WHO has recently confirmed a 25 percent increase in cases of depression and anxiety in the first year of Covid worldwide. Also in Italy there was an increase in cases and a worsening of the symptoms of these disorders during the lockdown. And this is only the beginning. Yet mental health wasn’t even mentioned in the Government’s National Recovery and Resilience Plan (PNRR) at a time when the growth of severe psychiatric conditions is on the rise.
The complaint comes from the National Coordination of Italian DSM Directors, who met in Rome to represent 25,000 operators including psychiatrists, psychologists, nurses, social workers, child and adolescent neuropsychiatrists, psychiatric rehabilitation therapists. But the Coordination also offers proposals to improve the situation: direct involvement in the actions envisaged by the PNRR, allocation of adequate resources and modification of the organization of the structures that must become inclusive, because today’s problems are those of comorbidity, the coexistence of disorders differences in the same person suggests the need for collaboration between experts from different fields of health.
Teenagers, the pandemic has doubled the number of cases of depression
by Valeria Pini
These are the second fundamental points Giuseppe Duccipsychiatrist and psychotherapist, spokesperson for the National Coordination of Italian DSM Directors and director of the Mental Health Department of the ASL Roma 1.
Appropriations
No funds are foreseen for mental health in the PNRR (National Recovery and Resilience Plan), which allocates 15.63 billion to technological innovation and digitalization of the National Health Service. “It is very serious that a Plan that aims at the development of territorial medicine ignores mental health which has always been the only element of hospital-territory continuity in Italy”, says Ducci.
State-of-the-art facilities, digital and technological services are welcome but be careful because they could be completely useless if there is no one who can work there. The risk is that to make the “new” operational, one draws on the operators already involved in the DSM, afflicted for years by a serious reduction in personnel, especially doctors. We are talking about about eleven thousand fewer operators than the standard of at least one every 1500 inhabitants, envisaged by the Progetto Obbettivo 1998-2000.
The effect of the pandemic on mental health: 100,000 have given up on treatment
by Massimo Cozza
The State Regions Conference has set the mental health share of the National Health Fund at 5 per cent, which for 2022 is 122 billion euros, but in reality the average effective allocation by the Regions is about 3.3 per one hundred. 60 million have been allocated to the strengthening of the mental health Departments, which however include the 30 million for the psychological voucher, aimed at private professionals, which is transformed to a maximum of 600 euros per patient, too little to complete a therapy. Furthermore, Ducci adds: “A private intervention is not a community psychology perspective, which we would be in great need of”. Wasted money, one might say.
The increase in problems related to the mental sphere brought about by the pandemic has also heavily involved the younger sections of the population, with a 30 percent increase in emotional-affective dysregulation among adolescents. This means self-harm, cutting, suicidal thoughts, depression, substance use, and a 70 percent increase in eating disorders in children. And again introversion, hikikomori, loss of school functioning.
“Covid has also brought effects on the cognitive level, those who have made the Dad have, for example, a gap compared to those who attended school in the presence, not only a delay in school skills but also in social skills, which are much more important” he adds. “Another strong and underestimated problem is that of the increase in drug use. It would be important to develop in our country a clear policy of integration between psychiatry and addiction medicine, bodies that should work together”.
Forced migrants
According to the Italian Society of Psychiatry, the conflict in Ukraine is bringing an overload of emotional stress to Italians, already tried by the pandemic. People once again feel helpless, at the mercy of events, uncertain for the economic future and spectators of a human drama that no one knows how to deal with.
“Taking into close consideration the data, we have no significant variations in the incidence of new cases in this regard, at least not yet – adds Dr. Ducci – neither among Italians nor among people arriving from Ukraine. All the ASL have developed structures for welcome but most of the Ukrainians who arrive in our country generally find themselves in a family, with a relative who already lives here, so the effect on public services is very limited “.
The DSM of ASL Roma 1 has been dealing with forced migrants for years, with listening centers, reception centers, and obviously health care paths. “People come from Nigeria, Syria, Eritrea, Afghanistan, Kurdistan, who have suffered torture, rape, who have very serious mental illnesses, for them we are in constant connection with the reception centers and with our mediators we prepare meetings, support, paths health workers to help them “.
Opinion
The psychologist bonus? Spot project, it just has an illusory effect
by Massimo Cozza
For all the work they carry out and to continue improving it, the Mental Health Departments cannot be overshadowed but must become an integral part of the hoped-for evolution, of the actions envisaged by the PNRR, they must be present in every House of the Community., Community Hospitals, Territorial Operations Centers. And they must be helped to make up for the lack of staff: today there are less than half of what is needed. Mental health is a vast, complex and at the same time fragile system, which is why it should be protected by teamwork, by strong integration between the various health sectors, by close collaboration between different fields, from health to economics, from social to scholastic. As they say, unity is strength and, in this case, it could make a difference for many people in our country.