World Mental Health Day is celebrated on 10 October 2021. An appointment that comes about 18 months after the start of the pandemic, which has had a strong impact on mental distress, in particular for those who live alone and for adolescents, for whom it is possible to estimate an increase in psychiatric disorders of about 30%. The Complete Mental Health Action Plan 2013-2030, updated on 21 September 2021 by the WHO, indicates among the determinants of mental disorders not only individual aspects such as the ability to manage one’s thoughts, emotions, behaviors and interactions with others, but also social, cultural, economic, political and environmental factors. The slogan of the WHO campaign this year is “Mental health for all: let’s make it a reality”. This is a commitment that should also be pursued in our country, starting with greater investments of resources.
Only 3% of the NHS funding
An analysis of the latest data from the Mental Health Report of the Ministry of Health for the year 2019 shows a cost of psychiatric assistance of approximately 3 billion and 300 million, approximately 3% of the financing of the National Health Service, compared to approximately 5 billion and 500 million which would have represented the percentage of 5% shared by the Regions.
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The operators, who constitute the fulcrum for a community-type mental health protection, are about 11 thousand fewer than the standard of the 1998-2000 Project Objective. The users assisted by public services are about 830 thousand, compared to millions of citizens with psychiatric disorders, without public care due to accessibility difficulties, but also due to stigma and prejudice.
Three million depressed people in Italy
The recent report of the Italian Medicines Agency (Aifa) published in July 2021 estimates in Italy about 3 million depressed people and notes that in the course of 2020, 6.5% of the Italian population, over 3 million and 850 thousand citizens, made use of antidepressant drugs, with double consumption in women than in men. The prevalence of use of sedative-hypnotic and anxiolytic drugs in 2020 (the year of the start of the pandemic) increased by 6.6% compared to the previous year.
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The assistance network
The criticalities of the mental health services of the Local Health Authorities, which in any case represented and still represent a fundamental free national network for those suffering from serious psychiatric problems during the pandemic, are also qualitative. The biomedical reductionist approach still appears to impose itself on the bio-psycho-social paradigm, both in training and in a more general functioning of services. Too often the combination of outpatient / hospitalization prevails and too little is the social and health integration based on recovery-oriented services, with appropriate psychotherapeutic and psychopharmacological paths, but with particular attention to the living / working / socializing axis. The same family doctors should play a greater role in following the patients with less severe disorders, as already foreseen by the National Action Plan for Mental Health of 2013, too often disregarded.
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New projects for mental health
October 10, 2021 is also a day of hope, starting both from the important National Conference for Community Mental Health organized in June 2021 by the Ministry of Health, which laid the foundations for a renewed planning, and from the commitments requested of the Government by Parliament with a specific motion on mental health passed unanimously.
There is no specific chapter on mental health in the PNRR, but the principles of territoriality, proximity, home care can also cross psychiatric care, favoring its necessary implementation. The same Conference of Regions has recently given a first signal of attention, committing itself to bind 60 million for mental health projects, to be defined.
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In this context, the next world day should represent an opportunity for renewed planning also in Italy, with more certain financial resources, first of all for a hiring plan and for a retraining of services, with training to change, and more in general with a strong cultural promotion, starting from the affirmation supported by the WHO itself: there is no health without mental health.
Massimo Cozza is a psychiatrist at the ASL Roma 2 Mental Health Department Director
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