Home » Needs for personnel and services for Mental Health: the number of psychologists foreseen is inadequate

Needs for personnel and services for Mental Health: the number of psychologists foreseen is inadequate

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Needs for personnel and services for Mental Health: the number of psychologists foreseen is inadequate

by David Lazzari

17 GEN

Dear director,
there has been much discussion, also in these pages, of the implementation of the law on the “corporate Psychology function” (law 176/2020), i.e. the coordination in each healthcare company of all the psychological activities of the NHS in order to be able to optimize their delivery .

A discussion that must always be done from the point of view of the citizen and the health needs he expresses and addresses to public health. This is the point of view of the Essential Levels of Assistance of 2017 which provide for the presence of transversal psychological skills, which concern prevention and treatment, all age groups, physical and mental health problems, disabilities and chronic conditions, disorders ranging from of psychological distress are to the more serious mental illnesses.

A transversal presence needs adequate forms of coordination to optimize resources that have a 360° view of the services and activities of the healthcare company and are also able to perform functions for the organization as such (relational quality, work stress and burnout, communication, etc.).

In the debate on this issue, unfounded criticisms have sometimes been heard, such as those who would hypothesize that this coordination would remove psychologists, who are also all psychotherapists in the NHS, from mental health services. Without foundation because it is clear that coordination is one thing and the presence of professionals in the structures that provide the services is another.

In discussing the optimization of the (few) psychological resources, it was pointed out that most of them, by virtue of the tasks performed, have already been in services other than mental health for some time: out of the 5,000 NHS psychologist managers who result from the data more recent than the Ministry of Health website, only half work in the DSMs.

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Two documents have come out in recent days which shed light on the strength of numbers and which speak an obvious language, even if not entirely acceptable.

The first is the State-Regions agreement on personnel standards for mental health services dated 12.21.22 but which has been released in recent days. This programming document indicates the standards that concern the territorial mental health services and hospitalization (SPDC): well, (also considering the DSM clinics in prisons) 41,448 operators are expected, of which 6,795 psychiatrists, 31,181 among nurses, OSS, psychiatric rehabilitation technicians, educators, social workers) and 2,647 psychotherapist psychologists. The proportion is: 16.4% psychiatrists, 75.2% nurses and others, 6.4% psychologists/psychotherapists (the percentage missing at 100% is administrative). This means that out of 100 operators, the foreseen psychotherapist psychologists are just over 6.

If we look at the data from the Ministry of Health‘s annual Mental Health Report alongside this, we find that 29,785 operators currently work in the DSMs, of whom 17.9% are doctors and 6.9% are psychologists and psychotherapists, with a workload in relation to users (calculations of Il Sole24ore) of one doctor for every 182 users and one psychologist/psychotherapist for every 284 users.

These data appear completely inadequate for a truly multidisciplinary treatment of mental illnesses already today, but above all those of the State-Regions agreement of 21 December 2022 show that the model of treatment of mental illnesses dealt with by the DSMs will not substantially change at a territorial and hospitalization level, today almost exclusively pharmacological due to lack of psychological-psychotherapy resources.

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Obviously we are not at all satisfied with this perspective which limits psychiatry and psychology and penalizes users, also due to the growing evidence on the role of the psychological-psychotherapy approach to the most seriously mentally ill and their families. Without an adequate number of psychotherapist psychologists, psychiatrists will be practically forced to adopt almost exclusively a certain type of approach and psychologists to follow only the most serious and urgent cases.

Partially different is the situation regarding child neuropsychiatry, which is also the subject of the State-Regions Agreement, where a standard of neuropsychiatrists and psychotherapist psychologists is set at 6 for every thousand underage citizens, which means 6,000 professionals nationwide.

What to say? With these numbers it is clear that the choice of the Government and the Regions is to respond in terms of prevention, listening, support and psychological therapy to the many situations of discomfort and the most common ailments, which today affect a large segment of the population in contexts different from the typically psychiatric ones, as largely already happens today. Just think of the family counseling centres, the psychological ones, the psychological services present in many territorial realities and in many regions.

However, this situation appears very fragmented and does not constitute a clear reference for the psychological needs of citizens, just think that the counseling centers are very far from the expected standards and in half of them there are no psychologists due to lack of staff, or in hospitals where compared to over a thousand psychologists who work there, only a third is hinged on structured psychological services, identifiable as such by users and capable of optimizing activities.

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Obviously there are local needs but the citizen looking for a psychologist should know clearly where to find him from Aosta to Ragusa, both in primary care and in community houses up to the hospital. Many Regions have activated basic psychology services and now a national framework law is needed, just as it is hoped that a State-Regions agreement will soon be reached on the “corporate Psychology function” which is in progress.

If the point of view is that of the needs of the users and the optimization of the responses, it is necessary that these nodes be quickly defined, overcoming the limits of the traditional “silos”, with new logics open to a sensitivity that is by now very widespread in the population.

David LazzariCNOP President

January 17, 2023
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