by Andrea Angelozzi
18 GEN –
Dear Director,
in Quotidiano Sanità, the President of the CNOP David Lazzari worriedly points out the small number of psychologists foreseen in the territorial standards indicated in thelState-Regions agreement on personnel standards for mental health services of 21.12.22. Moreover, I personally struggle to understand how these standards integrate with the others indicated in the “Guidelines for the function of Psychology in the NHS” drawn up by the Working table for Psychology set up at the Ministry of Health and arrived at the table of the Unified Conference which was reported by Quotidiano Sanità, where, for local services, there is one psychologist for every 9,000 inhabitants in the Community Houses and one for every 11,000 inhabitants for specialist services.
But apart from the mathematical conundrum of the various parameters indicated in ministerial documents which are only a few months apart, there is also another aspect which seemed important to me to dwell upon. In fact, Lazzari indicates that the corporate psychology function of the Health Trusts is a pure coordination action without subtracting resources from specific structures such as the Mental Health Departments. However, if we carefully read the “Guidelines for the function of Psychology in the NHS” drawn up by Working table for Psychology set up at the Ministry of Health and approved at the table of the Unified Conference which was reported to us on 18 October 2022 Health newspaper, the question appears a little more complex.
The document, which explains the objective of making psychological activities a public health service within everyone’s reach, indicates, in the establishment of this function, the purpose of “organizational optimization and maximum integration of psychological skills and activities with the overall activities of the SSN” that enhances a logic of “network system”.
In fact, this change offers large risks of separation and fragmentation with regard to mental health.
The indications for Hospital Psychology Services had already given rise to autonomous structures with respect to the Mental Health Departments. It is true that the field of psychology in the hospital environment is not identified with that which the DSMs are now dealing with, but it is also true that it has always been emphasized that “psychiatry” does not exhaust the concept of mental health, and is the latter broader vision that Mental Health Departments by definition should address.
The desire to preserve the autonomy of Hospital Psychology conversely operates an even more psychiatric identification of the DSM, collaborating, together with many other factors, in the progressive restriction of its functions to a medical/welfare approach that deals above all, if not only of serious pathologies and chronicity.
One of the senses of Law 180 was precisely that of breaking the separation between the institutional psychiatry of the asylum, which had to deal only with serious pathologies, and the other subjects disconnected from it (the neurologists, clinics and private therapists) who dealt with the other psychiatric pathologies. The dismantling of the reform law continues, under the somewhat inattentive eyes of mental health workers.
The document on the function of psychology is based on art. 20 bis of Law No. 176 of 18 December 2020, which in fact went largely unnoticed, with which “in order to guarantee individual and collective health and psychological well-being in the exceptional situation caused by the COVID-19 epidemic and to ensure psychological services, even at home, to citizens and health professionals, to optimize and rationalize the professional resources of employed and contracted psychologists as well as to guarantee the activities envisaged by the essential levels of assistance (LEA) [….] health agencies and other entities of the National Health Service can organize the activity of psychologists in a single corporate function.”
The Guidelines subsequently implement and regulate this Company Function, indicating that it is in fact responsible for the technical-professional coordination, the planning and verification of the interventions of the psychologists in the company as well as the organization and management of the functional and professional integration of the psychologists with other Units .OO. corporate.
They are also responsible for monitoring their activities, improving the quality of processes and preparing an annual training plan in compliance with the provisions of the national ECM legislation. As for the relationship between the corporate Psychology Department and other health services and not, this will be implemented through the definition of collaboration protocols.
The Corporate Psychology Function will therefore indicate the functions, services and time that the Psychologist must dedicate to the multi-professional team; to describe the activity for which the Psychologist is responsible within the multiprofessional team; the procedures concerning the type and modality of psychological management and data collection; indications on procedures to ensure continuity of care; the collection of activity data in the corporate information system. If we want to understand it as a pure “coordination” function, we can certainly say that it is understood in a very broad and incisive way …
Therefore, from what seems to be understood from the 91-page document, in which the DSM is mentioned only in a table, where the prevailing activities in that area are described, for the psychologists currently present in the Mental Health Departments, there is the possibility that no longer refer to these, but to the corporate Department, for the definition of the operating areas, the methods of intervention, multi-professional integration or training, .
We are certain that collaboration and common sense will prevail in local implementation, but it cannot fail to strike that in a situation in which the “strengthening of the DSM” is a sort of saving mantra repeated everywhere and which operators consider a reassuring guarantee, in fact such an important professional figure within it runs the risk of becoming a hybrid with multiple references, where it is indicated that outside the DSM it is defined what he will do in the DSM, how and with what training.
These are completely new scenarios for the DSMs, where the specificities require strong operational integrations and choices shared internally, which in fact can radically change not only their functionality but the same constitutive logic of the Departments.
It is singular that, while the majority of psychiatrists defend the current organization to the bitter end, the Ministry, through working tables in which psychiatrists are absent, introduces the changes in general silence, and certainly not marginal ones.
Andrea Angelozzi
Psychiatrist
January 18, 2023
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