Home » Care and presence. Veronica Rossi interviews Vito D’Anza. – Mental Health Forum

Care and presence. Veronica Rossi interviews Vito D’Anza. – Mental Health Forum

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from life”

The legacy of Franco Basaglia does he still live? This is the question that arises one hundred years after the birth of the great Venetian psychiatrist, which we at VITA have tried to answer with the March magazine, dedicated to this theme. If it is true that the mental health situation in Italy is not always rosy, it is also true that there are places where the thought that inspired Law 180 is still cultivated and kept vital. One of these is the Psychiatric Diagnosis and Treatment Service – Spdc of Pescia, where no one has been connected for many years. Heading the department until a few months ago was Vito D’Anzaof the National Mental Health Coordination.

How did your experience in this department begin?

I arrived in 2005 to direct the mental health department of the Tuscany health authority – Asl3, which at the time was made up of two functional units, one in the Valdinievole, with 130 thousand inhabitants, and one in the Pistoia area of ​​160 thousand. I first started working as a facility director in Valdinievole; I arrived at the beginning of March and on the first day I went to visit and get to know the place. The second day I went to the SPDC, I found some inpatients, but above all a lady, I think she was between 72 and 75 years old, tied to the bed. So I asked the doctor on duty why this elderly person, a really quiet woman, was tied up. He replied that it was to prevent her from falling, also due to the effect of the drugs.

And this first impact with an Spdc impressed her greatly.

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Given my personal history, I am “Basagliano”, even though this word can mean many things. I come from a school, that of Naples Sergio Piro, which had made mechanical restraint an important issue to debate. So upon my arrival in the facility I began to have weekly meetings with all the department staff on the need not to tie people to the bed and to set up the relationship with the patients in a different way. TO June I made a service provision, in which I said: «Starting from today, every form of restraint will be abolished within the SPDC». On this point I also had a regional health plan for Tuscany behind me, which strictly prohibited any form of mechanical restraint in SPDCs and provided for the careful monitoring of pharmacological sedation. At the beginning I asked that if there were occasions where the operators didn’t know what to do without tying up, they would call me, at any time.

And did it happen?

In fact, except for the first year, when they called me twice, in the following 18 years they never did so again. Which means that from that month of June 2005 until the end of 2023 there was no form of mechanical restraint. I would like to underline, however, that not tying is not an issue that depends only on the SPDC. What happens inside the department is determined by what is outside, by the rest of the services, whether there is a functioning mental health center, whether there are supported apartments, a territorial network. Containment is achieved more easily if the services do not have protocols with 118 and if there is a lack of interventions in people’s living places. At the time, for example, we created a protocol with 118, in which we established that during opening hours the service must always be notified before any psychiatric intervention, so that a doctor or nurse could go to the site. , to try to reduce the number of TSOs (mandatory health treatments, ndr) and Aso (mandatory health checks, ndr). So for 18 years we have only done four/five Tsos per 100 thousand inhabitants, I think one of the lowest numbers in Italy. Then, in this way, those who arrived at the hospital accompanied by the service workers, whom he already knew, tended to be more reassured and calm. So, even if we never bonded, we also didn’t have any more sensational or more numerous aggressive episodes compared to other departments. We can therefore testify that avoiding restraint is possible.

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