Rethinking hospital psychiatry in Italy in light of COVID-19 experience

Marco P Piccinelli; Paola Bortolaso; Greg D Wilkinson

doi:10.5501/wjv.v11.i1.73

Rethinking hospital psychiatry in Italy in light of COVID-19 experience

World J Virol. 2022 Jan 25;11(1):73-81. doi: 10.5501/wjv.v11.i1.73.

Authors

Marco P Piccinelli¹, Paola Bortolaso², Greg D Wilkinson³

Affiliations

¹ Psychiatric Unit Verbano, Department of Mental Health and Substance Abuse, Cittiglio 21033, Varese, Italy. marcopiero.piccinelli@asst-settelaghi.it.
² Psychiatric Unit Verbano, Department of Mental Health and Substance Abuse, Cittiglio 21033, Varese, Italy.
³ Liverpool University Hospitals NHS Trust, Liverpool University, Liverpool 2170, United Kingdom.

Abstract

Background: Italy retains a distinctive organization of mental health services according to a community-based model of care with a multidisciplinary team serving a well-defined catchment area under the coordination of the local department of mental health. The coronavirus disease 2019 (COVID-19) pandemic is forcing Italian mental health services to develop new organizational strategies at all levels of care in order to face the associated challenges.

Aim: To explore factors associated with changes in psychiatric admissions to an inpatient psychiatric unit located in Lombardia Region, Italy.

Methods: All hospital admissions (n = 44) were recorded to an inpatient psychiatric unit during a three month national lockdown in Italy in 2020 and compared with those occurring over the same time period in 2019 (n = 71). For each admission, a 20-item checklist was completed to identify factors leading to admission. Statistical analyses were performed using Statistical Package for Social Sciences for Windows, release 11.0. Chi-square test (or Fisher's exact test) and Mann-Whitney U-test were applied, where appropriate.

Results: Hospital admissions dropped by 38% during the COVID-19 pandemic. No significant differences were found in demographics, clinical variables associated with hospital admissions and length of stay between 2019 and 2020. Compared with 2019, a significantly greater proportion of hospital admissions in 2020 were related to difficulties in organizing care programs outside the hospital (chi-square = 4.91, df 1, one-way P = 0.035) and in patients' family contexts (chi-square = 3.71, df 1, one-way P = 0.049). On the other hand, logistic and communication difficulties pertaining to residential facilities and programs were significantly more common in 2019 than in 2020 (chi-square = 4.38, df 1, one-way P = 0.032).

Conclusion: Admissions to the inpatient psychiatric unit dropped significantly during the COVID-19 pandemic in 2020, with difficulties in organizing care programs outside the hospital and in patients' family contexts occurring more frequently compared with 2019.

Keywords: COVID-19; Italy; Mental health services; Pandemic; Psychiatric.