the NICE recommendations. Finally, the Services promote activities of vocational training and supported employment, but the outcomes of these are often unsatisfactory.
  
  
  CONCLUSIONS
  The results of the study show a picture of the Italian mental health services with bright yet also dark areas as regards recovery promotion activities. The Services seem to guarantee adequate pharmacological evidence-based treatments, an integrated assistance and good management of multi-problem patients. They have difficulty, however, with respect to the monitoring of the physical health of the patients, psychotherapeutic activities, including those for families, and the promotion of supported employment. Moreover, they still show problems regarding the structuring and formalizing of care processes. To improve this situation, they should make greater use of professional guidelines, protocols and written procedures.
authors.affiliation: Dipartimento di Salute Mentale ASL Provinciale di Bari, Centro di Salute Mentale Acquaviva delle Fonti, Bari. domenico.semisa@alice.it
authors.forename: Domenico
authors.initials: D
authors.lastname: Semisa
authors.forename: Massimo
authors.initials: M
authors.lastname: Casacchia
authors.forename: Walter
authors.initials: W
authors.lastname: Di Munzio
authors.forename: Giovanni
authors.initials: G
authors.lastname: Neri
authors.forename: Giacinto
authors.initials: G
authors.lastname: Buscaglia
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Burti
authors.forename: Cristina
authors.initials: C
authors.lastname: Pucci
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Corlito
authors.forename: Maurizio
authors.initials: M
authors.lastname: Bacigalupi
authors.forename: Roberto
authors.initials: R
authors.lastname: Parravani
authors.forename: Rita
authors.initials: R
authors.lastname: Roncone
authors.forename: Doriana
authors.initials: D
authors.lastname: Cristofalo
authors.forename: Antonio
authors.initials: A
authors.lastname: Lora
authors.forename: Mirella
authors.initials: M
authors.lastname: Ruggeri
mesh_terms: D003156:Community Mental Health Services / Q000592:standards*; D006801:Humans; D007558:Italy; D017410:Practice Guidelines as Topic / Q000592:standards*; D012559:Schizophrenia / Q000188:drug therapy / Q000628:therapy*; D012955:Societies, Medical