«There are specialist mental health services few psychologists and they have little say in the matter.” This is the summary of an investigation conducted by National Council of the Order of Psychologists – Cnop in 13 Italian regions and presented today in Rome, an event organized by Cnop in the year in which the 45th anniversary of the approval of the Basaglia Law occurs.
The data collected by the technical group “Residential Therapeutic Communities” of the Cnop coordinated by Claudio Bencivenga and by the Cnop Health working group coordinated by Donatella Fiaschi they show how it is only present one psychologist-psychotherapist for every fourteen operators and only 7 services out of 100 are of a psychotherapeutic nature. In communities for adolescents one psychologist-psychotherapist every twelve operators and in extensive communities for adults one in sixteen.
«The investigation highlights a problem and a macroscopic contradiction: the dramatic lack of figures (psychologists and psychotherapists) who should guarantee these activities. Not only in the staff in an adequate and recognized way but also in the moments of planning, planning and verification. Few psychologists and with little say in the matter», observes the president of the National Council of the Order of Psychologists, David Lazzari. «These are dramatic figures, numbers that have decreased by as much as 20% in the last ten years, and are the result of the more general trend involving mental health departments in our country».
Few psychologists and with little say in the matter. Not only in the staff but also in the moments of planning, planning and verification
David Lazzari
The studies of the last 40 years have highlighted how important an integrated therapy is for the intervention which takes into account not only the more purely health aspects, but also taking charge of the patient in his growth through everyday life, outside of ghettoizing and alienating institutions which at best had a custodial function rather than a therapeutic one.
«What is worrying is that over time we are witnessing regulations, in the various regions, which end up simplifying and trivializing the complexity of the intervention and which are, in fact, assimilating the communities more and more, in terms of characteristics and personnel, to care and hospital-like structures» observes Lazzari. «We are often faced with “flattened” regulations on what the structural characteristics must be (number of rooms, distribution of spaces) with less reflection on the specialist component of the professions that should operate in them.
«What does that adjective “therapeutic” mean next to the term community?», asks Lazzari. «The data highlights a truth that is in some cases merciless, that we are faced with “psychiatric structures” that can almost only do containment», he continues. «And rehabilitation without attention to the subjective and relational dimension, that is, to the psychological component of mental illness, to the person’s experiences, risks becoming welfarism».
We are faced with “psychiatric structures” that can almost only do containment
The economic aspect
In analyzing this dramatic picture, observes Lazzari, «it is not clear whether at the basis of this worrying drift there are cultural problems, the renunciation of a therapeutic horizon for these people (more and more often young people and adolescents), or economic pretexts . I’m talking about pretexts because years of health economics studies tell us that the lack of appropriateness in interventions increases costs, not reduces them.”
The “community-Ikea” model
The Therapeutic Community is a “family-sized” health facility (generally from 10 to a maximum of 20 people) for global voluntary treatment – psychotherapeutic, pharmacological, relational and social – which – at the request of the local services – welcomes patients preferably young and at the beginning of psychopathology, not treatable at home or on an outpatient basis, which do not require hospital treatment and which need to undergo a therapeutic and rehabilitative process through treatment
in residential care and a period of separation from the usual living context.
It is suitable for those patients who need the space and time necessary to restart interrupted evolutionary processes, to experience new significant relationships, to reconstruct, retell and give new meaning to their personal history with the aim of achieving adequate functional recovery.
The danger – but now in many cases already a reality – «is a return to a depersonalized approach to mental health, as if an internal world did not exist within people, which expresses itself by giving form to the outside”, despite the many studies and research on psychodynamic, relational and interpersonal psychotherapy. «If with the level of the norm, the psychological/relational depth of the patients’ existential interlocutor is eliminated, we will no longer be able to speak of therapeutic communities but mostly of “IKEA communities” prefabricated in series to entertain and make people stop: square, neat and very reassuring for those who have decided to embrace a naive approach to mental health issues».
Who are the new users?
«It is worth underlining that the users of therapeutic communities are characterized today more and more as young adults, these are not patients from the “residual mental hospital” where unfortunately little space remained for an evolutionary/transformative intervention”, explains Lazzari. «Daily experience in the field highlights the existence of disorders, many of which take on forms from a symptomatic point of view. previously unknown and related to social changes».
Complex clinical pictures, often characterized by traumatic experiences, think of cases connected to narcissistic vulnerabilities (daughters of our time, which “revolve” on the theme of challenge, competition and performance); to the increase in suicidal behavior and attacks on the body; disruptive behaviors made explosive by the increase in substance abuse; isolation at home; new forms of addiction; cases of high family conflict; situations generated by cumulative traumas deriving from stories characterized by repeated interrelational difficulties.
Therapeutic communities for adults and adolescents
«On the national territory, the therapeutic communities that respond to the needs of the adult population are sufficiently distributed; as far as the adolescent developmental group is concerned, however, there is still a small number with a “leopard patch” presence”, observes the president of the Cnop.
Specific training required
«Stories of suffering that require particular training both to enter into relationships than to tune into the deep needs of users. Skills that are acquired if a particular study path has been followed (if not also through personal training) where operators must be able to recognize “within themselves” what is happening to the patient, to resonate with it and restore it in thoughtful and reclaimed manner”. And instead “para/nursing figures are proposed (more suitable among other things for users characterized by a physical disability) in disproportionate numbers compared to professional functions competent in reading the internal dimensions of patients”.
Psychic containment vs physical containment
According to Lazzari, «the “psychic containment” – which means acceptance, holding, reverie, listening, mentalization, relationship, dedication, meeting – has been exchanged for the “physical containment“, for concrete, biological assistance, to “stop” the symptom, without attention and transformative listening to the internal reality of the users, their experiences, their lives, their existences. In this way we are able to propose a custodial model that sees patients as passive and not active subjects of a process.”
Perhaps “psychic containment” has been exchanged for “physical containment”, without attention and listening to the internal reality of the users
David Lazzari
In 7 out of 8 structures the total hours of health workers and nurses is greater than that of other professional figures, with the only exception being Puglia.
Research data in summary
In adult communities
As regards the “extensive” adult therapeutic communities, generally known by the acronym SRP2 Psychiatric Residential Structures, it emerged that only in 5 Regions is the figure of a psychotherapist contemplated in the workforce (Val d’Aosta, Veneto, Emilia Romagna, Marche, Sardinia).
Therefore out of 12 Regions only 41.66% of adult facilities have a psychotherapist on their staff (with a small amount of hours), in the others only a psychologist is provided (always with a small amount of hours).
In communities for adolescents
As regards adolescent SRP2 in 13 Regions analysed, it emerged that only in 7 Regions (Val D’Aosta, Piedmont, Lombardy, Veneto, Marche, Campania and Sicily) is the figure of a psychotherapist included in the workforce (in any case with a small number of hours).
In the other 6 regions the figure of a psychologist alone is contemplated (always with a small number of hours).
Therefore, in the 13 Regions analysed, 53.84% of the facilities for minors include the figure of a psychotherapist in their staff.
Top photo: Martha Dominguez by Unsplash