Mental health, the 2 million excluded from care in Italy need resources and personnel

On the whole, the European population declares itself dissatisfied with the care it receives; in fact, in the last year, 41% of the population reported difficulties in accessing services, due to waiting lists (considered too long for many urgent cases), high costs and lack of knowledge regarding the available health care pathways. It would be necessary to increase health care resources (in terms of the number of professionals available), to encourage direct access to services and to guarantee lasting care on the ground.

Other critical issues include the increasing incidence of new psychiatric disorders, such as behavioural addictions, personality disorders and self-harming behaviour; the long duration of untreated illness (an average of five years elapses between the first onset of psychiatric symptoms and a request for help); high levels of disability, with work and school absenteeism, presenteeism (i.e. being unproductive at work) and requests for retirement.

We are facing what can only be described as a perfect storm, and not only because new forms of mental distress are emerging for which we are not yet prepared.

Mental disorders recognise biological, psychological and social causes; from this point of view, we are still paying the consequences of the lockdown, to which is added a state of insecurity linked to the economic crisis and ongoing conflicts, all associated with a lower level of social, educational and family protection than in the past.

From a biological point of view, we now know that people with mental disorders present an alteration of certain brain neurotransmitters, a state of encephalic inflammation and alterations of the neuroendocrine system, as well as a certain degree of genetic vulnerability. Finally, we recognise certain overt risk factors for younger people, such as cannabis and alcohol abuse, bullying, and childhood abuse.

Another cause of mental suffering is loneliness, or rather isolation, a real emergency especially for the young and the elderly, which causes dysfunctional behaviour.

Investment in mental health in Italy is 3.5 per cent of resources compared to the 6 per cent required by the European Union. There is a shortage of operators and waiting lists are getting longer. The problem can be tackled by training personnel, increasing resources and improving collaboration with other professionals, such as psychologists, general practitioners, paediatricians, and rehabilitation technicians.

From a therapeutic point of view, we are facing important novelties. On the pharmacological level, new drugs are now available, such as psychedelic derivatives to treat certain forms of major depression, and new pharmaceutical formulations, such as long-acting antipsychotics to favour continuity of care.
But the most important step is greater attention to diagnosis, which in psychiatry is particularly complex. Today, the personalisation of diagnosis and treatment is possible, thanks also to the possibility of following patients through apps or through tele-psychiatry, which guarantee adherence to treatment, improve the therapeutic relationship and allow remote psychotherapeutic interventions. It is still fundamental that those who are ill seek help.

Mental health should be placed at the centre of the clinical, scientific and socio-cultural debate by implementing strategies for the prevention and promotion of mental health, especially with regard to the promotion of healthy and regular lifestyles and the reduction of psychosocial risk factors. To do this, it is necessary to break down the stigma and tear away that veil of fear and shame that still accompanies mental disorders and those who suffer from them.

* President European Psychiatric Association