For the third time it has been filed by the Honorable Members Deborah Serracchiani e Philip Sensi (Pd) the Bill “Provisions on mental health», designed to give concrete implementation tools to Law 180, the epochal «Basaglia Law», which, in 1978, sanctioned the closure of psychiatric hospitals. The rule, proposed by the Mental Health Forum – initially an informal group of doctors, operators, people with experience and active citizens on the subject, which has now officially become an association – had already been presented in 2017, signed by Viewing View (Article 1 – Democratic and progressive movement – Free and equal) e Louis Manconi (Pd) and re-proposed in the last legislature by the former deputy Elena Carnevali (Pd) and by the then senator Paola Boldrini (Pd).
The Ddl proposes the implementation throughout the national territory of tools suitable for taking care of people with psychiatric disorders, enhancing their role as an active part within the treatment process and the society in which they are inserted, as already happens in some Departments of mental health – Dsm in Italy. The purpose of the law would also be to recall the services, departments, regions, the judiciary to supervise the implementation of security measures, concretely identifying levels of assistance and treatment paths, providing for the operation of services on the territory for 24 hours a day and always putting the person and his needs at the centre. Interventions of this type are not only placed in the wake of the Basaglian revolution, but are also placed in the recognition of the principles of the action plan on mental health of the World Health Organization – WHO, as well as the UN convention on the rights of persons with disabilities.
According to its creators, the bill would be “dystonic” with respect to the trend that has been registered in the field of mental health – and health in general – in recent years, which would seem to be oriented more towards centralization, hospitalization and distancing from people. «The “residential structures” are present in all the Regions. In some, few, there is 1 bed for every 10,000 inhabitants, in others it reaches up to 5 times as much. More than half (up to 3⁄4) of regional mental health resources are consumed almost everywhere. The tendency to resort to the “residential bed” seems to be growing unstoppably and irreparably reduces the consistency and intervention capacity of local services», the representatives of the Forum write in a note. «It is therefore necessary to rethink the presence of social cooperation, forced to flatten out on unhappy regional policies. The spread of places resembling chronic hospitals risks becoming dominant. The huge resources, passively dedicated to “residentiality”, would be sufficient to rethink different forms of living, job placement, social life. Individual rehabilitation projects, where activated, produce results that are as evident as they are unexpected».
The association also focuses attention on the Mental Health Centers – CSM, poorly distributed in the country. « In some Regions, due to rationalizations and unifications, the CSMs are further reducing in number, insisting on extended areas and increasingly numerous populations. They are open for limited time slots: with the exception of some regional realities for eight to 12 hours a day for five days a week. Crisis management interventions, individual care, support for families and housing, social integration, end up being insufficient or completely absent. Frequently there is a reduction to outpatient visits only (with the use of endless waiting lists) due to prevalent pharmacological prescriptions». A parliamentary commission of inquiry was also formed on the subject, which noted: «As a consequence, the types of services are little or not at all adapted to the needs of the person, starting from the willingness to listen, there is a lack of integrated social support at home, 24-hour emergency and crisis response, family mediation in an alarm situation».
The central point of the bill is also the regulation of mandatory health treatments – Tso. According to the promoters of the law, this instrument would have been misinterpreted in its implementation and translated into violent practices, moving away from the idea with which this provision was born: it shouldn’t have been oppression, but rather a caring embrace that passes through confrontation and mediation. «We are all aware, but we will never get tired of repeating it, that this time too, and with this government then, this bill will not leave the deposit to at least be discussed in the classroom», write the president and the secretary of the Mental Health Forum, the psychiatrists Carla Ferrari Aggradi e Peppe dell’Acqua. “This is easy to predict to happen and then you all will ask: why bring it into play again? The answer is as simple as it is childish and optimistic. We think, as many have said so far, that it is a good document and that, despite five years having passed, it still manages to look ahead. And so we dare to think that it could become a sort of manifesto that commits us all to reconsider how much more the “revolution” can produce. The bill then seems to be, according to many, a manual of good practice, a sort of vademecum for those who are about to take up the profession of care».