Objective — The analysis aims to study patterns of care of patients in contact with 5 Psychiatric Services in Lombardy. Four patterns have been identified :long term-high users, non long term-high users, long term-non high users, non long term- non high users. Design — Data were provided by the regional Psychiatric Information System. The cohort of patients have been composed by 5,670 patients included in 1994 one year prevalence. Setting — Five Psychiatric Services (Merate, Treviglio, Crema, Desio, Castano Primo) with a total population of 610,184 inhabitants aged over 14. Main utilised measures — Some sociodemographic and clinical variables have been taken into consideration for a descriptive analysis; a multinomial logistic regression model was used to identify the characteristics of patients associated with different patterns. Results — Long term-high users were 5.3%, i.e. a mean rate of 4.9/10,000 residents over 14, and absorbed 60% of resources; the absence of a partner was associated in regression analysis with this pattern. Non long term-high users were 1.2%, i.e. a mean rate of 1.1/10,000 residents over 14, and absorbed 7.8% of resources; age below 45, unemployment, absence of a partner, severe mental illness and first contact with Psychiatric Services in the period 1985-1989 were predictive variables. Long term-non high users were 23.4%, i.e. a mean rate of 21.6/10,000 residents over 14, and absorbed 18.1% of resources; age below 45, unemployment, living alone, absence of a partner, severe mental illness and first contact with Psychiatric Services before 1990 were predictive variables. Non long term-non high users were 70.1%, i.e. a mean rate of 64.8/10,000 residents over 14 and, and absorbed 18.1% of resources. Conclusions — Data show that on the whole the activity of Psychiatric Services is addressed to most serious patients, though considerable differences between Psychiatric Services utilisation may be found. This study highlights the importance of a regional Psychiatric Information System, that allows the monitoring in time and in the regional territory of patterns of care.

Objective — This work proposes a series of indicators, based on routine data collection system adopted in the Emilia Romagna Region, with the aim of describing the quality and quantity of psychiatric care and the connections of psychiatric structures. We are bearing in mind the Plan aimed to Mental Health Care 1994-1996 and the Efficiency and quality indicators of National Health System (SSN) devised by the Department of Health of national government. Method — A working group has been instituted by the regional authority to define the indicators (definition of meaning, formula, danger level, finality, level od utilisation, data source and frequency of survey, congruent with the regional information system. Results — We present 105 indicators grouped according to the psychiatric structure they are aimed at (comunity centers, acute admissions wards, semiresidential and residential facilities, former mental hospitals, district mental health department) and according to code in three lists: 1) general indicators; 2) probing indicators; 3) outcome indicators. Conclusions — This set of indicators though created for local usage is aimed on objetives defined by the national Department of Health and can therefore be of interest for other Italian regions. Modular costruction permits flexible application ad adaptation to less complex information systems. Part of this system is since 1977 part of routine information flux in Emilia Romagna.

Objective — This article reviews the extent to which epidemiology and disability measurement can con-tribute to mental health and service policy and planning. Methods — The review explores the information required for local, mental and international policy and planning in a variey of settings. Results — Epidemiology and disability measurement are essential to underpin policy and planning that are responsive to local needs, together with information on service inputs and processes and health outcomes. Conclusions — Epidemiology and disability measurement should be an integral part of the policy and planning process to support the development of service, and service processes and the measurement of health outcomes for not only specialist mental heath services, but also activities in primary care, schools and workplaces.

Objective — To review the relevant literature on the effects of reductions in long stay beds on mental health services in the UK. Method — A selective literature review, with particular reference to research conducted by the author and colleagues at The Sainsbury Centre for Mental Health.Results — The evidence suggests that the effects of long stay bed reductions should be examined with regard to 'old' and 'new' long stay patients separately. While the 'old' long stay who have been most directly effected by these changes have generally fared well; the 'new' long stay have not. They are currently accumulating in acute inpatient units, often on general hospital sites, or are rotating in the 'revolving door' of acute inpatient care and inadequate community supports. Although it is clear that there is a shortage of acute beds especially in inner city areas many of the these beds are currently occupied by patients who would be better (and less expensively) cared for in community alternatives if these were available. The evidence suggests that it is possible to im-prove outcomes for this 'new' long stay group if specific kinds of housing, work and assertive community teams are provided. Conclusions — It is concluded that the effects of long stay bed reductions should be considered in a 'systems perspective'. Effective community services can be established, but in order to achieve effective substitution of one kind of service for another, there must be a well co-ordinated, clearly targeted, and technically efficient system. At the present time such services are rare. However, simply focusing on one element (e.g. beds) is unlikely to produce cost effective and efficient solutions.

Objective — Despite the ongoing moral and legal debate, there is still a paucity of empirical literature on the actual occurrence of Medical Decisions at the End of Life (MDEL). Moreover, the psychiatrist's role in this scenario is still unclear. Methods — This paper systematically reviews currently available literature on euthanasia (EU) and physician assisted suicide (PAS). Published articles were selected if they reported either: 1) prevalence estimates of patients' requests of EU/PAS; and/or 2) prevalence estimates of physicians' actual EU/PAS practices. Papers exploring the issue of MDEL-related psychiatric consultation have been also included in the review. Results — The empirical evidence reported in this paper shows that EU/PAS demands and acts are not uncommon in medical practice. A conservative estimate indicates that at least 10% of physicians have granted a request of EU/PAS. The involvement of consultation-liaison psychiatrists in MDELs seems to be relatively rare. Conclusions — Euthanasia and other MDELs require physicians' thoughtful evaluation of criteria guiding professional decision-making. To this purpose, epidemiological and psychosocial research can offer a valuable contribution.