Experiences, opinions and current policies on users' choice and change of the allocated primary mental health professional: A survey among directors of community mental health centers in the Emilia-Romagna region, Italy

Background: The subject of how the initial allocation of the primary mental health professional (PMHP) in community mental health services is made and the frequency and management of users' requests to choose and/or change their allocated PMHPs has been scarcely investigated. The present paper is aimed at exploring the experiences and opinions of directors of community mental health centers (CMHC) on this topic. Methods: A cross-sectional survey was conducted. Electronic ad hoc questionnaires with both multiple choice and open-ended questions were e-mailed to the institutional addresses of CMHC directors in the Emilia-Romagna Region (Northern Italy) with the consent of their heads of department and the Ethical Committee. Quantitative data were analysed by means of Microsoft Excel software and STATA 14.2 (College Station, TX), while the qualitative analysis was performed using the Nvivo12 software. Results: Twenty-eight questionnaires were collected (response rate: 71.8%) that were equally distributed between males and females. For the initial PMHP allocation, casual allocation by "fixed-rota" was commonly performed (39.3%). Moreover, hope for a change of prescription by a different psychiatrist was the most frequent reason for users' requests to change their PMHP. In two mental health departments only (Parma and Bologna), written guidelines to manage users' requests of change of PMHP were available. In this context, most participants classified the explored topics as relevant and believed that written policies, especially if shared with users, could be useful. Conclusions: In Emilia-Romagna CMHCs, neither users nor professionals were generally involved in the initial choice of the PMHP. Further national-level studies should be conducted in order to confirm this finding. Additionally, written and shared guidelines for managing users' request to choose/change their PHMP may be useful.