«I have wanted to write to you for a long time. Certainly not to talk to you again about resources, about the flight and lack of personnel, about the misery of regional policies, about the last places that our country occupies in Europe in terms of allocations for mental health; and I certainly don’t want to tell you about it spoil system and the obscure structure of company documents.
You already know all this.
I want to talk to you – because it has been discussed for some time in our numerous and crowded meetings – about the daily efforts that people, citizens, individuals make to take care of their health while living the threat of illness without superfluous fears.”
Thus begins open letter than the psychiatrist Peppe Dell’Acquaformer director of the mental health department of Trieste, and the Mental health forum they wanted to send to Orazio Schillaci, minister of health, to the presidents of the Regions, to the general directors of health companies and to the mayors. It is an appeal for treatment to return to meaning human relationships, attention to the person and a return to active life, not just pharmacological treatment and restraint. And so that mental health is given the importance it deserves, not only within medicine, but within the entire community.
Doctor Dell’Acqua, what are the motivations behind this letter?
This letter was born from the attention and passion of a group, that of the Mental Health Forum, which has very deep roots; was born in 2003, when other of our teachers were also alive, Franco Rotelli, Franca Ongaro e Sergio Piro. We have always tried to be present in all events – increasingly inadequate over the years – for the care of people with mental disorders. There is the desire to avoid once again putting a bottle into the sea with messages that no one will read; This letter is an attempt to open up a discussion, to bring what I call “sensible words” back into the mental health space..
At one point in the letter we read that “mental health is not psychiatry”. In what sense?
Psychiatry is a specialization of medicine, while mental health indicates everything that concerns our being in the world, in relationships and conflicts. Basically, in our lives. Mental health has to do with well-being: theOms in Helsinki in 2005 he used the slogan «There is no health if there is no mental health», as if to say that the latter is the substratum without which there can be nothing; even the most serious illness is experienced differently depending on whether it exists or not. Psychiatry is limited only to the pathology, the symptoms, the treatment. Therefore, saying that mental health is not psychiatry does not mean that I do not want to talk about psychiatry – it is very important to identify a condition of discomfort in order to find remedies together with others -, but it means that we need to relaunch a treatment modality that does not the patient’s corner, who was previously locked up in mental hospitals, today in diagnoses and drugs. And in prejudice and stigma, which sometimes are built even within the person who knows they have a condition of diversity. I would like to tell everyone that we must start dealing with mental health, but not by sending teenagers to psychologists and neuropsychiatrists or by sending the elderly to get an early diagnosis of Alzheimer’s and then putting them in retirement homes. Basaglia, in a famous interview with Sergio Zavoli, responded that for him it is more important to take care of the patient than of the disease. Well, for me mental health is taking care of the patient, psychiatry is taking care of the disease.
What do you ask the administrators with this letter?
To start questioning ourselves again about the condition of people who experience an illness – not just mental -, as it is necessary for administrators to deal more with the lives of citizens than with their pathologies. To give some concrete examples, we ask that services or places of care for people with mental disorders are not at the bottom of the list of all the most indecent spaces in healthcare companies. We ask that people with mental disorders can truly enjoy their right, because it is true that 180 has recognized it, but putting strategies in place to ensure that this right is exercised is another thing. We ask that there be support for families, parents and children. That there be support in the fields of work, education and free time, in all those areas that must concern the overall good life of people, almost putting mental illness in brackets. We should relaunch and resume all the experiences that were born with social cooperation, such as the initiatives implemented to support those who experience a condition of inequality and diversity. To use somewhat dry words, we want essential levels of assistance, adequate resources and pension schemes to be put in place. But it’s all at the crossroads: either I deal with the disease or I deal with the subjects, the people, the citizens. I was lucky enough to have someone who showed me this second path at the same time as him.
The letter also talks about the operators, who approach their work with a lot of good will and then risk being distanced from the reality of the facts.
Throughout this letter the word “care” is implied, by which I mean true attention, relationship, being close to, recognizing the other. All this seems to have completely disappeared from the fields of psychiatry and psychiatric treatments. Abandonment happens as if it were the most natural thing, people’s fundamental rights are violated and disregarded when they are abandoned, closed, tied to beds, objectified. This alienates young operators, but sometimes also those who have been working longer. We also talked about this with Franco Rotelli, who I always miss, as one of my dearest friends and teachers; when we look at the kids who do medicine, sociology, psychology, nursing rehabilitation we find eyes full of light. A “Basagliano look”, said Franco. Then these young people who study for many years go to work in departments where there is a head doctor who keeps people tied up and they have to adapt to this hell, which they didn’t think still existed.
Opening photo from Peppe Dell’Acqua’s Facebook page
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