In Gemona (Udine) the 24h CSM remains without doctors. The last of the 3 psychiatrists on duty leaves January 24th. Is it closing?
President Fedriga is proud of the result.
Finally the “Lombard model” arrives in Friuli Venezia Giulia.
The “Health” insert of the Corriere della Sera of 17 December contained a significant underlining of the importance and effectiveness of the so-called “Narrative Medicine”, i.e. health practices that take place in contexts and in relationships in which doctors and staff the health worker on one side and the patient on the other talk about themselves, they talk about their experiences of treatment, of illness, of feeling ill. “Narrative Medicine” differs from medical practices which are limited to the collection of medical history and diagnostic tests, diagnosis and therapies, in application of protocols developed, updated and indicated by scientific societies, according to procedures and standards. of a so-called “evidence-based” medicine.
The fact is that illness is not just a feeling of illness based on biological damage, but also a set of meanings attributed to it by those who suffer from it and by the networks of relationships that surround them. Taking this into account favors adherence to treatments, and therefore their effectiveness. For this reason it is important to know how to recognize and valorise the complexities and riches that lie in the doctor-patient relationship, but also more fully, between a multi-professional healthcare structure (not just doctors, not just healthcare personnel) and the person who is ill with his emotional and social relationships.
“Narrative Medicine” due to its methods and purposes is certainly a constitutive feature of the Italian territorial mental health services whose work has allowed the closure of mental asylums. All this has required and continues to require keeping clinics open at least 12 hours a day, every day of the week, residences with various degrees of protection, life and work paths towards the maximum possible autonomy, going to visit people at home in charge of DSM who, therefore having an adequate supply of personnel, are put in a position to plan and carry out the necessary and useful interventions. According to the national objective project for mental health of November 1999, a good DSM must be able to count on the standard of 1 dedicated operator every 1500 inhabitants, i.e. 67 every 100,000.
As Andrea Casadio wrote in the newspaper “Domani” on 22 December last, over the last fifteen years, successive governments have made a series of merciless cuts that have taken over 37 billion euros from the National Health Service, and things have gotten worse precipice: the latest data from the Ministry of Health tell us that 28,807 operators are now in service (57.4 per 100,000), of which 25,754 full-time employees, 1,789 part-time and 1,264 in the private sector. Compared to the standard set, at least 4,600 are missing. According to the Cittadinanzattiva Health Report, one in 4 psychiatric patients reports having had difficulty accessing public care, almost one in 4 citizens complains about the poor quality of care provided in mental health departments and centers, due to reduced hours of assistance , in terms of number and frequency of meetings, for a treatment almost always entrusted exclusively to pharmacological therapy”.
How do the Regions deal with the “Mental Health Services” emergency? The case of the Lombardy Region is eloquent.
The Coordination of the Directors of the Lombard DSMDs has denounced the lack of 300 psychiatrists and 2000 nurses, psychologists, educators and social workers in the entire public services of the Region: almost half the number of operators who should be present and active. And, on the Milanese pages of the “Corriere della Sera” of 18 December last, the condition of abandonment in which psychiatric patients in the care of the Departments of Mental Health and Addiction (DSMD) of the city of Milan have found themselves for some time was highlighted: for each of the tens of thousands of people with psychiatric diagnoses registered in the mental health information system, a personalized health project should be planned, discussed and agreed with the relevant mental health centre, which may include not only outpatient visits, but also home visits, opportunities for residence in protected accommodation as well as with family, accompaniment in work and whatever is useful for the best possible quality of daily life.
With the shortage of operators highlighted, this means an increase in the workload not only on the operators on duty, but also on the patients’ families, the cutting of the time dedicated to meetings, listening and interventions at home: a real disaster for the the impossibility of guaranteeing effective management and personalized health projects. As well as, evidently, the impossibility of a Narrative Medicine.
The Lombard Regional Council recently approved the Regional Social and Health Plan 2023-2027, a document of around seventy pages, three of which are dedicated to “Mental Health“, part of the chapter entitled “Social and health interventions”. The DSMD is confirmed as the “fulcrum of the system”, the importance of local services and the “reorganization of interventions by therapeutic, rehabilitative and welfare intensity” into first and second level services is proposed. The problems are highlighted:
– the management of aggression in the emergency room and restraints in the SPDC;
– of overcoming the OPG through the Residences for the execution of security measures (REMS), without however making any commitment regarding the need to put an end to the concentration of all the Lombard REMS in the former OPG area of Castiglione delle Stiviere and with a only mention of “strengthening mental health activities in prisons”
– the adaptation of child and adolescent neuropsychiatry to the health demands posed by the younger generations, especially with regard to the issue of pathological addictions. In particular, Child and Adolescent Neuropsychiatry (NPIA) teams must be established in all hospitals. They must build shared paths with the departments of psychiatry, paediatrics, emergency rooms and other structures involved in acute care, particularly for situations of substance addiction and social vulnerability or migration;
– strengthening the presence of DSMD operators in prisons.
Nothing or almost nothing is said about the urgent, necessary work for the mental health of migrants and daily life in the CPRs of Milan.
Finally, the objective of “strengthening the recruitment of medical and non-medical healthcare personnel by also supporting the strengthening of the training offer” is declared, strengthening programming in synergy with the Faculties of Medicine of both public and private Lombard Universities.
Faced with the dramatic data regarding the lack of operators, as also reported in the Lombard press, the 2023-2027 Social and Health Plan of the Region seems to recognize the existence of the problems, but at the moment it does not contain commitments, financial or otherwise, essential to get out of a situation that sees DSMD on the verge of collapse.
Mantua, 28 December 2023