title: A follow-up on patients with severe mental disorders in Sardinia after two changes in regional policies: poor resources still correlate with poor outcomes.
abstract: BACKGROUND
  This survey followed a cohort of patients with chronic psychosis recruited from five catchment areas (DSMs) of the Sardinian community mental health services. The objective was to examine whether the amount of resources in the different sites may be a determinant of the outcomes.
  
  
  METHODS
  Naturalistic follow-up study on 309 consecutive users with diagnosis of schizophrenic disorder, schizoaffective disorder, bipolar affective disorder with psychotic symptoms (DSM-IV TR) of five Sardinian community mental health services. Mental state and clinical symptoms along with functioning were assessed using semi-structured clinical interviews (ANTAS), Clinical Global Impression Severity Scale (CGI-S), Global Assessment of Functioning Scale (GAF) and Health of the Nation Outcome Scales (HONOS). Assessments were conducted at the beginning of the study and after one year.
  
  
  RESULTS
  The proportion of professionals working in all DSMs participating in the study was found lower than the national Italian standard (0.7 vs. 1.0 per 1,500 inhabitants). Follow-up revealed significant differences between DSMs in the improvement of the Honos scores (F = 5.932, p = 0.000). These differences correlate with the improvement of resources in terms of number of professionals during, and one year prior, to the trial.
  
  
  CONCLUSIONS
  The study shows that mental health services provided in the public sector in Sardinia are still very resource-poor, at least in terms of human resources. Our findings suggest that mental health service resources influence outcomes as regards the social functioning of users. We urge policy makers to take these observations into account when planning future services.
authors: Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, via Ospedale, 117 Cagliari, Italy. mgcarta@tiscali.it.
authors: Mauro Giovanni
authors: MG
authors: Carta
authors: Matthias C
authors: MC
authors: Angermeyer
authors: Federica
authors: F
authors: Sancassiani
authors: Francesco
authors: F
authors: Tuligi
authors: Roberto
authors: R
authors: Pirastu
authors: Anna
authors: A
authors: Pisano
authors: Elisa
authors: E
authors: Pintus
authors: Gisa
authors: G
authors: Mellino
authors: Mirra
authors: M
authors: Pintus
authors: Emanuele
authors: E
authors: Pisanu
authors: Maria Francesca
authors: MF
authors: Moro
authors: Davide
authors: D
authors: Massidda
authors: Giuseppina
authors: G
authors: Trincas
authors: Dinesh
authors: D
authors: Bhugra
mesh_terms: D000328:Adult; D003156:Community Mental Health Services; D005260:Female; D005500:Follow-Up Studies; D006291:Health Policy; D006295:Health Resources; D006301:Health Services Needs and Demand; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D011618:Psychotic Disorders / Q000628:therapy*; D016896:Treatment Outcome