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SSN psychologists

Mental health: little space in the Plan for integration and childhood, more funds for personnel

Forgotten is the psychic suffering related to serious organic or oncological illnesses, or to disabilities resulting from trauma or serious illnesses

by Stefano Milano*.

Preliminary diagnosis. Selective focus of psychologist notes being written during a psychological session

5' min read

Key points

5' min read

The National Coordination of Psychologist Directors of Complex Structures of the Public Health System enters the debate on the National Action Plan for Mental Health drawn up by the dedicated Table, established at the Ministry of Health and awaiting approval by the State-Regions Conference. The note produced, containing detailed observations, was sent to the various institutional players: the Mental Health Technical Table, the Minister of Health, and the President of the State-Regions Conference.

We appreciate the theoretical premises of the biopsychosocial model and the 'One Health' approach, which go beyond biomedical reductionism, including the role of the community and the living contexts in which distress arises and develops, requiring not only multi-professional but also multi-sectoral interventions.

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However, we stress the risk that the shift to the concept of 'One Mental Health' may attribute to Mental Health Departments and psychiatry a centrality that does not enhance all the other areas of intervention and related actors, which strongly contribute to the promotion, protection and safeguard of the good 'health'.

Relaunching the mental health service system

Strengthened by the conviction that every citizen, regardless of the Region to which he or she belongs, must find the best answers, in terms of prevention and assistance in the field of mental and psychological health, the redefinition of the Plan represents an opportunity for a significant relaunch of the system of mental health services for the entire life cycle, supported by coherent organisational models that achieve substantial integration with all the sectors and care pathways that are different and complementary to those traditionally assigned to mental health. The creation of an Integrated System of Mental Health Services responds to the growing need to manage psychological and mental distress with system logics that require the construction of networks, within the health services and integrated with community resources, to put in place adequate strategies, not only for diagnosis and treatment, but above all for early detection, prevention and combating the phenomena of exclusion and stigma.

Shared programming for prevention

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As Coordination, we focus our attention on the first 3 chapters of the Plan. With regard to the first chapter, "Mental Health and Pathways of Promotion, Prevention and Treatment", we stress the need for prevention pathways to go beyond the confines of the Departments of Mental Health and Addiction, implementing prevention and health promotion policies through an intersectoral approach and shared planning between services, stakeholders and social actors (schools, workplaces, meeting places, etc.). We believe that the primary care psychologist should be placed outside the Departments of Mental Health and envisage forms of close collaboration with general practitioners and paediatricians of free choice, in the context of District Services, with the task of countering the pathologisation of distress. The Consultorial Services are mentioned only in the context of the early detection of mothers' distress in the perinatal sphere and for their role as 'consultants' to the courts. Instead, it is believed, as provided by the regulation that established them, that they are the elective space of the SSN where health is promoted with early intervention on protective factors. It should be added that the Plan forgets the sphere of psychic suffering related to serious organic or oncological illnesses, or to disabilities resulting from trauma or serious pathologies, for which it is considered entirely improper to refer psychological support interventions to the Departments of Mental Health.

Inadequate care for children and adolescents

Regarding the second chapter "Mental health in childhood and adolescence, transition from services for childhood and adolescence to services for adulthood, access and continuity of care", we emphasise the serious error of language in referring to the field of Mental Health in the Age of Development with the very reductive term of "Neuropsychiatry of Childhood and Adolescence". There is a dangerous tendency to rename the services that deal with the 0-18 age group in this way, in spite of the complex, multi-professional work that is carried out in these services, which is almost completely unrelated to the medical profession. The use of the term 'Evolutive Mental Health' is therefore proposed. There is a great shortage of acute care beds for young people, with the consequence that, often, adolescents in a state of acute psychic distress, who would need to be accommodated in a protected and age-appropriate environment, find themselves admitted to adult diagnosis and treatment wards, with an increase in the traumatic value of the crisis. Hence the need for a reorganisation capable of ensuring acute management that respects the specificity of the adolescent age and knows how to welcome suffering in a way that is not exclusively pharmacological, providing integrated interventions from the moment of admission and in close integration with the competent Territorial Services. Bearing in mind the growing dimensions of the suffering of young people, in their various forms (addictions, eating disorders, self-damaging and anti-conservative tendencies, anxiety and depression, etc.), we ask that the plan provide for the creation, in each Local Health Authority, of a low-threshold service to which access is granted not by type of pathology, but by age (14-25 year olds), in close connection with all the specialist services present (Services for the Age of Development, CSM, SerD, etc.). An initial qualified listening and in-depth assessment can be guaranteed in these structures.

Separating care functions from prisoner control

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Concerning the third chapter "Mental health for detained/defendants and for mentally ill offenders in security measures" we agree with the need to strengthen the presence of Mental Health Units in prisons, to support mentally ill detainees. The criticality of taking care of mentally ill offenders, after the just closure of the Judicial Psychiatric Hospitals, implies the need to clearly separate the functions of care from those of control and custody, by intervening on the relevant legislation, in order to leave the Mental Health Services and operators the sole responsibility for care. This also means overcoming the principle underlying the so-called 'position of guarantee', decriminalising the professional liability of healthcare workers who treat offenders. With regard to the management of cases of serious antisocial personality disorders, which are often not immediately available for treatment, it is proposed that therapeutic modules be implemented within restraint contexts, which can also be implemented within prisons. It is also proposed to provide residential facilities for offender patients with serious psychopathologies, who are cooperative in treatment and could be taken into care within treatment modules with 8-10 places.

Strengthening Human Resources and Facilities

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In concluding our observations, the Coordination emphasises the need to massively strengthen the human resources committed and structures deputed to providing answers to the psychological health needs of citizens and communities, in a structural manner. We reiterate, with a strong voice, the proposal for the annual allocation of at least 5% of the national health fund to Mental Health, as already established - but never implemented - in 2001 by the Unified Conference. Likewise, adequate coverage must be found for the resources needed for those mental health needs that do not fall within the Mental Health Departments, such as the Consultatories, hospital psychology, first-level psychology, etc. Finally, as Psychologists, Directors of Complex Structures, we ask that the provisions of Law No. 176 of 2020, which establishes the "Corporate Psychology Function" be applied in all the Regions, which could perform that important function of connecting the "One Health" approach and the second-level specialist services, by virtue of its transversal dimension to the various services of the NHS".

*Spokesperson for the National Coordination of Psychologist Directors of Complex Structures of the SSN.

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