Implementing the ICF in a psychiatric rehabilitation setting for People with Serious Mental Illness in the Lombardy region of Italy

We describe issues encountered in implementing the International Classification of Functioning, Disability, and Health (ICF) in a comprehensive psychiatric rehabilitation settings for people with Serious Mental Illness (SMI), with the goal of facilitating other implementation projects and stimulating international discussion.In 2006, the Hospital Mellino Mellini Department of Mental Health undertook a 2-year evaluation of the applicability of the ICF to its community-based program for people with SMI, in collaboration with the Neurological Institute Carlo Besta Foundation. An ICF-based assessment of functional status was administered at intake, 3 months, and at 6 months, using an extended checklist of ICF codes determined to reflect the most important aspects of functioning among the SMI client population. All project focused on three important aspects of participation of these persons: housing, working, and socialization.Issues encountered during the project related to: (1) the identification of a relevant code set for the population; (2) difficulty in administering the checklist as a primary functional status measure; (3) whose perspective would be followed in rating functional status; (4) how to conceptualize the ICF Capacity qualifier; and (5) the need for teamwork and culture change for successful ICF implementation.On the basis of this experience and input from an international workshop convened by the Department, the project team concluded that the ICF is a helpful conceptual frame for functional status among people with SMI, promotes a common language and integrated treatment model, supports the development of individual rehabilitation plans, and can be used to improve services for this population.