by Veronica Rossi
January 24, 2023
Out of 318 psychiatric diagnosis and treatment services-SPDC, in 2022 they were the only ones that did not apply restraint, according to the census of the Club Spdc no restraint association. The situation is constantly evolving, because it is left to the initiative of individual doctors and undermined by the lack of healthcare personnel in the vast majority of Italian structures
Patients squirming, tied to beds against their will, in wards with locked doors, from which it is not possible to leave. Images like this immediately make us think of asylums, isolation structures of madness that, in our thoughts, we usually relegate to a less civilized past. Not everyone knows, however, that even now restraint is practiced in the vast majority of Italian psychiatric diagnosis and treatment services – Spdc. According to the latest census carried out by the association Club Spdc no restraint, dating back to 2022, in fact, the departments in which he does not bind are only 19 out of 318. «We notice a worsening trend», says Giovanni Rossi, former director of the Mental Health department of Mantua and now president of the association, «also historically non-restraint services struggle. At this rate, he risks blowing everything up».
Data collection must be done every year, because the situation is constantly evolving. The fate of the wards, in fact, depends on the doctor who directs them and on his work group. “On the part of the Regions there is a substantial lack of interest in mental health, which translates into a defunding, but also in a delegation to the directors of the departments,” says the psychiatrist. “Suffice it to say that, in Lombardy, the only interlocutor of politics is the coordination of the primary”. In a context like this, however, if the team changes or there is a change in management, the type of taking charge of the SPDCs risks sudden changes. «In Livorno there was one of the historic no-restraint departments», says Rossi, «but after the last change in management, we started to bond again. A gentleman, during the epidemic, died while he was in a restraint situation “(a story reported in 2021, by the former chief physician Mario Serrano, ed).
Mental health, however, should be – according to the expert – one of the main concerns of politics. “The Regions should have structures that give priority to this issue”, he says, “involving all the players: doctors, but also other operators, patients, family members, associations and volunteers”.
The changes in the organization of the Health Trusts are also putting the Spdc in difficulty. In Melegnano, a municipality in the metropolitan city of Milan where there is a no-restraint ward, for example, patients from Melzo have also converged, where the service has been closed. “For now, the SPDC is resisting”, comments the psychiatrist, “but they have a catchment area of about 800,000 people, followed by various psychosocial centres”. Due to the shortage of personnel, often the services – now throughout the peninsula – have to be entrusted to paid doctors, freelancers paid handsomely by the hour to make up for the shortage of doctors in hospitals. «This modality is contrary to everything that a territorial health service should be, especially in psychiatry», says Rossi, «in which the intervention is all the more effective the more the specialist knows the context in which he works. To deal with people with mental disorders, but also with other patients, knowing the local culture or dialect can also make a difference».
In this context in which the SPDCs are in difficulty, there is also a discrepancy between the activity of the Mental Health Centers – CSMs and what happens within the departments dedicated to emergencies. «In some territories there are rehabilitation and recovery activities, with good social networks», says the psychiatrist, «but, in the moment of the acuteness, there is restraint and a depersonalizing approach. It is as if a relationship of trust were built, but betrayed in the moment of greatest need». Not all operators, however, are aware of this dynamic. But the Basagliani do not give up. «Everything we have done, we have always achieved despite being a minority», concludes Rossi. «Even at the time of Law 180, most doctors were not in favor of the reform. He brought forward some ideas that had great support from the public opinion».
The Spdc no restraint, in 2022 were at:
Castiglione delle Stiviere (MN)
San Bonifacio (VR)
San Giovanni in Persiceto (BO)
San Severo (FG)