by Giorgio Bianconi
24 GEN –
Dear Director, it is
exciting for those who, like me, who as director of a Mental Health Department, participate in the media “chorus” on the need for adequate and coherent health planning in the organization of services and resources, against the “deregulation” left to decisions of individual local realities.[1]
This is the central point: now politics has a new opportunity to produce policies able to tangibly respond to the needs of that 20-30% of the population who suffer every year from a significant clinical condition attributable to mental pathology.
The call is therefore welcome and with it the possibility of other Manifestos in its support: if we raise our heads, patients, family members, associations and all those who recognize the protection and care of mental health as a right and as value to guarantee the share capital.
But there is another aspect, still in the shadows, which I believe it is necessary to re-propose today and perhaps bring back in the difficult work that will follow this media phase: we (psychiatrists) have already had good opportunities. I refer to the National Action Plan for Mental Health[2] of 2013 and the Document of Care Pathways[3] of November 2014. These are documents of great value “regulatory”, produced by technical tables under the political aegis of the Joint Conference. How much the Mental Health Departments have actually worked to ensure the widespread and systematic application of their contents in services in favor of the Essential Levels of Assistance and the required Care Pathways (even in historical moments in which the problem of resources was not as binding as today )?
That was certainly an opportunity to start the health planning in the organization of services and resources above, an opportunity that is certainly not exploited for various reasons that today it would certainly make sense to recognize and overcome. Reasons that someone has pointed out to us more than once: out of dutiful neutrality, I am referring only to the Academy (Bocconi), which both in 2017[4] as in 2022[5]points out that “the insufficient homogeneity of the discipline in terms of vision, designs and models can help to understand a certain difficulty perceived by psychiatry in interacting with the health system as a whole, despite the growing attention that the topic of mental health receives”. And what’s worse,”In the absence of a sufficiently defined and articulated idea of what it would be important to obtain, the requests, inevitably weak in the competition, remain only those relating to a generic attention and an increase in resources allocated to the Departments”.
And the epidemiological reflection confirms: the QUADIM study[6] points out that “the Italian mental health system could be improved by increasing accessibility to psychosocial interventions, improving the quality of care for first-episode patients, focusing on somatic health and mortality, and reducing regional variability”. Therefore, not only resources, but also the most scientific and homogeneous possible organization and practice in services, such as to guarantee an equally homogeneous clinical governance, against the risky and unfortunately frequent recourse to creativity, which today (in the time of EBM) is more an expression of organizational desperation than a productive search for innovations and changes.
What to do? The 91 Directors of the “Letter”[7], possibly under the aegis of the Scientific Societies (of which the most serene and fruitful approach is desirable) confront each other, inspired by the need both for homogeneity and for shared intentions and practices, starting the new road from the good things we (unfortunately still) have in the drawer. This will certainly be the stimulus for a “loud and clear” dialogue with politics, with the services and professionals who work in them, with the Managements of the Healthcare Companies towards real change. And the resources that will arrive will find the most fertile ground in which to best guarantee the protection of mental health and the required treatment, in a clear perspective of effectiveness and efficiency.
George Bianconi
Director of the Department of Mental Health and Addiction
ASST Ovest Milanese
Note:
[1] PRESS RELEASE of the Coordination of Directors of Psychiatry of the Lombardy Region, of the Italian Society of Psychiatry and its Lombard section (SIP-LO)
[2] National Action Plan for Mental Health (PANMS), Joint Conference of 24.1.2013
[3] DEFINITION OF THE CARE PATHS TO BE ACTIVATED IN THE MENTAL HEALTH DEPARTMENTS FOR SCHIZOPHRENIC DISORDERS, MOOD DISORDERS AND SERIOUS PERSONALITY DISORDERS, Ministry of Health, 13.11.2014
[4] Pacileo G., Tozzi. VD (2017), Mental health in Italy. Managerial challenges and perspectives in changing healthcare, Milan, Egea.
[5] Del Vecchio M. et al. (2022), Needs and service models in transformation: the role of Mental Health Departments, OASI Report.
[6] Lora, A. et al. (2022), The quality of mental health care delivered to patients with schizophrenia and related disorders in the Italian mental health system. The QUADIM project: A multi-regional Italian investigation based on healthcare utilisation databases. Epidemiology and Psychiatric Sciences, 31, E15. doi:10.1017/S2045796022000014
[7] Mental health. “Urgent resources for over 2 billion for the next three years”. The appeal to the institutions of 91 Department Directors, Quotidiano Sanità, 11 January 2023.
January 24, 2023
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