Valutazione partecipata dei Centri diurni di Salute mentale di Roma: Studio degli aspetti strutturali, delle rappresentazioni degli stakeholders e implicazioni per i processi di recovery.

An evaluation Research on the Day Centers of mental health of Rome was carried out using a multi-stakeholder approach. The thesis presents three distinct studies. In the first study, the structural aspects of the day centres were investigated. Results point towards a lack of personnel power, an increase of time in caretaking, the lack of activities supporting self-help and - in many cases - the lack of users" participation in the planning and supervision of their own therapeutic project. Further, the day centres'lack of integration in the territory was a problem of almost all day centres under study; only the network with the other psychiatric services was well developed, In the second study users", operators" and family members" representations of the day centre were analyzed; additionally, a set of goals of the ideal and actual day centre was surveyed. Main goal and purpose of the participative evaluation study must lie in the establishment of stakeholders" different criteria for the evaluation of the day centre. The free association data we collected to the primer "day centre" clearly showed the centrality of "socialization" as a closely associated concept to the day centre. "Socialization" is further reflected for each stakeholder group more specifically as "friendship" for users, "welcoming [it.: accoglienza]" for operators and "help" as well as "obligation" for family members. Further different, and well distinct conceptions of the day centre emerged: The day centre as an (.) educative (.) entertaining (.) therapeutic (.) or rather assisting facility. Entertaining, pedagogism, as well as therapeutical attitude, were the most developed conceptualizations of the day centres. In the third study, based on the analysis of focus groups, the critical issues concerning the day centres were investigated. Especially, problems related to the stigma of chronic illness and issues emerging from pharmacological treatments were often discussed. The conclusions of this thesis point towards the need for a reorientation of the day centres: they emerged as segregating rather than socially integrating structures. This is mainly due to the fact that most activities are carried out insider the services, characterized by rigid and horizontal management. The day centres will have to change into flexible structures, characterized by an increased co-management by users as well as the promotion of self-help groups.