by Daniela Rebecchi
02 MAG –
Dear director,
with the Decree of 27 April, the Minister set up a new technical table for mental health to ensure efficiency and effectiveness with respect to emerging mental health issues and to improve the quality of services through the implementation of prevention, treatment and rehabilitation pathways, in collaboration with the institutions, the bodies in charge, the scientific societies, the regulatory agencies, the associations of family members, the voluntary sector and the third sector.
One of the problems awaiting the table is how to provide citizens with interventions that are not only pharmacological. The official SISM 2019 statistical data indicate that psychological/psychotherapy interventions represent only 6.4% of the total services provided in mental health services. If we consider all users with serious diagnoses (severe depression, personality and behavioral disorders, mania and bipolar disorders, schizophrenia and other functional psychoses), it emerges that only 2.4% of these have received at least one treatment psychological/psychotherapy.
This despite the fact that in the document approved by the State-Regions Conference on 13 November 2014 in implementation of the PANSM it is recommended that for these disorders, in each of the three phases of the disease (early management, management of the acute phase and continuous and long-term treatments), psychological/psychotherapy treatments are foreseen, in many cases considered elective.
The latest SISM data available (2020) do not show significant changes as psychological/psychotherapy activity continues to represent only 6.2% of the total services provided in mental health services and that relating to psychological services aimed at users with serious cases stands at 3.2%.
A situation that goes against scientific evidence, international guidelines and the wishes of citizens, who, especially in the most common anxiety and depression disorders, prefer and require psychological/psychotherapy treatment in over seven out of ten cases.
A situation that is not in line with the legislation and with what the State and the Regions should guarantee to citizens: “the National Health Service guarantees people with mental disorders multidisciplinary care and the carrying out of an individualized therapeutic programme, differentiated by intensity , complexity and duration, which includes the services, including home, psychological and psychotherapeutic necessary and appropriate” (art. 26 of the Essential Levels of Assistance LEA).
Today in the NHS out of 4790 psychologists psychotherapists (Ministry of Health Statistical Yearbook 2020) 2058 work in adult mental health services and the others are distributed in other territorial contexts (childhood, counseling clinics, addictions, hospices, etc.) and hospitals.
A largely insufficient number both for mental health and for the wide range of activities that contemplate the presence of psychological skills within a logic of integration and networking and teamwork. Just browse through the LEAs to realize the situations and the number of articles that call into question psychological interventions for prevention, promotion, diagnosis, therapy and rehabilitation.
In the specific of adult mental health (from 18 years of age) the situation sees a substantial impossibility of providing users with evaluations and interventions of this type if not in a completely residual measure, with serious damage with respect to the concept of both clinical and economic appropriateness, given the evidence on long-term efficacy in many situations, the economic advantages and the benefits of combined drug-psychotherapy treatments.
It is true that the situation of mental health services needs to be improved and strengthened as a whole, even with a greater connection with social and employment services, with measures adapted to the evolution of needs, but all this requires greater integration and not the underestimation of an essential component such as the psychological one.
It is also true that the CSMs do not deal with all situations of psychological distress, which are more articulated in the different contexts and services of the NHS, but they undoubtedly represent a fundamental component of the response to these problems.
Unfortunately, the signs are not encouraging if one looks at the recent State-Regions agreement of 21 December 2022 which implemented an Agenas document drawn up without the involvement of psychological scientific expertise or societies, which established in adult mental health services (CSM and SPDC) a parameter of a psychologist-psychotherapist every 20,000 inhabitants (!!). While the standard of psychiatrists (6633 under regime) and that of the rest of the staff (nurses, educators, OTA/OSS, social workers, etc.: 30,864 under regime) appears measured to the new needs, that of psychologists-psychotherapists (2494 under regime) rather it appears to highlight a sort of renunciation of dealing with these aspects. A paradoxical situation when speaking of “mental health” services.
Will the new table be able to reverse this situation? Guaranteeing not only adequate numbers but an integrated approach (which includes the “psycho” between the “bio” and the “social”) and not only pharmacological for people with mental problems?
Looking at the composition of the new Table, one would have doubts and concerns, certainly not for the quality of the people (which is not in question) but for a substantially single-professional composition. We must and we want to hope that the components of the Table are able to “go further” and guarantee the necessary comparisons, bearing in mind that it is not a question of “satisfying” this or that component but of reading the real needs and giving appropriate answers, a primary requirement of every public service that is based on general taxation.
Daniela RebeccaFormer Director of Clinical Psychology Service AUSL Modena
Member of the CNOP Health Workforce
02 maggio 2023
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