title: Community residential facilities in mental health services: A ten-year comparison in Lombardy.
abstract: Residential mental health services grew steadily since 2000 in Italy. A reorganisation of residential facilities was implemented in 2007 in Lombardy, introducing supported housing in addition to staffed facilities. We compare the provision and characteristics of residential facilities in the 2007 and 2016. In 2007 there were 3462 beds (35.9/100,000 population) in 276 facilities. In 2016 beds were 4783 (47.8/100,000) in 520 facilities. The increase were unevenly distributed in the public and private sector, and the overall increase was due to a higher increase in the private sector. 72% of beds were in highly supervised facilities in 2007 and 66% in 2016. The public sector managed more facilities with a rehabilitation goal, while the private sector more for long-term accommodation. Mean numbers of beds were higher in facilities managed by the private sector in both years. The 2007 reorganisation and the stop to opening new facilities in the last years were not enough to correct the imbalance between highly supervised and flexible solutions. A wider and more diverse offer might have triggered off an increased demand, rather than a more rational use. Given the costs of highly staffed facilities, and the risk of reproducing custodial models, close evaluation of the use of residential facilities should inform policies.
authors.affiliation: Unit for Quality of Care and Rights Promotion in Mental Health, Laboratory of Quality Assessment of Geriatric Therapies and Services, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy. Electronic address: angelo.barbato@marionegri.it.
authors.forename: Angelo
authors.initials: A
authors.lastname: Barbato
authors.affiliation: Struttura Salute mentale, Penitenziaria e Interventi socio-sanitari, Direzione Generale Welfare, Regione Lombardia, Milan, Italy.
authors.forename: Graziella
authors.initials: G
authors.lastname: Civenti
authors.affiliation: Unit for Quality of Care and Rights Promotion in Mental Health, Laboratory of Quality Assessment of Geriatric Therapies and Services, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy.
authors.forename: Barbara
authors.initials: B
authors.lastname: D'Avanzo
mesh_terms: D006801:Humans; D007558:Italy; D008134:Long-Term Care / Q000706:statistics & numerical data; D008605:Mental Health Services / Q000706:statistics & numerical data*; D000072263:Private Facilities / Q000706:statistics & numerical data; D000067250:Psychiatric Rehabilitation / Q000706:statistics & numerical data; D011633:Public Facilities / Q000600:supply & distribution; D012112:Residential Facilities / Q000600:supply & distribution*
keywords: Italy; Mental health services; Residential care