Mental health, the map of free visits while waiting for resources and the new Plan for Italy

Then there is the super work of associations such as Telefono Amico Italia, which receives 300 requests for help a day, six out of ten of which are for loneliness, emotional malaise and existential discomfort. With a 19% increase in cases of self-harm and an 18% increase in eating disorders. The organisation receives a total of 110,000 requests for help and on Mental Health Day is relaunching its activities to support the population.

La priorità assoluta sono i giovani a cui il nuovo Piano nazionale salute mentale, quando sarà operativo, dedicherà un focus specifico. Anche qui i dati li ha messi in fila il ministro Schillaci, fresco di question time su quella che ha definito come «un’emergenza silenziosa». Per poi affidarsi di nuovo alla realtà dii numeri «allarmanti». Perchè «un adolescente su sette, tra 10 e 19 anni, soffre di disturbi mentali, spesso non riconosciuti - ha ricordato -. Il suicidio è la terza causa di morte tra 15 e 29 anni. Non possiamo più voltarci dall’altra parte».
Con il Piano c’è in arrivo, ha garantito il ministro, un vero e proprio cambio di paradigma: «Vogliamo potenziare diagnosi precoce, rafforzare la neuropsichiatria infantile, garantire équipe multidisciplinari che coinvolgano famiglie, scuole e istituzioni locali. Perché sta qui il punto fondamentale - ha avvisato Schillaci -: la salute mentale non è sola questione sanitaria. Le nostre politiche devono essere multisettoriali. Sani

For Schillaci, 'the real battle is cultural: normalising the request for help, breaking down the stigma, building a culture of prevention starting from schools and families. We want a young person who suffers to feel not wrong, but understood. That asking for help is not weakness, but courage. As Article 32 of the Constitution states, the Republic protects health as a fundamental right. And mental health is health,' he emphasised. It is not a second-class issue, it is not an optional extra. This government has made a precise choice: to invest in the mental health of young people, with multi-year plans, innovative projects, dedicated resources. Because every teenager who does not make it is a defeat for all of us. And every young person we manage to help in time is a victory for the whole of Italy'.

In the meantime, the National College of Directors of Mental Health Departments (DSM), meeting in Rome but in continuous connection with the 'piazzas' all over Italy - from Catanzaro to Perugia, from the Castelli Romani to Asti - has issued a decalogue to change the course of assistance on the ground in Italy: "The Congress," warns Giuseppe Ducci, vice-president of the College and director of the Dsm Asl Roma 1, "relaunches the theme of mental health in the context of the profound epochal changes that are marking our lives from the social, economic and cultural points of view, challenges that require new and more appropriate responses to the emerging needs of users and mental health workers in our country.

1) Resources: the College will work to ensure that the fixed and bound fund for mental health is respected at no less than 5% of the national and regional health fund, 2% for services for children and adolescents, and 1.5% for addiction services.

2) The quality of services: in the face of a prevailing model of generalist psychiatry in which the pharmacological medical approach prevails, while evidence-based psychotherapy and rehabilitation treatments and specific areas of intervention that require second- and integrated-level specialist skills are lacking, the College will work to ensure that systematic process and, above all, outcome evaluations are introduced.

3) Access to services: proximity interventions must be developed in living contexts, workplaces, schools, emergency rooms, fostering the growth of mental health networks extended beyond the organisational boundaries of departments, which also take into account the multiculturalism associated with significant migratory phenomena. The College will work to ensure that part of the professionals' work is carried out in these contexts with a systematic analysis of the demand for care, even if unexpressed.

4) The current organisational model of the integrated department with pathological dependencies and services for developmental age should be extended by guaranteeing the transition around the age of eighteen

5) The Dsm cannot cover the entire supply of mental health services, but must play a role in governing all the accredited bodies, both in the psychotherapy and residential sectors, which absorb over 40% of mental health expenditure (in some regions well above this threshold), often without the implementation and monitoring of truly evolutionary rehabilitation pathways. The Dsm must be recognised as having a directing role

6) Sociomedical integration: the College will work to achieve the greatest possible sharing and harmonisation of national and regional planning documents and to support the application of the Health Budget methodology, as envisaged by the Planning Guidelines approved in the State-Regions Conference on 6 July 2022.

7) The role of clinical psychology. The epidemiological escalation of DSMs and psychological distress in the broadest sense requires a much broader range of psycho-social treatments than those currently guaranteed by the DSMs. The College intends to support the figure of the district psychologist as the basic territorial expression of the DSMs (within the community houses), regardless of the organisational model that will be adopted at regional or company level.

8) Patients who are offenders: the College will work to support legislative activity aimed at overcoming regulations that are no longer in line with the current reality and to promote operational agreements with the judiciary for the management of security measures and expert activities. The mandate of care and not control by the DSMs will be asserted in every context

9) Voluntariness and compulsory treatment. The entry of offenders into treatment, the intertwining with the phenomena of addiction and behavioural deviance, the general increase in the phenomena of aggression and violence against health workers require an analysis of the use of coercive instruments and safeguards to guarantee the rights of users and the safety of workers, also in order to avoid the overt or creeping delegation of control that is still addressed to psychiatry. The College will work to promote joint action to monitor these phenomena with a view to their containment and to reform institutions such as the AdS, which show serious limitations in their practical application, especially in terms of substituting therapeutic choices. The College will also work to ensure the safety of workers, including through agreements with the police.

10) The DSMs must be active players and protagonists in the training of doctors and specialists, as well as of the health professions. It is necessary for the health authorities to invest the necessary funds to implement integrated training courses, which privilege Ebm clinical and rehabilitative practices and social inclusion interventions, linked to specific improvement objectives and assessed in relation to the change produced on the quality of care. The College will also work to "overcome inertia and rents of position that prevent a functional link between the University and the NHS in the training of DSM professionals". It is also essential to strengthen and finance research on and in the mental health services, the main guarantee of control of their quality and organisation. The College, in compliance with the most complete autonomy from commercial stakeholders, will promote forms of fundraising for the implementation of this