Association between organizational characteristics of community-oriented mental health facilities and treatment adequacy. A multilevel analysis from Lombardy, Italy

Introduction: The care provided to patients with severe mental disorders remains a major challenge for the organization of healthcare systems. Data on recent treatment patterns within mental health services are essential to estimate the unmet needs for care and to guide service planning and resource allocation. Aim: To identify individual patient and organizational-level predictors of the provision of minimally adequate care for patients with severe mental illness. Methods: A population-based study was designed, retrieving data from Healthcare Utilization databases of Lombardy region (Italy). 72,115 patients from Departments of Mental Health (DMHs) in care for schizophrenic, bipolar or major depressive disorder, were identified. Minimally Adequate Treatment (MAT) was calculated as either minimum psychiatric visits (≥4) with pharmacological treatment (≥2 months) or psychotherapy sessions (≥8, for major depressive disorder only). Patients meeting these criteria were considered as having received MAT; others were classified as having received less than adequate treatment. Multilevel analyses were performed to estimate the association between patients' individual (e.g., age, sex, education, marital status) and DMHs' aggregate (i.e., organizational features, activity volume, staff employed in facilities providing MHC) characteristics and provision of MAT. Results: Overall, 45% of patients received MAT. Patients with increased probability of receiving MAT included married individuals (8%, 95% CI: 4%–12%), those with schizophrenia (11%, 95% CI: 9%–13%) or bipolar disorder (23%, 20%–25%), younger patients (22%, 20%–25%), and those with previous continuity of care (48%, 46%–51%). Differences in DMHs' structural features (e.g., number of day-treatment facilities, presence of multidisciplinary teams) contributed to heterogeneous MAT coverage. Moreover, the composition of psychiatric teams (in terms of hours worked by each category of healthcare professionals) and the number of affiliated facilities were associated with MAT delivery. Conclusions: This study ascertained that the quality of care offered to psychiatric patients is still low and not adequate. Administrative data can usefully contribute to identify both individual and organizational-level predictors of MAT provision, offering a valuable benchmark for managing organizational features of DMHs and for optimally allocating the working hours in multidisciplinary professional teams, with the goal of maximizing the provision of adequate mental healthcare.