The next government must be very clear that if Italy’s health system is to be ‘saved’ from health, pandemic and now economic crises, this must begin, before any other sector, with an intervention dedicated to mental health. We have already entered a social phase in which thousands of families, companies, entrepreneurs, citizens see their work, their future at risk. And the consequences of this will be psychic, soon after economic. This letter starts today, October 10, on the occasion of the World Day on Mental Health, and – also – of the Global Mental Health Summit, which in two days will be hosted by our country, in Rome.
The numbers
Each year 84 million Europeans are affected by a mental health problem, around 80,000 people die from mental disorders and later from suicide. The pandemic has worsened global mental health for those who previously had obvious difficulties in accessing care, now that the disorders have greatly increased, even more people are not receiving timely and adequate treatment due to negative attitudes towards children. mental health services, its treatment tools with still very evident gaps between the various countries of the European Union. All this while confirming the estimate that by 2030 depressive disorders will be the main cause of disability in high-income countries.
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Despite these well-known numbers, in Italy for years we have been observing a progressive structural failure of many of the territorial and hospital articulations of mental health: a drop in departments from 183 to 141, a significant reduction in hospital beds around 10% ( -400), an increase in all residential situations and non-return to normal life.
The State-Regions conference has (had) set the quota for mental health of the national health fund at 5%, which for 2022 is 122 billion euros. Not only a largely insufficient percentage (in Europe we are at 10%), but regularly disregarded, a chimera: the average effective allocation of the Regions is in fact about 3% on average.
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Users have fallen inexorably from 850,000 in 2017 to less than 730,000 in 2020 of which a large percentage are over 45 and this is not a good sign as an indicator of a slow loss of appeal for public facilities with obvious damage to all mental health
To all this is added the flight of medical and nursing staff from departments already under staff for years, so much so that in 2025 there will be another 1000 psychiatrists between retirements and resignations as emerges from a recent study by Anaao-Assomed and about 9000 nurses, psychologists, social workers, rehabilitation therapists.
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These conditions of impoverishment have caused a slowdown in social and health integration, support for housing, work inclusion. In fact, a series of opportunities for the recovery of the suffering people have been lost sight of, failing what should be the central pivot of a public health policy.
The network of public mental health services appears to be poorer and poorer, less and less capable of intercepting youth mental illness which, in particular with the pandemic, represents a real emergency.
The possible solution
A paradoxical situation that needs to be handled with absolute urgency. And the first step – 44 years after the psychiatric reform – is to take stock and activate a National Agency for Mental Health that can fully review the sector and that only a political government, facing a new legislature, can plan. The values must be those of the National Agency for Territorial Cohesion. The government that will do so will be the first to declare mental health a fundamental right of people. A legacy of civilization for future generations.
All this after recognizing the need for mental health within the current PNRR. Because, for now, the DM 70 and DM 71 are just statements, and none of these forms of investment provide for new personnel or finance local services, the foundations of a close and supportive community.
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A National Agency, therefore, that coordinates the activities essential to meet the mental health needs of the country, and the Regions, so that they guarantee comparable quality standards for psychiatric care and shared diagnosis, treatment and assistance (PDTA) paths , so that proven levels of care and assistance are guaranteed and made payable in all mental health and addiction departments with evidence-based intervention models that ensure concrete treatment results. A National Agency that promotes mental health, with funds for prevention projects but also for culture and education starting from schools.
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A National Agency that cares about the mental and physical health of pregnant women, to fight material and social poverty, to guarantee childbirth assistance by reducing the associated risks, to promote screening in schools, demonstrating the importance of early recognition of trajectories that can become pathological both in the context of affective disorders (depression, bipolar disorders) and neurodevelopmental disorders (autism, ADHD, psychotic onset).
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Finally, a National Agency that establishes that in order to defend the right to health and guarantee its collectability, it is also essential to make personnel resources available.
There is no more time to procrastinate on this issue.
The Italian Society of NeuroPsicoPharmacology