Outcome measurement in Italy

This chapter provides an overview of outcome measurement initiatives conducted in Italian mental health services in Italy since the Reform that occurred 30 years ago, called ‘Law 180’, which radically changed the architecture of psychiatric care (De Girolamo et al., 2007). Gaining in-depth knowledge of the outcomes of people with mental disorders who receive community care has been a great challenge for both researchers and clinicians in the last 20 years, due to the lack of an agreed conceptual and methodological framework to assess outcome. Several important achievements have been fulfilled in the last decade and an agreement on the various facets of this concept has been reached. It has first been made clear that outcome measurement is not independent of ethical principles and thus should provide a wider balance of information for health policy and clinical service decisions (Thornicroft and Tansella, 1999). Then, it has been stated that for outcome measurement to be valid, reliable and useful for both programme planning and evaluation of interventions, it should be based on the principle of multiaxiality (i.e. the assessment should consider the perspectives of all those involved in the care process, including clinicians, patients, caregivers, user representatives, third-party payers, etc.) and of multidimensionality (i.e. the assessment should consider an intervention's effect on various dimensions of the patients' life, including both clinical and social aspects) (Lasalvia and Ruggeri, 2007).