Mental health, a plan to tackle the post Covid emergency and youth distress

The 2025-2030 Plan outlines a broad scenario analysis and is divided into six macro-themes: mental health promotion, prevention and care paths; childhood and adolescence with a focus on transition to services for adulthood, access and continuity of care; mental health in prisons and Rems; risk management and safety to stem aggression and protect patients; health integration; and finally training and research. With the solicitation, on this last point, to increase the budget that we currently have 'underrepresented compared to other EU countries', as well as to implement finalised research projects in healthcare companies and hospitals.
All this in a framework that in Italy sees about 3% of the total resources for public health allocated to psychiatry, equal to just over 3.5 billion, while according to insiders at least 2 billion more would be needed for adults alone and a +30% increase in personnel equal to 7,500 operators as estimated at the end of 2024 by the College of Directors of Mental Health Departments.

The new Plan would have been the right opportunity for a relaunch. But from the point of view of resources it appears dramatically 'naked' at the appointment with the examination of the Regions, scheduled after so much waiting for the end of July: the implementation of the Agreement in the Unified Conference - therefore between the government, regions and local authorities, that is, all the actors called upon to contribute to the renaissance of mental health - 'shall be provided within the limits of the human, instrumental and financial resources available' and in any case 'without greater burdens on public finance'.

A well-known formula that has marked the fate of many crucial public health planning tools. However, the ministry assures that the dialogue with the Mef is open and that within a few months - with the budget manoeuvre - adequate resources will be found. For the time being, it will have to be done with what there is.

It is certain that the stakes are very high, if only one considers the cross-section of the new generations to which an entire chapter (the second) of the Plan is devoted: the data document a 'significant increase in the incidence and prevalence of all psychopathological disorders in the age of development, especially in adolescence', including those of neurodevelopment, with 'a significant acceleration in the last three years in the post-pandemic era'. Not only that: 'there is a significant advance in the age of onset of serious mental disorders and an increase in their complexity, with considerable care overload for hospitals and territorial facilities'. The numbers listed in the Plan are chilling: between 2011 and 2021, access to third-level emergency services for suicidal ideations, self-harm and suicide attempts increased about 20 times. And in Lombardy alone, brought to its knees by the first Covid wave, between 2016 and 2022, accesses to emergency rooms for minors with red and yellow codes for any psychiatric disorder increased by 61%, while the regional rate of accesses for suicidal ideation tripled.

But there is not only the dramatic impact of the pandemic: in the early stages of life, prevention becomes strategic, as does the appropriate management of the transition to adulthood, for which the new Plan calls for 'case managers' and multidisciplinary teams. This, in the face of the overload of demand for care and the serious lack of dedicated pathways, of responses on the ground and of hospital beds: whether one considers early-onset neurodevelopmental disorders such as autism, Adhd, learning and eating disorders, or psychiatric disorders (45% of the global burden of disease in the 0-25 age group), half of which begin before the age of 14 and whose under-diagnosis delays treatment and aggravates the disease.

Prevention, treatment and rehabilitation of mental health are fully included, the document states, in the institutional mandate of the Departments of Mental Health. In order to implement the Essential Levels of Care (LEA), they will have to be 'integrated and inclusive' in a continuous dialogue with all the mental health actors (including family doctors and level I psychologists), the crossroads of interventions in view of the full and widespread implementation of that bio-psychosocial and socio-health model that until now 'has not had the necessary diffusion and capillary coverage'. This, also taking into account that the epidemiological scenario is dominated by the co-presence of mental disorders, substance-related and 'addiction' disorders and neurodevelopmental disorders.

The Plan does not so much invent new models, but rather looks at the implementation of what has already been designed and which has been implemented (at best) only in part: such as the State-Regions Agreement of the end of 2022 on the 'matrix model', which also contained standards on staffing requirements, which it calls for to be tested. And like the Evidence Based approach to standardise interventions in the very delicate perinatal period. Or again, such as the application of the Health Budget, also in collaboration with the third sector, to promote the autonomy of the person with support programmes for living and work inclusion.

Today these are models present in individual territories at best practice level. Because, as the experts confirm, "despite the Essential Levels of Care, unfortunately the Child and Adolescent Neuropsychiatry Services and the Departments of Mental Health struggle to provide an appropriate and effective response" since "the structural conditions and the technical and innovative contexts for an integration of the policies and resources of the health system with those of the social and health system are still lacking".