Aims — Monitoring of a community mental health service is presented, aimed at describing patients' demographic and clinical characteristics, pathways to care and decision—making process for the first contacts, distribution of interventions according to diagnoses, patterns of service utilization, and finally variables associated with intensity and duration of care, testing the hypothesis that high and long—term users are the most disadvantaged patients with regard to social and clinical variables. Design — Observational study, based upon first year implementation of the local informative system. Setting — Community Mental Health Service, San Giorgio di Piano, Bologna, Italy. Main outcome measures — The relative risk of being a high long—term user was computed for some socio—demographic and clinical variables against the reference category, i.e. the most favoured group. Confounding effects between social and clinical variables were controlled using stratified analysis. Results — Crude rates are presented for one—day prevalence (635.4/100.000 adult inhabitants) and one—year prevalence (1314.1/100.000). Among patients in contact with service at census day schizophrenic— type psychoses are prevailing, while patients coming for treatment in 1993 have more frequently organic psychoses and neurotic disorders. After the first contact 50% of patients are not taken in care; decision seems to be based on diagnosis and not connected with past psychiatric history or socio—demographic characteristics. Forty—nine per cent of outpatient care is delivered to 20% schizophrenic—type psychoses; moreover, this group of patients is seen to receive a wider range of interventions. Inpatient care is rare even for the most serious diagnoses; the global ratio between nonhospitalized and hospitalized users is 12.5 to 1. Factors significantly associated with long-term high user outcome are: being under 55 years old, unmarried status, living alone or without family, having functional psychosis, and having been long-term patient in 1992. Conclusions ‖ Consistently with the local guidelines for mental health care, service's resources are mainly devoted to most seriously ill patients. Evidence is shown for a strong community tenure and for a higher proportion of long-term users than in other Italian services. The hypothesis that high and long-term users are more disadvantaged is confirmed, even if no significant outcome difference is seen according to sex, educational level and occupational status.

The characteristics of the area utilizying the service, the tipology and the organization of the psychiatric services in the Liguria region of Italy are described with the same methodology employed for four other locations in Italy where a psychiatric case register is operative. This information gathering system officially began in March 1987, when the Regional Council decided to entrust the organization of this project to the Institute of Applied Medical Services of the University of Pavia. The source of the data collected is represented by the psychiatric services facilities operating in the Liguria Region. These include 20 territorial Mental Health Services (SSM), 9 Psychiatric Units in General Hospitals (SPDC) and 2 ex-psychiatric hospitals (PSS). The psychiatric case register is compiled in all Psychiatric Services of the Region by collecting data on charts; futhermore, in 12 of the Mental Health Services, in 2 of the Psychiatric Units in General Hospitals and in the ex-psychiatric hospitals this information has also been computerized. Data collection began in 1988, and in the first regional verification of the functionality of this system took place the following year. Results regarding the utilization of territorial services reveal annual prevalence rates that range from 200-500 per 100.000 inhabitants. As far as interventions involving hospitalization are concerned, SPDC and PSS data were analyzed separately. This analysis confirmed the situation described in the literature, namely that there is an excess of diagnoses of psychosis, most of all among males admitted to Psychiatric Units in General Hospitals and females admitted to ex-psychiatric hospital. Age-specific grouping of these results further revealed that most of these patients are elderly, especially the women.