The psychiatrists’ warning

Mental health: from teenagers to REMs – a map of an Italia moving at too many different speeds

“Slow” responses, a lack of personalised care, repeated hospital admissions and difficult access to the most innovative medicines: a fragmented regional landscape, whilst pressure on services has doubled in five years and experts are calling for a steering committee

by Health Editorial Team

19 June 2026

4' min read

Translated by AI

Versione italiana

4' min read

Translated by AI

Versione italiana

Italia’s mental health system all too often provides inadequate responses, with significant differences between the regions on crucial issues such as the ability to identify rapidly growing needs – the pressure on services has doubled over the last five years – the crisis affecting young and very young people, the management of offenders with mental health conditions in REMS residential facilities, and adequate staffing levels and the availability of innovative medicines.
The Italian Society of Psychiatry has taken stock of this ‘puzzle’ across the regions, presenting the results of local ‘performance’, as compiled by its regional branches. It is precisely from the National Conference of the SIP’s Regional Sections that an operational proposal has emerged: to establish a Permanent Conference of the Regions to monitor problems and services, and to define both immediate and long-term interventions.

Who’s on top and who’s struggling

Some northern regions, such as Emilia-Romagna, Friuli-Venezia Giulia and Trentino-Alto Adige, demonstrate a strong ability to identify needs and a good provision of local services: in Emilia-Romagna, the number of people receiving treatment stands at 234.8 per 10,000 inhabitants, compared with a national average of 171.9, whilst in the Province of Bolzano it exceeds 327 per 10,000 inhabitants. In other regions, however, specific challenges are emerging: Liguria has the highest prevalence in the country, with 447 users receiving treatment per 10,000 inhabitants compared with an Italian average of 171.9; Lazio has hospital readmission rates exceeding 20 per cent; whilst Marche, Abruzzo, Molise and Calabria continue to face staff shortages, with staffing levels in some cases falling to around 40 staff members per 100,000 inhabitants, compared with a national average of 66.2. In the South, significant differences also persist in the organisation of services, with regions such as Puglia having developed a robust local and rehabilitation network, whilst others have yet to strengthen their capacity to provide care. This is a complex picture, but one which confirms that the main inequalities do not strictly follow a geographical divide between North and South, but depend above all on the local organisation of services and the investments made over time.

National data

The number of people accessing child and adolescent neuropsychiatric services and A&E departments for psychiatric reasons has risen significantly, with estimated increases of between 30% and over 50% in the post-pandemic period, particularly for anxiety disorders, depression and self-harming behaviour. In the field of forensic psychiatry, REMS (residential facilities for offenders) continue to grapple with problems that often lie outside the medical sphere: there are currently around 632 people in these facilities and approximately 750 on the waiting list, against a limited number of places, with waiting times in some regions exceeding 12 months. There has also been a sharp rise in visits to A&E and requests for help from mental health centres and services for child and adolescent neuropsychiatry. These figures are also confirmed by the most recent epidemiological data: in 2024, approximately 845,516 psychiatric patients were treated by specialist services, with 272,497 people coming into contact with Mental Health Departments for the first time and over 10 million services provided (an average of 13.6 per patient), confirming an increase in mental health needs. In 2024, there were also 636,113 visits to A&E for psychiatric reasons (3.3 per cent of the total) and 4,586 cases of compulsory medical treatment (TSO). Added to this is the great complexity involved in managing psychiatric emergencies and the increasingly significant issue of the safety of healthcare workers.

The proposal for a Permanent Conference

“In Italia, mental health affects around 15–20 per cent of the population at some point in their lives,” explains Guido Di Sciascio, president of the SIP and director of the Department of Mental Health at the Bari Local Health Authority, “but the response from the services remains uneven. This is not so much, nor solely, due to geographical differences between the North and the South, but rather to the availability and organisation of services across the country: metropolitan areas concentrate expertise and facilities, whilst more peripheral areas struggle to ensure continuity and promptness in providing care. This is why it is necessary to strengthen coordination between regions and establish a permanent conference to monitor services.”

Focus on young people

The debate in Rome therefore highlighted the need for a more consistent implementation of interventions, with organisational models capable of ensuring greater equity in access to care. ‘We have paid particular attention to mental health among adolescents and young people (aged 18–30), who often fall through the cracks and represent one of the main areas of concern, particularly in light of the rise in pathological behaviours – explains Antonio Vita, president-elect of the SIP and full professor of Psychiatry and director of the Department of Mental Health at the University of Brescia – Spedali Civili. This is why we need to strengthen prevention and the early detection of disorders, especially during the transition to adulthood.”

The Rems node

The relationship between psychiatry and the judicial system, with particular reference to REMS and treatment pathways for offenders, is another key issue. ‘The system has significant shortcomings,’ adds Di Sciascio, ‘including a shortage of places, long waiting lists, inappropriate placements (up to 50 per cent of residents do not require high-security care), difficulties in managing transfers, and the absence of a structured pathway between high-security facilities, REMS and the local community, as well as regulatory and organisational problems that expose staff to liabilities inconsistent with their healthcare role. The need for greater integration between the healthcare system and the judiciary, and for clearer and more effective organisational models, is fundamental.”

Access to innovative treatments

Last but not least, the issue of treatment is also of paramount importance for patient management, both during hospitalisation and after discharge. Access to new, innovative treatments – whether pharmacological or non-pharmacological – should never be patchy or vary between urban centres and outlying areas within the regions. ‘A further critical issue concerns the availability of the most innovative therapies, which is currently not uniform across the country,’ concludes Antonio Vita. ‘The differences between regions, already evident in the data on services and patient management, are also reflected in access to treatments. This results in inconsistent care pathways, where the quality of care risks depending more on a person’s place of residence than on their clinical needs. Ensuring equitable access to treatments means reducing these inequalities and guaranteeing consistent standards of care across the whole country.”