A mental health plan

The crisis that the healthcare system is going through throughout our country from the Alps to the Mediterranean continues to be a matter of discussion. Let's try to address this reasoning with some reflections regarding the mental healthto then be able to extend it to all other disciplines. Why start from mental health? Mental health needs have grown over the past 15 yearsamplified during and after the pandemic with long-term consequences in particular on adolescents, young adults and women; they are partly still undefined needs, in fact they are a public health priority and there is a lot of talk about them, as has not happened since the end of the 70s of the last century when the “Orsini-Basaglia Law” was finally approved. There are also major critical issues in this sector and finding answers in this area would allow us to imagine a change that could involve the entire system. Let's start with a simple question: What should we expect for mental health services in the coming years? Some major critical issues can clearly be seen and have been widely reported for some time and could be summarized in a few points which summarize a sort of diagnostic process:

1) Guarantee the right to health for all citizens. The issue of financing a system that is rapidly becoming depopulated of professionals especially in the more peripheral areas. The Healthcare System is transforming into a set of disjointed care centers that provide answers to an increasingly smaller number of citizens. We are moving towards the loss of the enforceability of a constitutional right.

2) Investing in people. The medical staff, but also the nursing staff in serious suffering. An enormous disproportion between the load of responsibility, the impact on family balance and the return in terms of personal value and economic recognition produces an increasingly marked tendency to avoid professional commitment in the Health Service.

3) Quality of work. Working in emergencies amplifies these problems, working in the emergency room exposes you to the management of extreme conditions. The risk of suffering violence, the feeling of being abandoned on a line of intervention without protection, with the risk of feeling accused by your reference companies when something goes wrong.

4) Centrality of the Health Service with respect to other interests. The loss of the coordination role of the public service compared to those who should collaborate to improve the final result. The private sector and the university sometimes seem to pursue objectives that do not coincide with the need to guarantee adequate and appropriate treatment responses for everyone. We are for doctors and as such we cannot limit ourselves to a simple diagnostic observation of the serious difficulties that the system has been experiencing for too long now. I believe the time has come for professionals who have been working for years with passion and personal commitment to also propose a road map that can guide public opinion to understand how to find a central service for the social stability of our country, remembering that together with Education and Public Order, Health represents one of the cornerstones of society as we imagine it today.

Here then some intervention hypotheses for the mental health sector which we consider to be priorities in the healthcare organisation:

1) Efficiency in the use of resources. Strong planning must make it possible to direct the resources currently available where they are most needed, avoiding hyper-specialist escapes which only end up being extremely wasteful and in fact aimed at patients with limited needs. The private sector and the University must be involved in a process of reorganization of resources aimed at putting citizens' health back at the centre.

2) Accessibility to care. It is necessary to guarantee real integration of the Mental Health Department which can create treatment paths consistent with needs without leaving anyone out. Child Neuropsychiatry, the Addictions area and Psychiatry must work together in all places of care from the Emergency Room to Community Homes, guaranteeing paths that favor accessibility to services and continuity of care. It must be easy to ask for help and continue to receive it over time, whatever the person's trajectory, if they become adults, if they get worse, if the expression of their suffering changes… In all cases, the service continues to guarantee the necessary care.

3) Transparency in actions. Build a clear, transparent and easy-to-use data recording system that allows you to understand what is done and how. Which allows you to plan (invest more where there is most need) and make outcome assessments (in which areas resources are best spent and with which model).

4) Redefining the roles of Mental Health. Promote more careful management of people who commit crimes, both those who have been judged incapable of integrity and those who, detained in prisons, begin or continue to suffer from psychiatric pathologies for which adequate treatments are provided. Treat the most difficult people appropriately, as well as with respect, but at the same time re-establish with the Ministry of Justice the separation between care and custody.

These are some suggestions that we would like to propose for Mental Health, well aware that there are also issues relating tounsolved relationship between national and regional levels which needs to be resolved in order to build truly effective solutions. Issues that concern organizational regulations of services, relationships with bodies such as the Ministry of Justice which provides for a national organization or even everything concerning employment contracts would require changes consistent with the challenges that the mental health health service must face and which often find an answer that is not completely satisfactory in bodies such as the State Region Conference. We hope that this small contribution can help start a reflection in which the staff who are involved in mental health services on a daily basis with a great sense of responsibility are involved.
Letter signed by Emi Bondi, President of the Italian Society of Psychiatry, Giancarlo Cerveri, President of the National Coordination of Psychiatric Services for Diagnosis and Treatment, Claudio Mencacci Co-President of the Italian Society of Neuropsychopharmacology.

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