title: Do people with bipolar disorders have access to psychosocial treatments? A survey in Italy.
abstract: BACKGROUND
  Several guidelines consider psychosocial treatments an essential component of clinical management of bipolar disorders in addition to drug therapy. However, to what extent such interventions are available in everyday practice to the average patient attending mental health services is not known.
  
  
  OBJECTIVE
  This study aims to investigate access of people with bipolar disorders to psychosocial treatments in a community-based care system.
  
  
  METHODS
  Information on care delivery and service utilization were retrieved from the psychiatric database of Lombardy, Italy, covering a population of 9,743,000, for all adults who had at least one contact in 2009 with psychiatric services. Rates of patients with a diagnosis of bipolar disorder who had access to individual psychotherapy, couple/family therapy, group psychotherapy and family interventions were calculated and compared to patients with schizophrenia and depression.
  
  
  RESULTS
  A total of 8,899 subjects with bipolar disorder had been in contact with psychiatric services, corresponding to a treated annual prevalence rate of 1.1‰. More than 80% of patients were treated in community settings. Rates of patients receiving structured psychosocial treatments ranged from 0.7% for couple/family therapy to 6.1% for individual psychotherapy. No differences with patients with schizophrenia and depression were found. Patients with schizophrenia received more interventions labeled as rehabilitation.
  
  
  CONCLUSIONS
  Few people with bipolar disorders had access to psychosocial treatments. Even in a well-developed system of community care, offer of psychosocial interventions for bipolar disorders is inadequate. This issue should be a target for future research on dissemination and implementation strategies.
authors.affiliation: Laboratory of Epidemiology and Social Psychiatry, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy IRIS Postgraduate School of Psychotherapy, Milan, Italy angelo.barbato@marionegri.it.
authors.forename: Angelo
authors.initials: A
authors.lastname: Barbato
authors.affiliation: Laboratory of Epidemiology and Social Psychiatry, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.
authors.forename: Martine
authors.initials: M
authors.lastname: Vallarino
authors.affiliation: Department of Psychology, University of Milano-Bicocca, Milan, Italy.
authors.forename: Filippo
authors.initials: F
authors.lastname: Rapisarda
authors.affiliation: Mental Health Department, Lecco Hospital, Lecco, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Lora
authors.affiliation: Laboratory of Epidemiology and Social Psychiatry, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Parabiaghi
authors.affiliation: Laboratory of Epidemiology and Social Psychiatry, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy.
authors.forename: Barbara
authors.initials: B
authors.lastname: D'Avanzo
authors.affiliation: Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montréal, QC, Canada.
authors.forename: Alain
authors.initials: A
authors.lastname: Lesage
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001714:Bipolar Disorder / Q000453:epidemiology / Q000628:therapy*; D003866:Depressive Disorder / Q000453:epidemiology / Q000628:therapy*; D055317:Evidence-Based Practice; D005196:Family Therapy; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D007558:Italy; D008297:Male; D008605:Mental Health Services / Q000706:statistics & numerical data*; D008875:Middle Aged; D011613:Psychotherapy; D012559:Schizophrenia / Q000453:epidemiology / Q000628:therapy*; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Bipolar disorder; evidence-based practice; mental health services; psychosocial treatments