Abstract
Although many countries’ policies give Severe Mental Illness (SMI) priority inside Mental Health Services, researches assessing the prevalence of SMI in Mental Health Services according to operational criteria are still few. The aim of this is paper is to define annual SMI treated prevalence, describing socio-demographic and clinical characteristics, patterns of care and treatment costs of SMI and non-SMI patients. SMI prevalence in 10 Departments of Mental Health of the Lombardy Region (Italy) was assessed in 2000 by applying criteria concerning both severity, measured through HoNOS (Health of the Nation Outcome Scales), and utilisation patterns in the previous year. Annual SMI prevalence was equal to 3.1 cases per 1,000 inhabitants aged over 14; SMI patients’ costs were 5.5 times higher than those of non-SMI patients ($5,183 versus $939 per year) and patterns of care were different. The variables predicting the SMI status were diagnosis, presence of paid employment, duration of service contact, care packages delivered in 2000 and severity of some HoNOS items (self harm, drug abuse, cognitive problems, delusions, other symptoms, relationships, activities of daily living and housing). The use of the combined criteria of severity and intensity of contact with mental health services in the previous year seems to be able to define severely ill patients adequately.
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References
Department of Health (1999) National Service Framework for Mental Health - Modern Standards & Service Models. London, Department of Health
Endicott J., Spitzer R. L., Fleiss J. L., et al. (1976) The global assessment scale. A procedure for measuring the overall severity of psychiatric disturbance. Archives of General Psychiatry 33:766–771
Erlicher, A., Lora, A., Arrighi, E., et al. (2003). Pattern di trattamento e costi nei Dipartimenti di Salute Mentale della Regione Lombardia––il Progetto di Ricerca HoNOS 2. Epidemiologia e Psichiatria Sociale Monograph Supplement 5
Goldner E., Hsu L., Waraich P., et al. (2002) Prevalence and Incidence Studies of Schizophrenic Disorders: a Systematic Review of the Literature. Canadian Journal of Psychiatry 47:833–843
Kessler R. C., McGonagle K. A., Zhao S., et al. (1994). Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States: Results from the National Comorbidity Survey. Archives of General Psychiatry, 51:8–19
Kessler R. C., Berglund P. A., Zhao S., et al. (1996). The 12-month prevalence and correlates of serious mental illness (SMI). In: Sonnenschein M. A. (Ed.). Mental Health, United States, 1996. Washington, D.C., U.S. Dept. of Health and Human Services
Kessler, R. C., Berglund, P., Meyer D., et al. (2004). Estimating the prevalence and correlates of Serious Mental Illness in Community Epidemiological Surveys in Substance Abuse and Mental Health Services Administration (SAMHSA). Manderscheid, R.W. & Henderson, M.J. (Eds.). Mental Health, United States. 2002 Manderscheid, DHHS Pub No. (SMA) 3938 Rockville, MD: Substance Abuse and Mental Health Services Administration
Kessler R. C., Wai Tat C., Demler O., et al. (2005) Prevalence , Severity and Comorbidity of 12-Month DSM IV Disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry 62:617–627
Jonhson D. L. (1997) Overview of severe mental illness. Clinical Psychological Review 17:247–257
Lelliot P. (1999). Definitions of severe mental illness. In: Charlwood P, Mason A, Goldacre M., et al. (Eds.). Health Outcome Indicators: Severe Mental Illness. Report of a working group to the Department of Health. Oxford: National Centre for Health Outcomes Development, pp. 87–93
Lora A., Bai G., Bianchi S., et al. (2001) La versione italiana della HoNOS (“Health of the Nation Outcome Scales”), una scala per la valutazione della gravita’ e dell’esito nei servizi di salute mentale. Epidemiologia e Psichiatria Sociale, 10:198–212
Lora A., Bezzi R., Di Vietri R., et al. (2002) I pacchetti di cura nei Dipartimenti di Salute Mentale della Regione Lombardia. Epidemiologia e Psichiatria Sociale, 2:100–115
Ministero della Salute (1999). Progetto Obiettivo “Tutela della Salute Mentale” 1998–2000 DPR 10/11/1999. Roma, Ministero della Salute
Narrow W. E., Regier D. A., Norquist G., et al. (2000) Mental health services uses by Americans with severe mental illness. Social Psychiatry and Psychiatric Epidemiology 35:147–155
National Advisory Mental Health Council (1993) Health care reform for Americans with severe mental illness: report of the National Advisory Mental Health Council. American Journal of Psychiatry, 150:1447–1465
Parabiaghi A., Bonetto C., Ruggeri M., et al. (2006) Severe and persistent mental illness: a useful definition for prioritizing community mental health service interventions. Social Psychiatry and Psychiatric Epidemiology, 41:457–63
Regione Lombardia (2002)Progetto RESPIL Studio sui costi delle strutture psichiatriche residenziali della Regione Lombardia. Milano, Regione Lombardia
Regione Lombardia (2003) Atlante dei disturbi psichici in Lombardia. Direzione Generale Sanità – Unità Organizzativa Qualità e Appropriatezza dei Servizi Sanitari – Struttura Osservatorio Epidemiologico e Sistemi di Remunerazione. Milano, Regione Lombardia
Robins, L. N., & Regier, D. A. (Eds.) (1991). Psychiatric disorders in America: The Epidemiologic Catchment Area study. New York: The Free Press
Ruggeri M., Leese M., Thornicroft G., et al. (2000) The definition and prevalence of severe and persistent mental illness. British Journal of Psychiatry 177:149–155
Salvi G., Leese M., Slade M., (2005) Routine use of mental health outcome assessments choosing the measure. British Journal of Psychiatry, 186:144–152
Slade M., Powell R., Strathdee G. (1997) Current approaches to identifying the severely mentally ill. Social Psychiatry and Psychiatric. Epidemiology, 32:177–184
Substance Abuse and Mental Health Services Administration (1993). Final notice establishing definitions for (1) children with a serious emotional disturbance, and (2) adults with a serious mental illness. Federal Register 58(96), 29, 422–429, 425
Wing J. K., Beevor A. S., Curtis R. H., et al. (1998) Health of the Nation Outcome Scales (HoNOS): Research and development. British Journal of Psychiatry, 172:11–18
World Health Organization (1992). The ICD-10 classification of mental and behavioural disorders: diagnostic criteria for the research. Geneva World Health Organization
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Funding for this work was provided by the Health Authority of the Lombardy Region.
Antonio Lora is affiliated with the Department of Mental Health, Hospital of Desio, Milan, Italy. Roberto Bezzi is affiliated with the Department of Mental Health, Hospital of Legnano, Milan, Italy. Arcadio Erlicher is affiliated with the Department of Mental Health, Niguarda Ca′ Granda Hospital, Milan, Italy.
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Lora, A., Bezzi, R. & Erlicher, A. Estimating the Prevalence of Severe Mental Illness in Mental Health Services in Lombardy (Italy). Community Ment Health J 43, 341–357 (2007). https://doi.org/10.1007/s10597-006-9078-z
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DOI: https://doi.org/10.1007/s10597-006-9078-z