Mental health care in Italy: Organisational structure, routine clinical activity and costs of a community psychiatric service in Lombardy region

The Magenta Community Mental Health Centre (CMHC) is the public agency resp onsible for providing adult psychiatric care to about 85,000 adult resident s. In 1995, it had 1,145 clients and incurred costs of Euro 1.9 millions. A verage cost per patient and per adult resident were Euro 1,661 and Euro 22. 2, respectively. These values mask large variation across diagnosis: while patients with schizophrenia and related disorders had an average cost of Eu ro 3,771, those with neurotic and related disorders had an average cost of Euro 439. Patients with schizophrenia and related disorders (28% of the pat ients) absorbed about 60% of total costs and made extensive use of several types of services (hospital, outpatient, domiciliary, social and rehabilita tive care). Since integrating different types of services is the key elemen t of Italian psychiatric care, the new fee-for-service system adopted by th e NHS to fund providers does not appear appropriate, particularly for schiz ophrenic patients.