Effectiveness of community care for patients with severe mental disorders in Italy

BACKGROUND: The quality of care provided to patients with severe mental disorders (SMD) often does not correspond to the standards set by the recommendations. In addition to monitoring the coverage rate achieved by services, the evaluation of the effectiveness of interventions provided by mental health services for the treatment of SMD, in preventing an exacerbation of psychiatric symptoms, becomes of relevant importance. METHODS: Data were retrieved from Healthcare Utilization databases of four Italian Regions (Lombardy, Emilia-Romagna, Lazio, Sicily). 45,761 newly referred cases of depression, schizophrenia, bipolar and personality disorder were included. A variant of the self-controlled case series method was adopted to estimate the incidence rate ratio (IRR) for the relationship between exposure (use of different types of mental healthcare such as pharmacotherapy, generic contact with outpatient services, psychosocial intervention, psychotherapy) and relapse (emergency hospital admissions for mental illness). RESULTS: 11,500 relapses occurred. Relapse risk was reduced during periods covered by (i) psychotherapy for patients with depression (IRR 0.67; 95% CI: 0.49-0.91) and bipolar disorder (0.64; 0.29-0.99); (ii) psychosocial interventions for those with depression (0.74; 0.56 to 0.98), schizophrenia (0.83; 0.68-0.99) and bipolar disorder (0.55; 0.36-0.84), (iii) pharmacotherapy for patients with schizophrenia (0.58; 0.49-0.69) and bipolar disorder (0.59; 0.44-0.78). Coverage with generic care, in absence of psychosocial/psychotherapeutic interventions, did not affect relapse risk. CONCLUSIONS: Psychosocial interventions, psychotherapies and specific pharmacotherapies can be considered particularly effective in treating patients with bipolar, depressive, and schizophrenic disorders. This study showed that real-world data can represent a useful resource to monitor mental healthcare paths and to assess the effectiveness of a mental health system. KEY MESSAGES: • Real-world data can represent a useful resource to monitor mental healthcare paths and to assess the effectiveness of a mental health system. • To evaluate the effectiveness of interventions provided by mental health services in preventing an exacerbation of psychiatric symptoms becomes important in the transition to community mental health.