Community residential facilities in mental health services: A ten-year comparison in Lombardy

• Published in: Health policy (Amsterdam) Vol. 121; no. 6; pp. 623 - 628
• Main Authors: Barbato, Angelo, Civenti, Graziella, D’Avanzo, Barbara
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier B.V 01.06.2017; Elsevier Science Ltd
• Subjects: Community mental health services; Growth rate; Health care expenditures; Health care policy; Housing; Humans; Imbalance; Internal Medicine; Italy; Long-Term Care - statistics & numerical data; Mental health care; Mental health services; Mental Health Services - statistics & numerical data; Private Facilities - statistics & numerical data; Private sector; Psychiatric Rehabilitation - statistics & numerical data; Public Facilities - supply & distribution; Public sector; Rehabilitation; Reorganization; Residential buildings; Residential care; Residential Facilities - supply & distribution; Risk; Supported living; Italy; Lombardy Italy; Residential care; Italy; Mental health services
• ISSN: 0168-8510; 1872-6054; 1872-6054
• DOI: 10.1016/j.healthpol.2017.03.012

•There was a marked increase in residential beds in Lombardy in 2007–2016.•The residential care provision was highly supervised in both years.•A wider offer introduced by the 2007 reorganisation triggered off increased demand.•The imbalance towards highly supervised solutions remained after the 2007 reorganisation. 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.