Objective – The analysis aims to identify the main patterns of Psychiatric Services provided by Local Health Unities in Lombardy. Setting – Data were collected by regional psychiatric information system in Lombardy in 1992 and 1993, concerning resources and activity. Design – We developed Cluster Analysis based on previously selected indicators of facilities, staff and activity. Multivariate analisys was performed in order to eliminate redundancy of information. Results – Five clusters corresponding to different patterns of psychiatric services were identified. In the first cluster services are particularly concerned with admissions (in private hospital, as well); other community activities can be considered quite dull both in composition of teams and variety of therapy. In the unities of the second cluster we pointed out low rates of community activities (mainly inside and hardly diversified) and admissions as well. The third cluster is distingueshed by an intensive community activity (both in quantity and variety) and turning to private sector for admissions, maybe because of a lack of rehabilitative facilities. Unities belonging to the fourth cluster have got many structures and a lot of staff dedicated to the hospital activity and to a intense (but little diversified) community activity. In the fifth cluster psychiatric services have got many rehabilitative facilities and community staff are well diversified; the considerable (but little diversified) community activity is carried outside. Conclusions – The community psychiatric services in Lombardy are not homogeneous and it is possible to identify five different and well definied patterns. The cluster analisys is useful to follow up the model, using information system data.

Objective – To describe the trends over time of mental outpatient contacts in the Region Lazio. Design – Descriptive study. Setting – The data are based on information routinely collected by 21 mental health outpatient services during 1989–1992 period. Main outcome measures – Frequency distributions and prevalence and incidence rates. Results – Prevalence and incidence rates of psychiatric patients in treatment have been increasing in the study period. The one–year prevalence rate (per 100.000 residents) was 900 in 1989 and 1020 in 1992, with 13% increase. The incidence and point prevalence rates have increased, from 517 and 410 in 1989 to 564 and 540 in 1992 respectively. Initial diagnostic assessment was the most frequent activity performed during the first contact, accounting for about 55% of total performances. During one year, 25% of patients terminated the treatment with a dropout rate of almost 75%. In 1992, 28% of psychiatric patients terminated the treatment with a diagnosis of neurotic disorders and 69% with a diagnosis of psychotic disorders; a large number of patient terminated the treatment without any diagnosis. Conclusions – The observed increase of prevalence and incidence rates may be due to a number of factors, notably, an increase in true prevalence rates in the study area, more efficient treatment practices and an improvement in the coverage of the information system. The high rate of dropouts points to the need to evaluate the interaction between treatment settings and patient characteristics.