The long journey of monitoring and evaluating a new mental health service

During a long journey it is refreshing, and also useful, sometimes to break and take the opportunity to think over, to consider critically the road travelled and to decide which direction to take further. This is also true for the long-term exercise of monitoring and evaluating a new mental health service. However, in this case, the pause has to be an active one and the goal of making it useful should prevail on that of bringing about a restoration. This is what Antonio Lasalvia and Mirella Ruggeri have done with this Supplementum of Acta Psychiatrica Scandinavica: an active, critical pause during the long journey of evaluating the new community-based mental health service (CMHS) implemented in Verona, Italy, after the approval of the Italian Psychiatric Reform in 1978. It is well known that this reform was intended to be, and has been, a revolutionary one. It aimed to close the front doors of mental hospitals abruptly, while the new community-based mental health services, the alternative to mental hospitals were, almost everywhere in the country, still either in a preliminary phase of organization, or non-existent. Mental hospitals, according to the Italian reform, were planned to be closed completely at a later stage, when it would have been possible to discharge the old long-stay patients. The complete closure actually happened some years ago, with some delays over the initial plan. We had therefore to build up and run the new services while the old hospitals were still functioning: a doubled-sided revolution. As often happens in revolutions, those actively involved play different roles and may have different tasks. In Italy, some mental health professionals have been very active in giving professional support to the reform and in involving administrators, users and their families in community mental health care, while defending at the national, regional and local level, its principles. At the same time, unfortunately, in most regions of Italy, a major gap remained unfilled between the new, innovative clinical practice and evaluative research that was supposed to assess the outcome of that practice. Those colleagues working in Italy in the most popular and well-known community-based services have not been able to produce evidence of the effectiveness of their radical interpretation of mental health care in the community, nor have attempted to identify the active ingredients of their system of care, while indulging in a very active and vociferous propaganda of their approach and in politically supported attempts of exporting their model to other areas. Since the beginning of our revolution the psychiatric department and the WHO Collaborating Centre at the University of Verona had the experience and the resources to take the lead in the process of monitoring and evaluating, mainly at the local and regional levels, the new system of care, while implementing in Verona a new, comprehensive, community-based service. Not all University departments have been and are fully involved in the implementation of the reform and in providing the full range of mental health care, in the community as well as in hospital. The Verona service and our university department have therefore been a unique setting for the training and education of the new Italian psychiatrists and, to some extent, also of the new clinical psychologists. More than 200 psychiatrists (and many clinical psychologists) have been fully trained in Verona in these 30 years: a small, but significant proportion of all doctors trained in psychiatry during this period in the Schools of Specialization of the Italian universities. It is worthwhile to mention that these Schools, in our country, are the only institutions officially entitled to provide postgraduate training in psychiatry. The new CMHS, set up in Verona in 1978, has developed in these years, paying continuous attention to the need to have organization and reforming on one side and monitoring and evaluation on the other going hand in hand. To document this long journey, our team published several books (see for example 1–8), and more than 250 papers (see our web site http://www. psychiatry.univr.it), on evaluation of mental health care, with particular reference to the Acta Psychiatr Scand 2007: 116 (Suppl. 437): 3–5 All rights reserved DOI: 10.1111/j.1600-0447.2007. 01088.x Copyright 2007 The Author Journal Compilation 2007 Blackwell Munksgaard