Mental illness and psychological distress require specific and different responses

by David Lazzari

24 OCT

Dear Director,
how many health problems are there? The situations for which the citizen turns to the health services or goes to hospital? How many of these involve the whole person and not just his body? How many of these have relevant psychological aspects or require a psychological response?

Let’s take some examples. A couple who have problems with sterility or infertility, who may have to resort to assisted reproduction. Or that he wants to follow a path of foster care. A woman who needs psychological help in pregnancy, after childbirth or in the first months or years of the baby’s life, the famous thousand days so fundamental for the future of the baby. Accompaniment in situations where the child has a particular or difficult condition. A woman who intends to terminate the pregnancy or who is forced to do so for health reasons. A woman who has to face the problems of menopause. A family that is in conditions of discomfort, perhaps in the relationship of a couple or in the relationship with children, a teenager who wants to deal with her problems. The different situations of psychological distress in which a person is not yet sick but is no longer well.

But still, the field of physical diseases, intervention in the communication of serious diagnoses, support and preparation in particularly invasive diagnostic and therapeutic interventions, in the management of new technologies, support for people with diseases with a high stressful and psychological impact, such as those oncology or many cardiovascular ones just to give an example, which require important subjective resources to be addressed, but also of family members and caregivers. Support to sick people, family members and caregivers for the management of situations, often chronic, in which psychological aspects are fundamental for the management of the disease. The treatment of psychological aspects in pain therapies and palliative care.

The recent experience of the pandemic has shown us that psychological interventions integrated with medical and nursing interventions have been an important part of the health response, expanding it to the person and to the his experiences.

And the assistance also includes prevention, the promotion of behaviors and lifestyles, psycho-counseling and education to improve adherence and the therapeutic alliance, rehabilitation that is increasingly widespread thanks to advances in care and which is not only physical .

The data of the evidence are striking: the subjective and relational aspects, that is what psychologists deal with, make the difference in terms of the success of treatments, disease trends, quality of life and economic costs for citizens and for the system. The impact of the psyche on the body and on how to deal with situations is often crucial.

Finally, the management of fundamental psychological aspects in healthcare personnel, in the care process, in the quality of relationships, in humanization, in the management of emotions, stress, critical issues and emergencies. Having a context of care and operators human oriented it is now indispensable, also because more and more technology requires more psychology.

This long but not exhaustive list of problems and situations is not chosen by chance: it is only a part of the psychological answers that our NHS must give to citizens according to the laws in force.

This clarifies, if anything were needed, the scope and transversality of psychological activities in the NHS. A situation that, especially with limited resources, requires a “control room” at the level of each health and hospital company to organize, distribute, optimize resources in the various departments, services and structures that make up the company.

The lack of this coordination in most situations has seriously penalized citizens and companies themselves. Now finally there is a law that provides for a single “corporate Psychology function” for each company and there is a guideline resulting from a commission of the Ministry of Health which saw the participation of ISS, Regions, Agenas and scientific societies as well as the CNOP.

Each Region, in its autonomy, will be able to give the most appropriate form to this reality, the essential thing is that an organizational gap is filled by taking advantage of many other similar initiatives, such as those for pharmaceutical activities, anesthetists in hospitals, nursing professions. , techniques and rehabilitation. The essential point is to put this function at the service of the entire company, without “sacrificing” it or compressing it into a sectoral department. It is enough to read the list from which we started to understand that in a hospital or in an ASL there is no clinical sector that can, alone, even for the treatment of mental illnesses, cover the whole.

In the CSM / DSM there must be psychologists and in adequate numbers because mental illnesses also require psychology and psychotherapy and not just drugs. But tracing all psychology to psychiatry and all psychological issues to mental health services is a mistake that ignores reality. It is no coincidence that less than 40% of NHS psychologists work in mental health services. The citizens themselves have now clear the difference.

There will be resistance because often the organization of services is guided by the logic of power but if those who organize them look at the objective reality, this law will finally find its application.

David Lazzari

CNOP President

October 24, 2022
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About Banner Leon

Videogames entered his life in the late '80s, at the time of the first meeting with Super Mario Bros, and even today they make it a permanent part, after almost 30 years. Pros and defects: he manages to finish Super Mario Bros in less than 5 minutes but he has never finished Final Fight with a credit ... he's still trying.

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