Process of care in general hospital psychiatric units: national survey in Italy

Objective: To investigate the process of care in Italian public acute inpatient facilities. Method: Each facility's head psychiatrist (in all Italian regions except Sicily) completed a structured interview concerning provision of treatment and facility rules. Results: Twenty-three university psychiatric clinics with 399 beds (mean = 17.3 beds), 16 24 h community mental health centers with 98 beds (mean = 6.1 beds), and 262 general hospital psychiatric units with 3431 beds (mean = 13.1 beds) were surveyed. Mean length of stay was 18.5 +/- 7.1 days, 37.0 +/- 55.3 days and 12.0 +/- 3.4 days, respectively. Pharmacotherapy was ubiquitous. Approximately 80% of facilities held regular clinical evaluations, supportive talks, and counselling. Dynamic focused psychotherapy was available in 29% of the facilities; 24% provided cognitive behavioural therapy; 32% family therapy; and 39% structured rehabilitative intervention. Vocational training and activities targeted at helping patient integration into their local communities were uncommon. Most facilities did not allow the possession of cutting utensils (96%), personally possessed medication (96%), or lighters (72%), and most had locked doors (75%). Fewer facilities (37%) prohibited the use of mobile phones (32%) and metal knives during mealtimes (37%). Frequency of physical restraint was associated with number of internal rules. Delivery of psychotherapy was associated with nurse provision. Conclusions: The process of psychiatric inpatient care in Italy shows considerable variability. Future clinical practice guidelines should address the currently limited provision of evidence-based psychosocial intervention in these facilities. Efforts should also be devoted to improving the effectiveness of the hospital-community mental health service interface.