Monitoring and evaluating the Italian mental health system: the "Progetto Residenze" study and beyond

Filling an alarming gap in evidence-based data on the post-1978 reformed Italian psychiatric system, two turn-of-millennium nationwide projects, Progetto Residenze (PROGRES) and PROGRES-Acute, provided detailed qualitative-quantitative information about care facilities. In 2000, there were 2.9 residential beds per 10,000 inhabitants, hospital care being delivered through small (15-bed) psychiatric units. Private inpatient facilities had proliferated, private inpatient beds per 10,000 inhabitants outnumbering public beds. In 2002, there were 1.7 acute inpatient beds per 10,000 inhabitants, one of Europe's lowest current ratios. The PROGRES and other subsequent projects showed marked nationwide variation in the provision of residential inpatient and outpatient care, grounds for concern about the quality of such care, and an uneven service use pattern. Although the Italian reform law produced a broad network of facilities to meet diverse mental health care needs, the present overview article confirms that further efforts are required to improve quality, balance public and private sectors, and coordinate resources and agencies.