Open Access Research article

The characteristics and activities of child and adolescent mental health services in Italy: a regional survey

Laura Pedrini1, Giovanni Colasurdo2, Stefano Costa3, Michela Fabiani4, Linda Ferraresi5, Emilio Franzoni6, Francesca Masina7, Renato Moschen8, Vittoria Neviani9, Stefano Palazzi10, Roberto Parisi11, Antonia Parmeggiani12, Antonio Preti13, Cosimo Ricciutello14, Marco BL Rocchi15, Davide Sisti15, Antonella Squarcia16, Stefano Trebbi17, Donatella Turchetti18, Paola Visconti19, Andrea Tullini20, Giovanni de Girolamo1* and the PREMIA Group

Author Affiliations

1 IRCCS Centro San Giovanni di Dio-Fatebenefratelli, Brescia-Italy

2 AUSL di Forlì, UONPIA, Forlimpopoli-Italy

3 UOS Psichiatria e Psicoterapia età evolutiva, Ospedale Maggiore, Bologna-Italy

4 AUSL di Reggio Emilia, UONPIA, Reggio Emilia-Italy

5 AUSL di Modena, UONPIA, Sassuolo (MO)-Italy

6 A.O. Universitaria Orsola-Malpighi, Bologna-Italy

7 AUSl di Cesena, UONPIA, Cesena-Italy

8 U.O. NPI Ospedaliera-Psicopatologia dell'Adolescenza e U.O. NPI Ospedaliera-Neurologia RIMINI-Italy

9 Il Nespolo, Ospedale Privato Villa Igea, Modena-Italy

10 AUSl di Ferrara, UONPIA, Ferrara-Italy

11 AUSL di Piacenza, UONPIA, Piacenza-Italy

12 IRCCS Institute of Neurological Sciences and Department of Neurological Sciences, University of Bologna

13 Department of Psychology, University of Cagliari-Italy

14 AUSL of Imola, UONPIA, Imola (BO)-Italy

15 Institute of Biomathematics, University of Urbino-Italy

16 AUSL di Parma, UONPIA, Parma-Italy

17 AUSL di Bologna, UONPIA, Monzuno (BO)-Italy

18 AUSL di Ravenna, UONPIA, Ravenna-Italy

19 AUSL di Bologna, Ospedale Maggiore, Bologna-Italy

20 AUSL di Rimini, UONPIA, Rimini-Italy

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BMC Psychiatry 2012, 12:7  doi:10.1186/1471-244X-12-7

Published: 30 January 2012

Abstract

Background

To date, no studies have assessed in detail the characteristics, organisation, and functioning of Child and Adolescent Mental Health Services (CAMHS). This information gap represents a major limitation for researchers and clinicians because most mental disorders have their onset in childhood or adolescence, and effective interventions can therefore represent a major factor in avoiding chronicity. Interventions and mental health care are delivered by and through services, and not by individual, private clinicians, and drawbacks or limitations of services generally translate in inappropriateness and ineffectiveness of treatments and interventions: therefore information about services is essential to improve the quality of care and ultimately the course and outcome of mental disorders in childhood and adolescence.

The present paper reports the results of the first study aimed at providing detailed, updated and comprehensive data on CAMHS of a densely populated Italian region (over 4 million inhabitants) with a target population of 633,725 subjects aged 0-17 years.

Methods

Unit Chiefs of all the CAMHS filled in a structured 'Facility Form', with activity data referring to 2008 (data for inpatient facilities referred to 2009), which were then analysed in detail.

Results

Eleven CAMHS were operative, including 110 outpatient units, with a ratio of approximately 20 child psychiatrists and 23 psychologists per 100,000 inhabitants aged 0-17 years. All outpatient units were well equipped and organized and all granted free service access. In 2008, approximately 6% of the target population was in contact with outpatient CAMHS, showing substantial homogeneity across the eleven areas thereby. Most patients in contact in 2008 received a language disorder- or learning disability diagnosis (41%). First-ever contacts accounted for 30% of annual visits across all units. Hospital bed availability was 5 per 100,000 inhabitants aged 0-17 years.

Conclusion

The percentage of young people in contact with CAMHS for mental disorders is in line with those observed in previous epidemiological studies. The overall number of child psychiatrists per 100,000 inhabitants is one of the highest in Europe and it is comparable with the most well equipped areas in the US. This comparison should be interpreted with caution, however, because in Italy, child psychiatrists also treat neurological disorders. Critical areas requiring improvement are: the uneven utilisation of standardised assessment procedures and the limited availability of dedicated emergency services during non-office hours (e.g., nights and holidays).

Keywords:
Child and Adolescent Mental Health Services (CAMHS); Process of care; Adolescence; Child Psychiatry