The pandemic has opened the Pandora’s box ofinadequacy of psychological services in public health organizations, which suffer from a long-standing shortage of personnel and are unable to provide the full mandate provided for by Lea (essential levels of care). Today, more than ever, it is a priority to address citizens’ need for mental health, which has worsened in this period of social isolation, and to invest in hiring psychologists. This is the strong appeal that the Cnop (the Council of the Order of Psychologists) e 19 scientific societies of psychological area address in a letter to the government and Parliament, asking for the immediate activation of “psychological vouchers“, That is” packages “of interviews for families and individuals directly impacted by Covid, already proposed in June also by the task force of Vittorio Colao. “Bonuses have been made for everything, holidays, bikes and scooters, but the psychological support has gone by the wayside. In nine months for psychological health, public resources are the same as before the pandemic ”he points out David Lazzari, president of the Cnop. The toll-free number for psychological support set up by the Ministry of Health and Civil Protection with the precious free collaboration of psychologists from associations and scientific societies, highlighted the great call for help from citizens: the service, active from the end of April to the end of June, received about 60 thousand contacts. Of these, 30 percent benefited from a more in-depth listening, receiving on average three interviews (the maximum number allowed was four).
The most frequent reasons were linked to states anxiety, depression, other previous issues that emerged due to the coronavirus, or the processing of a bereavement (this request doubled with the end of the first lockdown). The need for psychological assistance can therefore no longer be postponed. But according to a survey conducted by the Cnop in 2019 solo one in ten citizens with mental health problems accesses public services. Because waiting lists are sometimes prohibitive. You can wait up to six months for a first interview. Even nine if it is a minor. And then those who can go private and every month pay for the therapy almost like the rent of a room. While the indigent gives it up and will feel more and more sick. All this because there are not enough psychologists hired. Taking the Statistical Yearbooks of the Ministry of Health, from 2013 to 2018 (last year available) is noted a decrease of 646 units of employees: from 5,675, that is 9.5 per 100 thousand inhabitants, to 5029, almost 8.4 per 100 thousand inhabitants. “To guarantee territorial psychological assistance the minimum standard would be 15 psychologists for every 100 thousand inhabitants – observes Daniela Rebecchi, former director of the psychology services of the Modena Local Health Authority and member of the ministerial table on mental health -. It is time that dignity was given to this service, which brings well-being and savings for the National Health Service. A person who suffers does not go to work, neglects his children, resorts to hospital and medication more frequently, getting worse and never solving his problem “. “Many months have now passed since the start of the pandemic and the forms of psychological distress have increased and worsened – as shown by all the studies carried out – with impact on various dimensions of life and on health“The experts write in the appeal, underlining” the need to ‘systematize’, in a structural way, psychological prevention, the promotion of psychological well-being, listening, support, psychotherapy, making the most of the large containers of society: health, school, welfare, the world of work”.
High litigation, self-harming behaviors, suicide attempts, domestic violence, increased eating and personality disorders, exasperated obsessions, anxiety and fear of the indeterminate, sadness and depression of sudden job loss. These are some of the pre-existing ailments that lockdowns and pandemics have unleashed. “Impulsive behaviors are on the rise, you get to use the knife as a threat at home, there are those who wash their hands with hydrogen peroxide to cause injury and force others to sanitize themselves continuously for fear of getting infected – he says Camillo Loriedo, president of the Italian Society of Psychotherapy. “Isolation – he continues – has also brought about new problems in children who they experienced the closure of the school as a refusal towards them and the adolescents who were trying to integrate with their peers and now feel abandoned. Assistance in the public has practically disappeared, the ASL could make agreements with non-profit organizations formed by psychologists who teach in training schools. The solution of the voucher can only be impromptu. We have a great offer of professionals, it’s a shame to waste it ”.
Rita Ardito he is the head of the Italian society of behavioral and cognitive therapy: “Patients have certainly increased during the pandemic. The age group is concentrated from 20 to 50 years. Those who have taken Covid experience a sense of anguish linked to no longer feeling the master of their own life. Isolation has forced many to measure themselves with inner voids and loneliness never experienced before. Mental health – he reiterates – it is a right and an indispensable condition for the relaunch of our country. Politics can no longer ignore it and must work to ensure access to adequate public services ”. There are also those who found themselves in quarantine without a job overnight and he had to interrupt the therapy he was already paying at a subsidized price, offered by one of the psychologists of the “Open Psychotherapy” network, aimed precisely at those with financial difficulties. “The sessions have social rates from 25 to 40 euros – explains Luigi D’Elia, the psychologist promoting the network, born in 2018, with over 1200 professionals from all over Italy -. Requests have increased by at least 30 percent since last March. Italians also contacted me from abroad. Many twenty-year-olds with relational disorders, which have closed even more with the lockout of schools and meeting places, couples that break out. Insomnia, depression, anxiety, loss of any interest are other post traumatic stress disorders more present today. The real problem – warns the psychologist – are the people left without a salary who have stopped the therapy and nobody can intercept “.
The activities of psychological competence in the light of the new Lea are many. At least on paper. Psychologists as well as moles family counseling centers, mental health centers and addiction services, should be enrolled in the paths of palliative care, in the assistance of minors with neuropsychiatric disorders, people with disabilities, cancer or chronic patients with maladjustment to the disease, to the elderly, in out-of-hospital residential treatments. But in practice, meeting all these needs for regional health authorities is next to impossible. “I cannot guarantee the constant presence of the psychologist in any of the territorial psychosocial centers, where there are waiting times of up to six months – he explains Elena Vegni, Head of Clinical Psychology of the Asst Santi Paolo e Carlo in Milan -. Even the clinics are underpowered, they wait at least four months for the first meeting, we are not always able to offer adequate psychotherapy treatment, but we respond to all emergencies, which may concern abused women or children, postpartum depression or a abortion. Child neurospychiatry, on the other hand, is suffering ”.
Psychological treatments for children with mental disorders are severely insufficient throughout Italy. “With us, the waiting list is nine months, we are invaded by requests for evaluation from the courts, which have precise deadlines and leave little room for the rest” he says Giancarlo Marenco, who directs the Psychology of the Asti ASL, as well as being the president of the Piedmont Association of Psychologists. It is complicated to give assistance in the developmental age even in the ASL of Tuscany or Lazio. In Puglia, to the ASL of Taranto, explains the doctor Dora Chiloiro, head of the Psychology department, “the highest demand comes from adolescents and young adults aged between 15 and 25 but it is very difficult to satisfy them. Just as we are unable to draw up all the diagnoses of mental retardation or dementia that courts, schools, neurologists, mental health centers ask us for. We are too few to do everything, this pandemic has clearly brought out the inattention of politics towards psychological services“. In Sardinia, he confirms Angelo Quakers, president of the regional category order, “the taking in charge of a patient for a psychotherapy course is almost in fact feasible. The services are totally insufficient with respect to health needs. The risk is that those with mental discomfort, not being listened to, rely on the drug. But without an accompanying path, the drug alone does not lead to change and awareness of one’s discomforts “. The most tragic situation, however, is in Calabria.
“Until ten years ago there were 300 psychologists in the Calabrian health service, now there are about eighty left, although the Lea to be satisfied are many more, and we will drop by June to 50 units due to retirements if we do not proceed with new hires “he makes a sad point Armodio Lombardo, president of the Calabrian order of psychologists and head of the mental health center of Mesoraca (Crotone). “Already now, in these conditions, we are unable to comply with the Lea’s – he continues -. In one of the three mental health centers of the Crotone ASP there is not even a psychologist, he remained only a psychiatrist for all the patients. Two out of three counseling centers lack psychologists because they have retired. Even the only sert is devoid of psychologists and the expectations are incalculable ”. The 0-18 age group is completely abandoned. Children and adolescents with autism, learning disorders, language disorders, eating behavior, with anxiety or conduct problems cannot count on the public structures of the territory. Because, Lombardo denounces, “in all of Calabria there are no neuropsychologists for minors”.
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