Dissemination of IPS in Italy Problems and opportuinities A. Fioritti, R. Sabatelli, Manchisi D., Piegari D., DellAlba N., Trono V. WPA Congress, Buenos Aires,

Content Background –Italy and work –Italian community psychiatries and work Strategies and policies for employment by MI –Current approaches and outcomes –Innovative approaches and IPS Experiences of IPS in Italy –EQOLISE in Rimini and after –TIPS in Bologna and Emilia-Romagna Future developments

Italy and work LItalia è una repubblica democratica fondata sul lavoro, Costituzione della Repubblica, art. 1. Work as a citizens right (and due) Social responsibility in ensuring work to individuals High level of protection for workers How long will it last?

Italian Community Psychiatries 1904: law on mental hospitals 1965: pilot CMHC (secteurs) 1968: pilot experiences (Gorizia, Trieste, Reggio) 1978: National Health System – Psychiatric Reform Law n : MH plan, standards for CMHTeams 1999: Devolution 2009: Regional MH Plan (DGR 313/09)

Italian Community Psychiatries National Health System Universal -Tax funded Regional Government Public Health Approach – geographical responsibility, Unità Sanitaria Locale, all community and hospital facilities Psychiatry within NHS –All goods and staff from previous administrations –New mission included

Mental Hs beds GHPW beds Private clin. Beds Residential short Residential medium Supported housing CMHC N.41 /12941/13643/140 MH staff?3.036? Day care /PHC44658

Strategies for employment Personal initiative Mainstreaming Responsibilization Empowerment Support Motivation Place and support Social responsibility –Specialization –Institutional –Reservation –Welfare –Protection –Train and place

Strategies for employment Personal initiative Personal research Counselling Transient job agencies (Adecco) Supported Employment Individual Placement and Support Microcredit Social responsibility TEG (A, B, C…) Free attendance, training contracts Cooperative B Simulazione e creazione dimpresa Collocamento obbligatorio (l. 68)

Currently Most resources dedicated to social responsibility programs Prevalence of pre-vocational, vocational training and cooperatives programs Increase in less disabled population with higher expectations Trends of: –Deregulation of labour market –Decommodification of social services

Dipartimento di Salute Mentale e Dipendenze Patologiche - Area CSM Percorsi dinserimento formativo - lavorativo Utenti in carico per progetti dinserimento formativo e lavorativo ITR Borse lavoro Inserimenti in Formazione prof.le Percorsi L.68/ Inserimenti in Coop. Soc. B (ITR Borse Lavoro e Assunzioni) Assunzioni

Dipartimento di Salute Mentale e Dipendenze Patologiche - Area CSM Percorsi dinserimento formativo - lavorativo

Dipartimento di Salute Mentale e Dipendenze Patologiche - Area CSM Inserimenti lavorativi in Cooperative Sociali di tipo B ITR Borse Lavoro e Assunzioni ITR Borse lavoro in Coop. Soc. B (ITR BL) di cui occupazionali a retta in Coop.Soc. B Assunzioni in Coop. Soc. B

Dipartimento di Salute Mentale e Dipendenze Patologiche - Area CSM Inserimenti lavorativi in Cooperative Sociali di tipo B ITR Borse Lavoro e Assunzioni

Totale complessivo (6 regioni) = persone inserite

Progetto Inserimento Lavorativo 16/ persone sostenute nei PilDSM

EQOLISE 6 centers: –Londra (UK) –Rimini (I) –Ulm (D) –Zurich (CH) –Groeningen (NL) –Sofia (BUL)

Worked at least for one day

15 (34.9%) 5 (45.5%) 3 (42.9%) 0 (.0%) 7 (87.5%) 0 (.0%) 0 (.0%) Vocational 16 (18.8%) 8 (36.4%) 1 (11.1%) 0 (.0%) 6 (37.5%) 1 (7.1%) 0 (.0%) IPS Total n=128 Sofia n=33 Groningen n=16 Zurich n=14 Rimini n=24 Ulm n=25 London n=16 Service Table 16: Worked in informal labour market n (%) of those who obtained employment

EQOLISE in Rimini Continuously effected by three IPS specialists since 2003 More than 180 clients treated Replication of standard outcomes (>40% of clients in treatment work) Seminars across Italy Preparing TIPS project

PROGETTO TIPS TRAINING ON INDIVIDUAL PLACEMENT SUPPORT

IPS Training SEDI FORMATO RI OPERATO RIOPER AUSL REF.AUSLREF.ENAIP IPSENAIPobbligatoriofacoltativo FORLISabatelli CESENASabatelli 1111 RAVENNASabatelli 1111 BOLOGNAFioritti IMOLAFioritti 1111 FERRARAFioritti \\21 MODENAPiegari 1111 REGGIOPiegari PARMAManchisi PIACENZAManchisi tot

Time schedule 9/6/2010 – Start-up meeting 16-18/9/2010 – Full immersion residential training in Rimini 1/10/2010 – Starting recruitment. Monthly meetings of supervision and sharing of experiences. 31/12/2010 – End of recruitment 30/6/2011 – Midterm evaluation 1/12/2011 – Final evaluation workshop

SITES Clients enrolled Job interviews Clients employed Informal employm. Interruptions Piacenza Parma Reggio E.12 6 Modena BO SG BO Zanolini Imola Ravenna Forlì Cesena BO Casa BO Nani Ferrara85322 Portomagg4422 TOTAL (66.7%) (33.3%) 22 (13.9%) 26 (15.7%)

Regional Policies

Regional Policies and IPS Regione Emilia-Romagna (DGR 313/09) Sicily Region (2011) Rome Province Some Veneto Departements

IPS in Italy - Opportunities Users dissatisfaction with traditional vocational rehabilitation Awareness among professionals of more empowering opportunities (self help, supported accomodation, IPS…) Social welfare cuts, labour market «deregulation» Interest in evidence based practices (FEP, ACT, Psychoeducation…)

IPS in Italy - Problems IPS specialist: project vs. program. –What is «team approach»? –Are we bound to instability? IPS and informal work. –Are we supporting workers exploitation by blackmarket employers? PseudoIPS: the «we are already doing this» issue. –Ensuring fidelity and reasonable adaptation

Dartmouth-J&J Intl learning coll. Good opportunity for: –Linking with international network of experiences –Access to training and research material –Improving training and fidelity locally –Better coordination of local practice –Provide training to other centers/regions –Participating in international research and training activities

Thank You!