Home » Unasam thirty years later, new challenges. by Loredana Di Adamo – Mental Health Forum

Unasam thirty years later, new challenges. by Loredana Di Adamo – Mental Health Forum

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The conference for the thirtieth anniversary of the National Union of Mental Health Associations (Unasam), held in Rome on 22 and 23 November at the Frentani Congress Center, has concluded. Two days full of testimonies, experiences, but also full of questions, food for thought and proposals for improving the quality of life of vulnerable people and their families. And of concern for the fragmentation of the field and the urgency to find meeting grounds to rethink the organizational, participation and coordination forms to recompose the picture of multiple active and distant presences.

There were not many of us but there were many rich voices that animated the conference: those of family members and service users, those of the operators and associations and organizations present on the Italian territory, united by a common desire: the defense of inviolability of the rights and dignity of people. “A galaxy of people who are committed and who struggle to find representation”, but who nevertheless continue to be a valuable resistance to the dehumanization of treatments, as reported by Antonello D’Elia, President of Democratic Psychiatry.

Two intense days where the name of Franco Basaglia was mentioned several times. A name that is absent in universities and academies, and which is often omitted in training courses for future mental health workers. A manualistic and standardized logic of need that denies the historical memory denied to generations who were born without mental hospitals who cannot remember or discriminate, and therefore choose. The work of the Unasam associations and volunteers is significant who, in these thirty years, have been able to implement the values ​​of law 180/1978, which do not consist in learning a technique but in knowing how to “be Basagliani”, that is, in the will to assume that ethical disposition that allows us to always keep the “person” at the center without ever retreating in the face of the difficulties and limits of politics and services.

Although Basaglia is not mentioned, he shows what the path to take should be to face the unavoidable contradiction in the lives of men and women, to open a dialectic with the absurd, with the suffering and fragility that we would like to lock up again behind a wall.

The history of psychiatry took voice in this conference, through the anecdotes and experiences of the people who gave substance to that horizon of the “possible” which represents law 180, unfortunately disregarded by wicked policies. A law that must not be thought of as winning or losing, as Maria Grazia Giannichedda, President of the Franco and Franca Basaglia Foundation, invites us to do, but rather “thinking outside the logic of victory or defeat”, because as Basaglia said “this is a logic that deceives.” In fact, a law does not win or lose in itself, but requires implementation and everyone’s commitment.

A commitment that Peppe Dell’Acqua, former director of the DSM of Trieste, and one of the founders of the Mental Health Forum, also talks about, recalling the experiences of those years, the discussion and the necessary reflections between operators, and with inmates and families, to achieve that dimension of treatment capable of giving the “crazy” people back their say, and opening not only the doors of the asylum but the minds of men and women, bringing psychiatry back to its dimension of humanity.

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The same humanity that Eros Cosatto, Elio Pitzalis, Luca Papandrea and the many family members who in these two days spoke about their painful experiences, often exacerbated by the carelessness of neuropsychiatrists, psychiatrists and operators, but which instead found support and the possibility of redemption thanks to the care and concern of the people and operators of Unasam; as happened to Janila Mezzatesta who decided to study psychology and put her suffering at the service of others.

A culture of care, the one invoked in these two days, which perhaps can still guarantee a future for psychiatry, as stated by Giovanna Del Giudice, President of Conf Basaglia, and which no longer makes people say “where do I put the patient?”, but rather “how do I treat the person?”, so that subjectivity does not disappear behind the biological and methodological reductionism that destines the “patient” to be irrecoverable, and so that the possibility of “imagining” good practices does not disappear. To this end, perhaps it is important and necessary that suffering is not placed solely in the hands of professionals, says Vito D’Anza, former director of the DSM of Pistoia, but that it is also placed in the hands of non-professionals; Nerina Dirindin, of the Associazione Salute Diritto Fundamentale, also agrees with this and comments: “mental health is too important to leave it to specialists”. Necessary for the purpose that we continue to increasingly broaden the boundaries of mental health, opening the doors to volunteers, family members, operators and all those who can and wish to make their contribution, with what they know and what they are able to do, because, as Gisella Trincas Maglione, President of Unasam, says, “if you have to do psychiatry you can only close, but if you want to do mental health you have to open”.

But how do we build good practices and guarantee the quality of life of vulnerable people?

Building community! This is the response most invoked during the conference, without forgetting that communities do not build themselves, as Daniela Pezzi of Caritas underlines, but with the commitment of people and operators; fundamental commitment to structure “resistance to the barbarity” of bad practices, which are unfortunately very widespread today.

Good practices are also built by abandoning textbook psychiatry and implementing “community psychiatry”, as indicated by Paola Carozza, Director of DSM Ferrara, so that the person is understood and helped starting from the context of life, encouraging his autonomy and creating a personalized care plan. To this end, a different preparation of operators is needed which is not based on the standardization of the symptom but on a dimensional interpretation of the same, against a “performanceist” and reductionist logic that is strongly imposed in the clinic today.

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Support for needs that must never forget family members, as Paolo Paolotti of the Di Liegro Foundation says, so that life is more sustainable in everyday life. The voice of Elena Canali, head of Unasam Lazio, also joins her warning, calling for the need for personalized therapeutic responses and support interventions for family members, who are often excluded and left alone, so that the drug does not remain the only solution to the lack of proposals appropriate therapeutics. Countering the guilt of psychiatry is still the invitation that comes from other psychiatrists, such as Massimo Casacchia of SIRP Abruzzo and Renato Ventura of Urasam in Varese, whose warning is to continue to create a resistance made up of good practices in the area.

This is what Cinzia Migani, former head of the Mental Health Area of ​​the Minguzzi Institute in Bologna, also invokes, recalling a past of experiences and projects that can still be implemented, but as long as we “are able to imagine other futures” . A future that can only be thought of starting from guaranteeing the quality of life of vulnerable people, as stated by Claudio Cossi, President of Afasop Noi Insieme di Trieste and spokesperson for the associations of Friuli Venezia, with the promotion of continuity of care in services open 24 hours a day and initiatives that can ensure the right to autonomy and work.

The numbers regarding the impoverishment of services are dramatic, as shown by Fabrizio Starace, President of Siep. Numbers that highlight abysmal inequalities between different regions and the stalemate that governments, academies and psychiatry have culpably caused. Perhaps we need to think, in the dramatic daily life we ​​are experiencing, about how to get out of the stalemate.

It is important to hinder the political pressure towards the privatization of services, and it is essential to counteract the push towards the differentiated autonomy of the regions as underlined by Massimo Magnano of the Community of Sant’Egidio in Rome. It is also essential not to retreat in the face of difficulties, but to move forward with the little, but a lot, that remains! This is the desire of all the participants in the conference, who spread with their testimonies that utopia necessary for improvement and which Roberto Pezzano of the Unasam Board calls “realistic hope”, recalling the optimism of Basaglia’s practice to be contrasted with the pessimism of reason.

We must do it for that denied humanity, as Francesca Moccia of Cittadinanzattiva says, to take back our rights and implement them. It is necessary to do this by counteracting stigma, often supported by the absence of an existential and ethical vision of care that allows the person to be included rather than labeled. The stigma of the disease changes shape depending on the era and diagnostic denominations. “Mental illness”, once based on delirium, today takes shape as emotional dysregulation, so the age of onset of disorders is increasingly decreasing. Some needs are no longer recognized in their educational, developmental, personal and social complexity, but are defined on the basis of a diagnosis, and “treated” often within a horizon of clinical significance increasingly devoid of humanity. Fundamental to this aim is the dissemination of the values ​​of the Reform, of risk prevention and support for fragility even in schools, as Natalia Barillari of the Libellula Foundation of Catanzaro states, which helps children to exercise the ability to welcome diversity and need without any discrimination .

A quality of life invoked in this conference for all people, even for prisoners, as Patrizio Gonnella of the Antigone Foundation says, which highlights the criticality of prisons and our healthcare system, where there is no vision of recovery but only of detention, and who, quoting the words of Cesare Beccaria, recalled that “crimes are better prevented than punished” and invited to counteract the tendency of our society to always arrive later, with therapy and restraint, rather than intercepting in a preventive manner the need of people.

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The need to continue to resist has come from countless voices, and that this resistance can echo and resonate even outside is the appeal of Carla Ferrari Aggradi, President of the Mental Health Forum, who calls those present to unite even more , to become firm in this desire to continue to work for change, underlining the need to spread the word to young students and operators, so that the Basaglia culture is not forgotten and we continue to go in a “stubborn and opposite direction” compared to to practices of repression, exclusion and discrimination, as recalled by Assunta Signorelli’s motto cited several times during the conference.

The fruit of these two days will be a shared document, with proposals for improving mental health practices, which will be submitted to the government by the National Coordination for Mental Health. The fruit of thirty years will certainly be the good sowing for the future, because Unasam has demonstrated that “if you want you can, and if you can you must” as Ernesto Muggia used to say, one of the first activators of the Union of families for mental health..

Spring doesn’t knock, she enters confidently. These are the words of a song by De André that Antonio Esposito, journalist and independent researcher, addressed to Gisella Trincas Maglione and the audience at the closing of the conference, recalling the power of the feeling of love, which has the ability to penetrate even where one decides to exclude it, perhaps in the name of scientistic rationalism; that feeling that Unasam has demonstrated is capable of overcoming the arrogance of politics and psychiatry of the last 30 years, because it is stronger than anything that rapes, gags, restricts, stiffens, oppresses and denies life.

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