After that in the past few days Pier Paolo Urbani, head of the Ulss psychiatry department for years, told Qdpnews.it that “the tragedy that took place in Moriago was potentially avoidable”, discharging some responsibilities to the health company in a not completely veiled way, the response of the psychiatrist Leonardo Meneghetti, for about two years at the head of the psychiatry department of Ulss 2 Marca Trevigiana.
“I am pleased to be able to intervene and, in some way, clarify some aspects – underlines Meneghetti – that were highlighted in the previous interview (here the article). What I would like to do is not to express personal opinions, otherwise there would be a risk of a conflict between my ideas and those of Dr. Urbani. I believe I can say what I will say as it is supported and supported by what is expressed by an accredited scientific community “.
Doctor Meneghetti, in recent days the psychiatrist Pier Paolo Urbani declared that the tragedy of Moriago was “potentially avoidable”. What is your point of view on this?
The first thing I would like to say is that the trials should never be in the media, but that they should be done in the classroom: this means that no psychiatrist and no team shuns the responsibility of understanding what their role is in such tragic events. This will have to have a course, which has already begun, because all the clinical documentation has already been requested and it will be a question of understanding what responsibilities psychiatry may have with respect to the possibility that the Moriago event was avoidable.
I disagree with what my colleague said, but here too I somehow address what is argued in much wider areas, in the sense that thinking that there is a linear connection between a violent event like this and the mental disorder is not scientifically acceptable.
Violent behavior, even if carried out by a person who has a mental disorder, is multidetermined, that is, it has multiple causes. This is what the Italian forensic psychiatric guidelines say. So even when there is a mental disorder, the reason for which a person performs an act of this type has different facets; there can in no way be linear causality.
Article 32 of the Italian Constitution provides for the possibility of interrupting treatments independently, imposing health treatments only by law. Can you better explain these dynamics and why Fabrizio Biscaro, self-confessed guilty of femicide, interrupted treatment?
This article establishes an absolutely fundamental principle, also reaffirmed by the World Health Organization, and that is that psychiatry care should be aimed at the human and civil rights of people. This means that the treatments should always favor the patient’s self-determination, because this is the aim of a treatment in psychiatry. Self-determination means making sure that the person who also has a serious, mental disorder can still have a space of freedom to choose, to face what may be their own resources, their desires and their needs.
The element of self-determination is fundamental and in this self-determination also enters the choice, reaffirmed also by the law of 2019, in which there can be no cure, except for the reasons for which one can resort to a TSO, which is not contextually shared with a patient.
A patient can stop treatment. In this case, psychiatry evaluates from time to time what it can do. Dr. Urbani says that in his day people used to go to patients’ homes, we do home visits on a daily basis. The operators go to the patients’ homes but one cannot think that things will be resolved neither with the TSOs nor because it would be simplistic to think that drugs are sufficient, just as he mentions long acting. He is absolutely right in saying that mental pathology must be treated with drugs, but we know that these are not the only decisive element within the treatment of a person with a mental disorder.
What is the role of the health company in the treatment of psychiatric diseases and in the prevention of episodes such as that of Moriago?
The role is to propose the so-called community psychiatry. Mental health is not done only by the health company or the mental health department, but it must be done together with users, family members, local authorities and the whole community. The main objective of the mental health department is that of treatment and prevention, which is an extremely complex path, and which we, in some way, propose together with another series of indispensable actors in this field.
How is Treviso psychiatry structured? Is it true, as some claim, that there have been cuts?
It is not that there have been cuts within the ULSS. If we refer to the lack of doctors, this is certainly not a consequence of choices made by the strategic management, which has always moved in exactly the opposite way: trying in every way to propose competitions and free professional contracts. The problem is that there are fewer psychiatrists than there were many years ago and then what we are doing is trying to enhance all the existing fundamental professional figures which are nurses, educators, social workers and psychologists.
How does a psychiatrist feel when he learns of facts such as the murder of Elisa Campeol?
I had a meeting with the Pieve di Soligo team on Monday; it is not a controversy, but I would have liked that Dr. Urbani and anyone else had the opportunity to attend a meeting where an extremely important pain was expressed. There was room for emotion, for questions.
I found a strongly shaken working group, and when we are faced with a patient’s suicide or such tragic facts our professional identity necessarily enters into crisis: we cannot but ask ourselves what we have done and what we have not done.
In this case, however, the patient had interrupted the treatment in agreement with the family, and from that moment the service had not received any more reports. Because when the patient interrupts the treatment it is totally evident that at the first report a service does not remain with its hands in its pockets but is actively proposed.
I don’t want that sort of police state that Professor Urbani mentioned in his interview, we can’t think of doing a psychiatry by dint of compulsory health treatments or long acting. I repeat that these are aspects in which we too run into, but the treatment in psychiatry is far more complex.
What role do drugs play in the treatment of these diseases?
Medicines play an important and fundamental role in the case of serious diseases and disorders. However, if we have to ask ourselves what role drugs can play with respect to the prevention of violent behavior with respect to third parties, having said before that violent behavior is multidetermined, we cannot ask drugs to be able to prevent this. Drugs cure the mental disorder, but they cannot cure all those factors that are involved in such behavior.
(Video: Qdpnews.it © reserved reproduction).
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