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Eating disorders, suicidal ideations, suicide attempts and self-harm. Often grafted onto depressive syndromes or mood disorders. It is children and young people who suffer more and more. An escalation of cases which is also a heavy legacy of the pandemic and the health emergency, with the forced isolation imposed by the lockdown, the rarefaction of relationships with peers, the stop to school and sporting activities. But faced with this boom in cases, the National Health Service is not ready.
Double the number of beds is needed
Today, as explained by Elisa Fazzi, president of Sinpia (Italian Society for Child and Adolescent Neuropsychiatry), 10% of the total pediatric hospitalizations are due to neuropsychiatric disorders, with a significant increase in the prevalence of mental illnesses, as noted by the Abio Italia Foundation. «Hospitalizations for anorexia have tripled, as have those for attempted suicide and self-harm», says Fazzi. An emergency that finds our healthcare completely unprepared. At least half of the beds in the child neuropsychiatry departments are missing, only now does a national information service seem to be close to being released to collect timely data and bring order, remedying serious inefficiencies. «The strong increase in requests is completely saturating the available places and is compromising responses to serious and complex disorders for which specialist expertise is essential», continues Fazzi.
The shortcomings of the Health Service: the numbers
There are currently just 403 ordinary child neuropsychiatry hospital beds throughout the country. Completely insufficient to cope with the progressive increase in cases. At least 700 would be needed. And even this allocation would, in any case, only be a minimum threshold to deal with at least the most urgent situations. It follows that many children and adolescents are admitted to adult wards: 30% of the total. «A seriously inappropriate placement according to all the indications of precision medicine», observes Fazzi. Yes, because the teams in the adult departments are not trained for a type of relationship with the young patient that involves the whole family, which in the therapy analyzes the social context, the relationship with parents, with peers, the behavior within of the school. It is one of the cornerstones of childhood and adolescent neuropsychiatry: the child’s disorder is often the tip of the iceberg of dysfunctional relationships within the family unit or in the social context.
Admissions to adult wards are a trauma
«Almost always – warns Fazzi – hospitalization in an adult ward, not equipped to welcome and involve the family as happens in a facility for children and adolescents, constitutes a serious trauma for the young patient». Conditions aggravated by the fact that psychiatric disorders appear at an increasingly earlier age. Anorexia, for example, now manifests itself even at eleven or twelve years of age, causing victims not only among females but also among males, even if the former remain prevalent. «The great suffering of children and young people during the pandemic was also manifested in the drawings – explains Fazzi -. Terrible, distressing drawings, which also express all the concern for the health of the family, for their future work, in a state of isolation and great insecurity.”
Commitments not met compared to needs
In the general and serious shortage of beds in the departments responsible for child neuropsychiatry, the regions that do not even have one stand out. Umbria, Calabria, Abruzzo, Basilicata, Valle d’Aosta: here is the desert. As for the few departments that exist in Italy, they should be recognized as having a high intensity of care and the local services, according to specialists, should be strengthened with at least one complex unit for every 150-250 thousand inhabitants, with complete multidisciplinary teams. Yet everything is at a standstill despite the guidelines developed by Sinpia itself four years ago, in 2019. A document that dictates the minimum conditions to be guaranteed. That document was examined and discussed by the Unified State-Regions Conference, which approved it again in 2019. «We have been waiting since then – concludes Fazzi -. Those guidelines have not yet been implemented at a national level.”