Creazione di valore sanitario e sistemi di finanziamento: il caso del dipartimento di salute mentale

Health-value adding is the new priority and a watchword for all clinicians and health service workers. The creation of health-value requires a team work involving different actors: A. the clinical staff, whose task consists in the creation of treatment models and in their formalization into guidelines and protocols; B. the managers, since effective clinical and therapeutic practices must go along with coherent organizational models and valuable control instruments; C. the public institutions responsible for the definition of health policy guidelines: among these, a prioritary role is played by funding methods, which can affect significantly the results of health-value adding initiatives. This work aims at studying the relationships between funding methods and health-value creation, with particular reference to mental health services. Particular relevance is given to the funding of mental health departments, with a view to putting aside the shortcomings of the current models and proposing the DRG as an alternative funding method for mental health services. The procedures for patients classification and evaluation envisaged in the psychiatric DRG can assist health service managers in evaluating the outcomes and the patients’ health conditions. In other words, the issues concerning funding and management evaluation will be articulated in the same language: this, in turn, will eliminate the lack of integration which can be presently identified as the main fault of most funding methods, and improve the degree of coherence among resource allocation, activities and results. The case of mental health services can therefore be taken as an example of successful and effective cooperation among management, health policy and clinical staff

Appropriatezza clinica ed economica: strumenti e modelli di valutazione e gestione dell’attività psichiatrica

The Italian health care system is experiencing a profound reform process: due to the increasing level of expenditures, new models of organizations are being experimented to increase both efficiency and efficacy of the health care delivery system. In this general framework, our group has developed a research project with clinical, statistical and economic implications. The ambitious aim of the project is to improve the allocation and management of resources assigned to Mental Health Departments, on the basis of recent experiences in the Piedmont region. The paper presents the methodology developed to implement the project “ Evaluation of Appropriateness of care and Costs of Psychiatric Disorders”. The project aims at analysing both appropriateness and efficiency of the routine care provided by the various agencies of three Mental Health Departments. We believe that a regular monitoring of both appropriateness and efficiency of care would assist in the development of rational choices for the allocation of funds and the clinical management of patients

CMHC Adherence to National Mental Health Plan Standards in Italy: A Survey 30 Years After National Reform Law

none6OBJECTIVE: The PROG-CSM (Progetto Centri di Salute Mentale) survey was conducted in all Italian community mental health centers (CMHCs) with the aim of evaluating the extent to which these services adhered to the standards defined by the Italian National Mental Health Plan 1998-2000. METHODS: The policy recommendations of the Italian National Mental Health Plan were translated by a multidisciplinary group of experts into key indicators, including continuity of care, coordination with other community-based services, accessibility, implementation of specific programs, and provision of care. RESULTS: There was high adherence to the standards of the National Mental Health Plan in continuity of care and coordination with other services, but there were lower levels of accessibility and implementation of specific projects. CONCLUSIONS: CMHCs were sufficiently developed throughout Italy, and continuity of care and service coordination levels were satisfactory; however, adherence to the standards was unrelated to the duration of activity of the CMHCs.noneMunizza C.; Gonella R.; Pinciaroli L.; Rucci P.; Picci RL.; Tibaldi G.Munizza C.; Gonella R.; Pinciaroli L.; Rucci P.; Picci RL.; Tibaldi G

Creazione di valore sanitario e sistemi di finanziamento: il caso del dipartimento di salute mentale

Health-value adding is the new priority and a watchword for all clinicians and health service workers. The creation of health-value requires a team work involving different actors: A. the clinical staff, whose task consists in the creation of treatment models and in their formalization into guidelines and protocols; B. the managers, since effective clinical and therapeutic practices must go along with coherent organizational models and valuable control instruments; C. the public institutions responsible for the definition of health policy guidelines: among these, a prioritary role is played by funding methods, which can affect significantly the results of health-value adding initiatives. This work aims at studying the relationships between funding methods and health-value creation, with particular reference to mental health services. Particular relevance is given to the funding of mental health departments, with a view to putting aside the shortcomings of the current models and proposing the DRG as an alternative funding method for mental health services. The procedures for patients classification and evaluation envisaged in the psychiatric DRG can assist health service managers in evaluating the outcomes and the patients’ health conditions. In other words, the issues concerning funding and management evaluation will be articulated in the same language: this, in turn, will eliminate the lack of integration which can be presently identified as the main fault of most funding methods, and improve the degree of coherence among resource allocation, activities and results. The case of mental health services can therefore be taken as an example of successful and effective cooperation among management, health policy and clinical staff

Terrorismo, terrorista e funzionamento mentale

Gli autori affrontano la difficoltà di pervenire a una definizione generale di terrorismo, e delimitano l’ambito del loro ragionamentoal fenomeno conosciuto come “terrorismo internazionale di matrice islamica”. Illustrano quindi le ragioni per cuil’interpretazione del TIMI come condotta sintomatica di psicopatologia non è accettabile, in quanto le considerazioni sullabase delle quali il terrorista opera la sua scelta possono non essere condivise sul piano morale o politico, ma non possonoessere considerate prive di una loro logica. Altri aspetti di natura psicosociale – età giovanile, difficoltà di integrazione aseguito di una vicenda migratoria propria o dei genitori, contesto violent, tratti di personalità narcisistici o psicopatici, suggestionabilità,fenomeni gregari presenti all’interno del piccolo gruppo o della famiglia, fattori collegati all’identificazionedella religione come elemento di polarizzazione identitaria, o autentiche necessità religiose di espiazione ecc. – possonoessere presenti con una certa frequenza, ma occorre, secondo gli autori, prestare attenzione a non attribuire a nessuno di essiun ruolo decisivo nella scelta dell’atto terrorista. La quale rimane comunque, secondo la letteratura, la scelta politica di unsoggetto in grado di assumere le proprie decisioni alla quale deve essere riconosciuto, per coglierla nel suo significato, ungrado in genere elevato di libertà, consapevolezza e di responsabilità

Appropriatezza clinica ed economica: strumenti e modelli di valutazione e gestione dell’attività psichiatrica

The Italian health care system is experiencing a profound reform process: due to the increasing level of expenditures, new models of organizations are being experimented to increase both efficiency and efficacy of the health care delivery system. In this general framework, our group has developed a research project with clinical, statistical and economic implications. The ambitious aim of the project is to improve the allocation and management of resources assigned to Mental Health Departments, on the basis of recent experiences in the Piedmont region. The paper presents the methodology developed to implement the project “ Evaluation of Appropriateness of care and Costs of Psychiatric Disorders”. The project aims at analysing both appropriateness and efficiency of the routine care provided by the various agencies of three Mental Health Departments. We believe that a regular monitoring of both appropriateness and efficiency of care would assist in the development of rational choices for the allocation of funds and the clinical management of patients

Public Beliefs and Attitudes towards Depression in Italy: A National Survey

<div><p>Background</p><p>Previous studies have shown that attitudes towards depression may be influenced by country-specific social and cultural factors. A survey was carried out to collect beliefs on and attitudes toward depression in Italy, which has an established community-based mental health system.</p><p>Methods</p><p>A telephone survey was carried out in a probabilistic sample aged ≥15 years. A 20-item questionnaire was administered to explore knowledge of depression, stigma, causal beliefs, treatment preference, and help-seeking attitudes.</p><p>Results</p><p>Of the 1001 participants, 98% were aware of depression, and 62% had experienced it, either directly or indirectly. A widespread belief (75%) was that people suffering from depression should avoid talking about their problem. A minority of the sample viewed depression as a condition that should be managed without recourse to external help or a “socially dangerous” illness. Among perceived causes of depression, most respondents mentioned life stressors or physical strains. Psychologists were often indicated as an adequate source of professional help. Half of the sample believed that depression should be pharmacologically treated, but drugs were often seen as addictive. Referring to a primary care physician (PCP) was considered embarrassing; furthermore, many people thought that PCPs are too busy to treat patients suffering from depression.</p><p>Conclusions</p><p>Our findings indicate that depression is seen as a reaction to significant life events that should be overcome with the support of significant others or the help of health professionals (mainly psychologists). However, there are still barriers to the disclosure of depressive symptoms to PCPs, and concerns about the addictive effect of antidepressants. In the presence of a gap between people’s beliefs and what health professionals consider appropriate for the treatment of depression, a “shared decision making” approach to treatment selection should be adopted taking into account the patients’ preference for psychological interventions to ensure active compliance with effective treatments.</p></div