Pathways to mental health care in Italy: results from a multicenter study.
OBJECTIVE
In Italy, the reform of the mental health system in 1978 should have drastically changed the provision of care and pathways of patients seeking to obtain it. The aim of this article is to examine the current pathways to psychiatric care in Italy.


METHODS
We used a method developed in the World Health Organization international collaborative studies to investigate pathways to care in 15 Italian mental health centers. We recruited 420 patients with a psychiatric illness and explored the care pathways they took to reach to psychiatric services and the delays from the onset of illness to reaching psychiatric care.


RESULTS
The majority of patients (33.8%) had direct access to mental health care, whereas the others arrived to a specialist in psychiatry through general hospitals (20.3%), general practitioners (33.0%) or private practitioners (9.8%). The main diagnosis for referral was neurotic disorder (36.6%), followed by affective disorder (35.4%) and psychotic disorder (11.5%). The delay from onset of illness to psychiatric care was greater for patients with psychotic disorders than for those with affective and neurotic disorders. The most frequently prescribed treatments were pharmacotherapy (56%), psychological support (8%), and psychotherapy (7.0%); 15% of the patients received no treatment.


CONCLUSIONS
Our multicenter study shows that although general practitioners and hospital doctors are still the main referral point for mental health care, a greater proportion of patients are first seen in private settings or directly reach mental health centers, compared to previous surveys conducted in Italy. However, a stronger collaboration of psychiatrists with general practitioners and psychologists is still needed.
Department of Psychiatry, University of Naples SUN, Naples, Italy umberto.volpe@unina2.it.
Umberto
U
Volpe
Department of Psychiatry, University of Naples SUN, Naples, Italy.
Andrea
A
Fiorillo
Department of Psychiatry, University of Naples SUN, Naples, Italy.
Mario
M
Luciano
Department of Psychiatry, University of Naples SUN, Naples, Italy.
Valeria
V
Del Vecchio
Pathways to Care Study Group, Early Career Psychiatrists Committee of the Italian Psychiatric Association, Italy.
Claudia
C
Palumbo
Pathways to Care Study Group, Early Career Psychiatrists Committee of the Italian Psychiatric Association, Italy.
Salvatore
S
Calò
Pathways to Care Study Group, Early Career Psychiatrists Committee of the Italian Psychiatric Association, Italy.
Sara
S
Piras
Pathways to Care Study Group, Early Career Psychiatrists Committee of the Italian Psychiatric Association, Italy.
Maria
M
Signorelli
Pathways to Care Study Group, Early Career Psychiatrists Committee of the Italian Psychiatric Association, Italy.
Dario
D
Filippo
Pathways to Care Study Group, Early Career Psychiatrists Committee of the Italian Psychiatric Association, Italy.
Massimiliano
M
Piselli
Pathways to Care Study Group, Early Career Psychiatrists Committee of the Italian Psychiatric Association, Italy.
Pasquale
P
De Fazio
Pathways to Care Study Group, Early Career Psychiatrists Committee of the Italian Psychiatric Association, Italy.
Simona
S
Gotelli
Pathways to Care Study Group, Early Career Psychiatrists Committee of the Italian Psychiatric Association, Italy.
Francesco
F
Bardicchia
Pathways to Care Study Group, Early Career Psychiatrists Committee of the Italian Psychiatric Association, Italy.
Giancarlo
G
Cerveri
Pathways to Care Study Group, Early Career Psychiatrists Committee of the Italian Psychiatric Association, Italy.
Silvia
S
Ferrari
Pathways to Care Study Group, Early Career Psychiatrists Committee of the Italian Psychiatric Association, Italy.
Alice
A
Mulè
Pathways to Care Study Group, Early Career Psychiatrists Committee of the Italian Psychiatric Association, Italy.
Michele
M
Ribolsi
Department of Psychiatry, University of Naples SUN, Naples, Italy.
Gaia
G
Sampogna
Department of Psychiatry, University of Naples SUN, Naples, Italy.
Corrado
C
De Rosa
Association for the Improvement of Mental Health Programmes, Geneva, Switzerland.
Norman
N
Sartorius
D003156:Community Mental Health Services / Q000458:organization & administration / Q000706:statistics & numerical data; D019091:Critical Pathways / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007558:Italy; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000523:psychology / Q000628:therapy; D008605:Mental Health Services / Q000458:organization & administration / Q000706:statistics & numerical data*; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D013997:Time Factors
Pathways to care; community mental health service; general practitioners; mental health systems; primary care; psychiatric care in Italy