Different approach for mentally unwell

As Otago's mental-health sector braces for spending cuts, a visiting Italian psychiatrist says the secret of a successful mental-health service is integrating physical and mental health and allowing people access to 24-hour help centres.

Prof Roberto Mezzina is deputy director of Trieste's mental-health department, which is recognised by the World Health Organisation as a model for successful de-institutionalisation.

Prof Mezzina, who visited Dunedin yesterday as part of an Australasian tour, said his city's mental-health department received hundreds of visitors every year from other health jurisdictions.

The Trieste model involves 24-hour centres to which people self-refer, where clinicians were rostered for random referrals, with help given immediately without lengthy needs-assessment processes.

Rather than admitting people to hospital, they were intensively supported in their own homes, although some inpatient beds were available.

Prof Mezzina said physical ailments were treated alongside mental-health issues where possible, encouraging integration between psychiatric and other health services.

Former asylums housed radio stations and cafes run by mental-health patients.

Music and theatre groups, and artists' workshops were encouraged, and they were open to the wider community.

Co-operatives provided work, with people paid market rates.

Starting in the 1970s, the process of closing the old psychiatric institutions in Italy was drawn-out and controversial, with initial resistance from families and many psychiatrists.

The Trieste experience had not been replicated as successfully in other parts of the country, with some privately-run institutions popping up to replace asylums, and the continued use of seclusion and restraints, Prof Mezzina said.

Prof Mezzina was pleased that electroconvulsive therapy (ECT) was firmly out of favour in Italy, where it was invented in the 1930s, and that only 1500 people were in forensic psychiatric care, in a country of about 60 million people.

New Zealand has about 400 forensic inpatients.

In 2008-09, 217 New Zealand mental-health patients received ECT, including 30 in Otago.

Pact chief executive Louise Carr said New Zealand could learn a lot from Trieste, particularly its comfortable integration between inpatient and outpatient services, and the ease with which people could self-refer.

Prof Mezzina's visit was sponsored by the Arc Group, an alliance of non-government organisations.

In a statement promoting his visit, Arc Group spokesman Rob Warriner said New Zealand could save up to $100 million a year if it adopted the Trieste model.

The Southern District Health Board has called a meeting early next year with the region's mental health sector, to discuss ways of cutting costs, because of an impending budget over-run.

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