Male Erectile Dysfunction

be a higher proportion of upper class users than before which might be an indication of the lowering of psychiatric stigma. Another study-" has demonstrated that chronic patients who have been able to be transferred from hospitals to outpatient community facilities have needed an average of three years of care; a far shorter time than they would have spent within large psychiatric hospitals. Some of the innovative steps have been collated by Ramon", All the psychiatric hospitals closed have been converted for community use such as group homes, schools or cooperatives. The outpatient clinics, now called Mental Health Centres, have been deployed in the community. They represent the cornerstone of the new system in that they function in a very informal way providing ad hoc therapies, day care, recreation activities as well as longterm solutions such as housing and hostels, though the latter is still far from satisfactory!". Rehabilitation cooperatives, cultural associations, workshops, counselling services and relatives' pressure groups are mushrooming, obtaining more and more support from the public and the local politicians, and informal and voluntary organizations are now seen as having professional status. Such a trend can now be seen in UK where GPs are increasingly turning to other mental health care professionals such as nurses and counsellors for help with mental health problems'". There are important and useful lessons that can be learnt from the Italian reform-": (1) Planning and implementation of adequate alternative structures must be provided before the closure of mental hospitals (this well acknowledged point has been recently emphasized-"). (2) Regional and local, political and financial commitment are vital prerequisites. (3) Detailed epidemiological evaluation should precede any planning. (4) Primary care should be in the forefront of any community psychiatric care. To conclude it is true that an epidemiologist from Mars21 could prove invaluable to help with the figures, but we will all still have to grapple with political and cultural context. Consequently it would seem arrogant to foreclose on a reform that with all its failings, has enabled us to think.