**1. Introduction**

Residential facilities are a key resource for the Italian Mental Health Department; the facilities are dedicated to the treatment of patients suffering from mental illness who require therapeutic rehabilitation or social and health support interventions in residential settings. Nonmedical residential care facilities (RCFs) are a common residential setting for many people with mental illness, especially those with limited social support and greater supervision and care needs. Residential service models emerged as alternatives to deinstitutionalization, and RCFs base their work on the continuity of care; patients who moved back and forth between different care settings were most likely to change residence and to have the highest number of short admissions [1], while the continuity of the care setting could play a role in containment and help in the management of symptomatology [2].

Therapeutic psychiatric communities are complex organisms with a complex care path defined spatially and temporally. The path begins at the initial moment of reception

**Citation:** Cordellieri, P.; Barchielli, B.; Masci, V.; Viani, F.; de Pinto, I.; Priori, A.; Torriccelli, F.D.; Cosmo, C.; Ferracuti, S.; Giannini, A.M.; et al. Psychological Health Status of Psychiatric Patients Living in Treatment Communities before and during the COVID-19 Lockdown: A Brief Report. *Int. J. Environ. Res. Public Health* **2021**, *18*, 3567. https:// doi.org/10.3390/ijerph18073567

Academic Editor: Paul B. Tchounwou

Received: 25 February 2021 Accepted: 28 March 2021 Published: 30 March 2021

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**Copyright:** © 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/).

in individual interventions, group interventions, or interventions with family members, and it is a path of inclusion, attachment, and detachment with involvement in the social network; great importance is given to the daily life and climate of the patient [3].

Indeed, residential programs in therapeutic psychiatric communities are often based on the integration of educational, psychiatric, and psychotherapeutic treatments within a therapeutic setting [4]. The assumptions of therapeutic psychiatric communities are represented by the shared construction of a therapeutic project between the patient, family, sending service, and community staff, and, moreover, by the therapeutic alliance that is built after a preliminary phase and that each community must try to guarantee [5,6].

Community-based residential mental health services are judged to be less restrictive and regimented models of care; for these reasons, they are considered less isolating and stigmatizing than other models of care [7]. Clinical intervention in the healthcare organization involves overcoming an individualistic conception [8] derived from the medical model, according to which the only patient is the individual. In addition, over time, increasing importance has been given to relational and intersubjective conceptions, highlighting the importance of social ties for the mental health of individuals and groups.

The group constitutes the modality through which the community of care can operate to achieve its aims [9]; that is, it is a space for the sharing and symbolic re-elaboration of experiences of suffering and the sharing of experiences, which are nourished by the transformative and "generative" capacity characteristic of "group thought" [10]. Despite growing evidence for their effectiveness, little research has been conducted to establish how therapeutic communities (TCs) work to produce positive outcomes. Pearce and Pickad [11] argued that there are two specific factors that, in combination, contribute to TC effectiveness: the promotion of a sense of belongingness and the capacity for responsible agency. Although both factors are found in other therapeutic approaches and are important to the psychosocial aspects of psychiatric care, the authors argued that their combination, extent, and emphasis are unique to TCs [11]. These characteristics could be considered crucial during the lockdown implemented to avoid the spread of coronavirus disease 19 (COVID-19). Patients living in psychiatric treatment communities during the COVID-19 lockdown showed unchanged depressive, anxious, and stressful symptoms; in particular, residential patients had lower perceived stress scores due to the COVID-19 situation compared to those of the general population, and the uninterrupted care provided by the residential community was considered to be an important protective factor [12]. In contrast, psychiatric patients, a population that could be considered at greater risk of distress and psychosocial pathological responses to exposure to a stressful situation such as a COVID-19 lockdown, were underinvestigated [13]. In people with preexisting mental illness, the impact of COVID-19 may be different than that for the general population. A rapid review of the literature on the potential impact of COVID-19 on psychotic patients during past epidemics and pandemics (e.g., Severe acute respiratory syndrome, SARS; Swine influenza, H1N1; Ebolavirus disease, EVD; Middle east respiratory syndrome coronavirus infection, MERS-CoV, and Equine influenza) highlighted that individuals with preexisting psychosis appeared to be less compliant with measures to prevent the spread of the virus (e.g., physical distancing and personal hygiene) [14]. Even in the healthy population, compliance factors are important in preventing the spread of the virus, although they are not often applied [15].

To the best of our knowledge, a comparison between symptomatology before and during the pandemic situation in the psychiatric population has not yet been performed. Aiming to address this gap, we compared clinical conditions of the psychiatric population living in health facilities before and during the COVID-19 pandemic in several domains, such as psychological impairment, social skills, and psychiatric symptoms. The study aimed to investigate the role of therapeutic communities in the management and containment of symptoms of patients with psychosis living in psychiatric residential facilities. The first data collection was conducted in November 2019 (COVID-19 had not yet spread), and the second was conducted in April 2020 (during the lockdown in Italy).
