Objective - After a review of recent developments in the economic evaluation of mental health care, the study described in this paper suggests a methodology for the measurement and evaluation of costs in the Italian psychiatric system. Method and results - To conduct such an evaluation it is necessary to identify all relevant services, collect data on patients' receipt or utilization of health services (direct costs) and other services and resources within the socio- economic system (indirect costs), and to attach monetary values for the costs. A detailed unit cost list (LICU) was constructed for facilities available at South-Verona Community Psychiatric Service (CPS), as well as in many other community-based psychiatric services in Italy. This list covers psychiatric services, other public and private health services, criminal justice services, voluntary organisations and self-help groups. The procedure for calculating costs in three of these facilities (hospital inpatient service, psychiatric outpatient service and rehabilitation groups) are described in this paper in detail. A new instrument (ICAP) was developed to collect the data required to calculate the costs of community care for individual patients. In order to check the applicability and comprehensibility of the instrument, and the time ne- eded for its administration, the ICAP was tested with five patients. Conclusions - It will be interesting to utilise ICAP and LICU in a larger sample. The methodology described here would provide the basis for epidemiologically-based studies, as well as exploration of the factors which predict cost differences (such as socio-demographic characteristics, diagnosis, psychiatric history, ecc). It is important to emphasise the insights for policy and practice which can flow for the merged examination of costs, needs and outcomes. This research is presently in progress in South-Verona.

Objective - This paper reports on sensitivity, and content validity of the Verona Expectations for Care Scale (VECS) and the Verona Service Satisfaction Scale (VSSS), two newly developed, multidimensional instruments which measure expectations and satisfaction with community-based psychiatric services (CPS) in patients and their rela- tives. Instruments - VECS and VSSS consist of various sections and include questions eliciting spontaneous answers and an 82-item multidimensional questionnaire on various aspects of clients' interaction with psychiatric services. Setting - The South-Verona community-based psychiatric service. Subiects - The patients were selected among those who, ac- cording to the South-Verona Psychiatric Case Register, were living with their families in the South-Verona catchment area and had had more than 18 contacts with the South-Verona CPS in the three years preceeding the interview. For each patient, the relative identified by professionals and patients as primarily involved in caring for the patient in the given period was asked to participate. Results - We demonstrated the higher sensitivity of VECS and VSSS question- naires compared to unstructured interviews in measuring service expectations and satisfaction and the higher sensitivity of a domain-specific measurement vs. an overall one. VECS and VSSS proved to be sensitive to variation both between groups and across dimensions. Content validity of the questionnaires, according to patients and relatives views, was very good; moreover we demonstrated that a key-characteristic of content validity is the questionnaire's multidimension- ality. Conclusions - The findings presented in this and in a companion paper demonstrate that it is possible to measure subjective aspects of the interaction with a psychiatric service such as expectations and satisfaction in an acceptable, reliable, sensitive and valid way and that VECS and VSSS have good psychometric properties.

Objective — Eighteen years after the 1978 reform law no. 180, psychiatric services have to find new roles and goals in the social arena, in order to continue to effectively pursue the improvement of mental health in the commi nity. The aim of the present paper is to show some theoretical and practical elements that could stimulate in the psychii trie services a deep consideration about the relationship between psychiatric services and «private social» bodies, part cularly social co-operatives and voluntary organisations. Method — The elements shown in this study come from an ani lysis: a) of the literature about the crisis factors of the Italian welfare state, particularly in the Public Health Service and i the social assistance; b) of the literature about the development of the «private social» and about the relationship with tl public services; c) of national and regional laws, particularly of Veneto region; d) of the present experiences in Sout Verona Psychiatric Service. Results — The crisis of the traditional welfare state, the emergence in large sectors of gener; population of needs related to social fragmentation and relational impoverishment, the aspiration of a great number (individuals excluded from society to benefit of the right to full citizenship, all this urgently questions the traditional roh and responsibilities, the organisation, operational modalities, and the community orientation of existing health and hi man services. Within this framework, the relationship between psychiatric services (or, broadly speaking, public serviet in general) and «private social» bodies, particularly social co-operatives and voluntary organisations, has become part of a foreseeing, strategic new awareness of mental health workers. Conclusion — A shift from a relationship of mutual exploitation between organisations, to one of co-operation between them, each considering the other as an equal partne may be a critical step forward a new model of welfare. This, in turn, would hopefully meet the needs for health of th population in terms of efficiency, quality, relevance and consideration of the users' resources and social competencies.

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.

Aims – Taking the scientific literature on psychotherapy as a starting point, the paper suggests a few remarks for the debate over psychological treatments in the mental health services in Italy. Methods – A survey of reviews and papers on process and outcome of psychological treatments and on psychotherapeutic practice in mental health services. Results – The paper examines some organizing hypotheses in order to increase psychological treatments supplies. Conclusion – The practicability of such solutions requires on the one hand more attention for empirically supported psychological treatments in mental health professionals training and, on the other hand, that various health services become able to be different in their treatments supply.

Objective - This paper reports on acceptability and test-retest reliability of the Verona Expectations for Care Scale (VECS) and the Verona Service Satisfaction Scale (VSSS), two newly developed, multidimensional instruments which measure expectations and satisfaction with community-based psychiatric services (CPS) in patients and their relatives. Instruments - VECS and VSSS consist of various sections and include questions eliciting spontaneous answers and an 82-item multidimensional questionnaire on various aspects of clients' interaction with psychiatric services. Setting - The South-Verona community-based psychiatric service. Subiects - The patients were selected among those who, according to the South-Verona Psychiatric Case Register, were living with their families in the South-Verona catchment area and had had more than 18 contacts with the South-Verona CPS in the three years preceeding the interview. For each patient, the relative identified by professionals and patients as primarily involved in caring for the patient in the given period was asked to participate. Results - Acceptability of VECS and VSSS to subjects was good: most items were easily understood and all subjects cooperated and gave accurate evaluations. The test-retest reliability (1-2 weeks interval) of VECS and VSSS was good in patients and relatives both when considering item-by-item percentage agreement and Cohen's weighted kappa in each dimension. Conclusions - The findings presented in this paper demonstrate that it is possible to measure subjective aspects of the interaction with a psychiatric service such as expectations and satisfaction in an acceptable and reliable way and that VECS and VSSS have good performance in the psychometric properties studied.