**2. Background and caseload**

#### **2.1. Population, Mental Health Department and schizophrenia**

The province of Ferrara, in the Emilia-Romagna region (Italy), has a population of around 360,000 inhabitants. The treatment of psychiatric disorders is guaranteed by the Local Public Health Agency of Ferrara, through the Mental Health Department (MHD), using the community care model. The territory has an important feature in offering personalized care paths and on relies to hospitalization only in the case of onset of acute symptoms that cannot be treated as outpatients.

The treatment path uses different instruments: medical and nursing interviews, drug therapy, psychoeducational groups, cognitive groups, expressive therapies, family intervention, and proposals for enrolling in specific training programs stage.

People affected by schizophrenia spectrum disorders are diagnosed and taken over by the MHD Territorial Service, which starts a personalized treatment plan and carries it on over time, referring also, where necessary, to rehabilitative semi-residential or residential programs or to short-term hospitalization (average 11 days) in acute pathology ward. In recent years, it was also initiated a very interesting departmental project of early intervention for psychosis [1].

In 2009–2010 [2], a systematic evaluation of all people affected by schizophrenia spectrum disorders [category 295 of International Classification of Diseases (ICD9)], in charge of the provincial MHD, allowed to get several important and useful information. The cases were 842: 486 males and 356 females, with an average observation time of 13 years.

The research considered both symptoms, evaluated using the Brief Psychiatric Rating Scale (BPRS) 24 item [3] and personal/social functioning evaluated using the Personal and Social Performance Scale (PSP) [4]. Only 5.3% of cases showed severe symptoms versus 78% of cases asymptomatic or mildly symptomatic. Conversely, the evaluation of personal and social functioning evidenced, in the sample, a widespread situation of disability, with relevant difficulties in one-half of cases in the work/social utility area and in personal relationships area. There were statistical significant gender differences with males less able than females.

A very important result of this research is that course and outcome of the disease are not affected by early onset or long disease duration: the possibility of improvement or healing exists for all cases, even those with a long history of illness and hospitalizations.

#### **2.2. The psychiatric users association**

experiences and self-perceiving, and external points of view, including those of family members

The transition from a hospital care model, almost always based on seclusion, to a territorial care model has eliminated the artifacts of institutionalization, allowing to highlight the wide range of individual differences in the onset, course, and outcome of the disease. It is impossible to apply a unique model of approach and therapy; instead, it is essential to work using individual projects, which should be adapted to the evolution over time of the person-diseasecare system. In Italy, the model of nonhospital psychiatric assistance is now being implemented by almost 40 years, allowing to accumulate an enormous asset of experiences and expertise in a system in which everyone plays an active role: patients, better defined as users, family members, practitioners and psychiatric workers, associations, schools, and other agencies of

The challenge of the last years is not the treatment of the symptoms, which, at least for the positive symptoms, finds a wide range of effective drugs: the challenge is to recreate or to build up *ex novo* personal skills and social relationships networks, to find a valuable role in society, and to achieve a satisfactory quality of life. To achieve these objectives is an ambitious, but possible, goal, and requires employing all the available resources. In this context, a psychiatric users Association proposes the sport as one of the possible strategies within a wider therapeutic project for schizophrenia. The main characteristic of this work is that schizophrenic disorders and sport as a method of rehabilitation and social inclusion are observed first of all from the point of view of users, main recipients of the intervention: subsequently, they have broadened the point of view, involving other figures that operate in this project: psychiatric workers, facilitators, trainers, referees, family members, teachers and students, local Author-

The province of Ferrara, in the Emilia-Romagna region (Italy), has a population of around 360,000 inhabitants. The treatment of psychiatric disorders is guaranteed by the Local Public Health Agency of Ferrara, through the Mental Health Department (MHD), using the community care model. The territory has an important feature in offering personalized care paths and on relies to hospitalization only in the case of onset of acute symptoms that can-

The treatment path uses different instruments: medical and nursing interviews, drug therapy, psychoeducational groups, cognitive groups, expressive therapies, family intervention, and

People affected by schizophrenia spectrum disorders are diagnosed and taken over by the MHD Territorial Service, which starts a personalized treatment plan and carries it on over time,

and practitioners, judgments, and prejudices of society.

152 Schizophrenia Treatment - The New Facets

civil society.

ities, and other associations.

not be treated as outpatients.

**2. Background and caseload**

**2.1. Population, Mental Health Department and schizophrenia**

proposals for enrolling in specific training programs stage.

Club Integriamoci NGO Association, based in Ferrara, was founded in 1998 by a group of psychiatric users and former users, psychiatric workers, and volunteers.

In the early years of the association, the psychiatric workers have provided a constant presence and played a very important role, supporting users in their path toward autonomy: they started activities, participated in them, and identified the most suitable users carrying out management functions or activities conductors. Many activities and projects were also financially supported by the MHD. Over the years, manual and craft activities have been carried out, especially for females and a 3-year theater project as part of a European project of which the town of Ferrara was partner.

Currently, the Association is completely managed by the users, who hold all the management positions, perform administrative functions, and take all decisions as a group and plan together the activities and initiatives. The main activity of the association has always been and nowadays is to practice sports, in collaboration with the Mental Health Department, the UISP (Italian Union Promoting Sport for All) and the Municipality of Ferrara. The Association participates in further outdoor activities, especially hiking, walking, and bike riding, as part of a regional project ("Moving Citizens 2") that promotes physical activity outdoors.

The Association undertakes activities of information and contrasting stigma, especially in high schools: testimonies, but also volleyball or football matches. Moreover, it participates in regional sport tournament and collaborates with different NGO Association in ethical projects.
