“What is the discomfort of feeling looked at badly? For many patients with mental illnesses it is often an internal sensation linked to the pathology. But very often it is also linked to society. Indeed, perhaps more to society than to the pathology”. This is said by Carlotta Palazzo, psychiatrist and head of the Social Psychological Center (CPS)-4 in Milan – ASST Fatebenefratelli-Sacco which follows 1100 patients. Today, on the occasion of the centenary of the birth of Franco Basaglia, the promoter of psychiatric reform in Italy, Palazzo tells us what the challenges of mental health care are in the area.
Dr. Palazzo, why are CPSs important?
“The Basaglia law had the enormous advantage not only of closing mental institutions, but also of passing the message that the place where a patient is treated is important. If we find ourselves in an ugly and bare closed place, we cannot help but identify with it. This is also why mental hospitals were not functional. Another concept he introduced was territoriality: if a patient needs psychiatric care he cannot travel 20 kilometers to receive it, but must be able to find it in his neighbourhood. Over the years it has the concept of mental health has also evolved, which is no longer just the absence of symptoms, but also includes integration into society, which is what we try to do in the CPS”.
What is needed to promote integration?
“We must first understand what patients want: whether it is better care, employment or autonomy. And to do this we must change perspective, work in a multidisciplinary way and not only consider the therapeutic aspect. We need social workers who deal with employment and re-schooling. Unfortunately, psychiatric pathologies begin at an extremely young age and very often those affected interrupt their education.”
So is there a need for 360 degree management?
“Yes. A concept that I find very beautiful is that of emotional residence. The outskirts of cities are full of solitude, but the greatest solitude occurs when you don’t know where ‘your heart lives’, for example when you perceive the own home as a tiring place to be in. Well, for many of our patients we are an emotional residence: a place where they can come to rave, but also to build. We want them to feel the CPS as a home, not as a a place of containment like the mental hospital was. Hence the need to improve the environments: for this reason we joined the ‘Let’s color the places of mental health‘ project, which involves the redevelopment of the spaces”.
What did this mean for you and your patients?
“I see a parallel between the plasticity of new environments and the idea of being plastic to change. The CPS is not a space just for patients or just for operators, but for everyone. Furthermore, the images painted on the walls come from the competition People in Mind (in which everyone was able to participate: patients, caregivers, operators. At the beginning some patients looked at the new spaces with fear, but working on the acceptance of change is also part of the treatment process”.
In addition to the works, there are also sentences on the walls of the waiting room…
“They are not slogans, but messages for patients in what could be the most difficult 20 minutes of their life, before having a psychiatric interview. We have chosen messages of welcome and openness to make them understand that their discomfort is listened to , that they don’t have to do it alone, as current society often suggests. That we are here for them and that somehow a solution will be found.”
The mural behind him depicts an embrace, why did you choose this work?
“The first thing that is lost in mental illness is the ability to desire, to think about the future. Those with a mental illness often spend all their energy in resisting the symptoms: they no longer imagine, they no longer dream. In 2024 we cannot think that there are young patients who cannot hope to work, have a home, or live independently. This work therefore represents precisely what we are trying to do here: protect their dreams. And make sure that their hearts feel in a valid place.”