by Mario Sellini
07 DEC – Dear Director,
a document entitled: “Manifesto for mental health” has already been circulating for several months. On this document, even then, accessions and subscriptions were asked. Reading the first drafts well, the Manifesto aroused many perplexities starting from the request for adhesion and signing of what was in reality only a draft. One question: how do you sign a draft? And who will turn the draft into the final document? But these are absolutely formal and above all secondary questions.
The greatest criticality that I was able to highlight and share, even with some of the promoters of the Manifesto, consisted in the total separation between principles and reality. It is written Mental Health, it is read Psychiatry.
Discussing Psychiatry in the more general context of Mental Health is not only legitimate, but absolutely meritorious. Defining their role, areas, possible integrations with other disciplines, discussing ‘multidisciplinarity’ and ‘multi-professionalism’ is desirable.
The criticality arises when an attempt is made to establish absolute fungibility and total equivalence between a discipline, Psychiatry, and the area in which the activities of this discipline, Mental Health, are implemented.
It is not a transparent operation to represent a part, Psychiatry, even if fundamental, for the whole. To tell the truth not even all of psychiatry but a part of it.
And it is at this point that the accounts do not add up. They don’t come back because the field of Mental Health includes very different disciplines and subjects, professional and otherwise.
Just to remain in the disciplinary field, there are at least three other disciplines called to carry out roles and functions in the field of Mental Health: Psychology, Child Neuropsychiatry and Psychotherapy.
In the professional field, the protagonists are even more numerous than the disciplines: nurses, psychiatric rehabilitation technicians, social workers, OS, animators, psychologists, etc. And then there is the whole world outside Mental Health that must be included in the assistance processes: families, voluntary associations, private health and social health care, the world of cooperatives, etc.
It is a mistake to reduce this world, the whole world of Mental Health, to Psychiatry or a part of it.
These critical issues, already present in the very first drafts of the Manifesto, were confirmed and accentuated in the Conference for the presentation of the Manifesto, organized in Naples on 4 December.
Criticalities accentuated by a further element that emerged during the Conference and made explicit by interventions by representatives of the world of Psychiatry: the equivalence between Psychiatry and Mental Health, which in itself cannot be proposed, has become, in the Conference, the equivalence of a part of Psychiatry and the entire universe of Mental Health. The major criticisms were addressed, by some speakers, to the self-referentiality of a Manifesto which, as pointedly pointed out by a speaker, is opposed to Hidden, Invisible.
It is about Manifesto v / s Hidden, which makes disciplines, professional profiles, individuals and communities that must be and are an integral part of the Mental Health process invisible. It hides mistakes made and of which, perhaps, there is no awareness. It often hides failures.
It is true that these are criticisms expressed only by some speakers, but the fact that they are in the minority does not mean that they should not be given due consideration. Criticisms that I feel in part to share and that I expressed starting from the documents of the National Conference for Mental Health of 24 and 25 June 2021 and of which this Manifesto is perhaps an appendix.
The criticism already expressed in June, inside and outside, before and during the Conference, referred precisely to what was ‘Hidden’ to this Hiding disciplines (Psychology and Psychotherapy) professional profiles (nurses, social workers, psychologists, psychiatric rehabilitation technicians , etc.).
Manifesto v / s Hidden. When the Hidden is the large part or in any case a substantial part of the Mental Health process, there is a risk of continuing to waste a huge opportunity.
Beyond the assertions of principle, all of which can be shared, the overall framework of the approach to Mental Health seems to have returned to the pre-Basaglian era and not much is left of 180.
An aspect Hidden-Not Manifest it is the organizational model that is gaining momentum.
The territorial organizational structures, articulations of the Department of Mental Health are changing their name. By 180 these joints had been defined as Mental Health Centers, to guarantee the Multidisciplinary and Multi-professionalism of the interventions. Today they are re-defined: Complex Structure of the Discipline of Psychiatry called “UOPsychiatry”, within the Department of Mental Health.
There is no one who cannot affirm that the change in definition follows / anticipates substantial changes in the content of care.
We went from: ON (psychiatric hospital, pre Basaglia), al CIM (mental health center), al CSM (mental health center) a Complex Operational Unit of Psychiatry.
And I can affirm it with knowledge of the facts having started my professional activity as a psychologist in the OP. Subsequently to the CIM, then to the CSM and now, at the end of my career, a few weeks after retirement, as in the goose game, I find myself in the Psychiatry Unit.
Objectively, we went back 50 years.
The opportunity to give substance and substance to concepts such as “Multidisciplinarity” and “Multi professionalism”, which, although indicated in the Manifesto, are in fact emptied of meaning when their meaning is not fully declined, the components ‘multidisciplinary’ and not ‘multi-professional’ ones. Not only do they not indicate and decline, but they hide (Manifesto v / s Nascosto).
And why not insert another principle: the trans-disciplinarity, which allows you to work in an integrated way on common goals?
Really today it is possible to build a Manifesto with the participation of all the components, on one condition: that everything is truly rendered ‘manifesto‘. We are there. The professional community, about 2,000 psychologists and psychologists practicing in Mental Health, is there. We are there every day with our commitment and our professionalism. We are here to build a real shared but above all inclusive project open to all components. By users and with users.
Mario Sellini
Presidente Form-AUPI
07 December 2021
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