If a bad knee can’t wait months or suffer marked deterioration, a wounded soul can’t wait. Under penalty of a chronicization of the situation which, paradoxically, leads to a much more serious domino effect. It is also more expensive for society. We make this clear right away because the mental health paradigm shift is underway. Two years of pandemic and now a war has accelerated what psychologists preached and not only them for some time: we need to invest in mental well-being. Don’t talk about “expenses”.
The Psychologist Bonus and the 2014 Trial
To unlock this taboo for which the psychologist was almost a “secondary” professional in the health galaxy was the psychologist bonus launched by the government. A more symbolic than concrete release given the allocation of only 20 million euros for the whole country. Many Regions are mobilizing to make up for the insufficient endowments to deal early with anxieties, traumas and depressions. At the beginning of March, Emilia-Romagna allocated 23 million euros, more than the entire national budget. Lazio ten and Campania an additional 3.5 million, thinking above all of the discomfort of adolescents. And what is Veneto doing? Let’s start with the context: in 2014 Palazzo Balbi approved the experimentation on the figure of the basic psychologist. The mental wellbeing equivalent of the GP. It goes without saying that early management has led to a drastic reduction, for example, in the prescription of psychotropic drugs.
Pezzullo (Order): “From premium to basic psychologist”
“The basic psychologist and the investment in psychological services is an absolutely central theme – he explains Luca Pezzullo, President of the Order of Psychologists – Two years of pandemic, dad, mourning… the previous situations exploded. Well, the paradigm shift represented by the psychologist bounty is not enough. In Veneto, funding could cover the needs of only 1,600 people out of 5 million inhabitants, a proportion largely insufficient compared to real needs. In itself I consider this an important initiative, as an Order we wrote to the Venetian parliamentarians to support this initiative and I must say that in twenty years of politics I had never seen such transverse support. Now, however, we must do more. As an Order, we have already initiated and are carrying out various contacts also at regional level, for example with the President of the V Commission Sonia Brescacin”. The data speaks for itself: in Europe the average number of psychologists per 100,000 inhabitants is 20, in Italy between 5 and 6, in Veneto it is less than 4. “Too little, now Azienda Zero has a tender for the recruitment of 47 new colleagues and it’s like water in the desert but it’s really not enough. Those already at work report assembly line situations and months of waiting that become a problem within the problem. The objective must be structural: with the hiring of psychologists on permanent contracts”. An additional expense for the public purse? No, a real investment according to Pezzullo: “Consolidated health economics studies estimate that for every euro invested in mental health, 3 to 10 is saved between the health service, law enforcement, courts and social services. This is not surprising because psychological ill-being has cascading consequences, including economic ones, on society. Let’s take an example: a father who loses his job risks becoming violent at home, becoming dependent on alcohol with devastating consequences on the children, on his wife, on those around him. The combination of pandemic and war has highlighted past issues. In a situation of collective stress, the internal resources are used first but then the ordinary resources are no longer sufficient, it is necessary to intervene before the affective and social ties are broken. There is a window period between the first symptoms and the chronicization of a mental health problem, it is necessary to act quickly to avoid a spiral of costs, conflicts and anguish.
The Democratic Party: “Covid injuries push us”
An emergency that was also approved by leader of the Democratic Party, Giacomo Possamaisignatory of a written response to the Councilor for Health, Manuela Lanzarin at the regional council: “I ask you if, after two years of pandemic which has considerably worsened the mental health of a considerable part of the most fragile population as well as of many young people, intends to reassess and expand the experimentation of 2014, promoting the inclusion of the basic psychologist in group medicine and in other services dedicated to the prevention and treatment of mental illness. All the more so in view of the PNR funds which will finally make it possible to complete the missing link, territorial health, with the birth of community houses where, among the basic services, that of the psychologist could also arrive on a permanent basis.
Here it may seem like a novelty, but in the Netherlands, the primary care psychologist was established in 1982 and has been an integral part of the Dutch health service ever since. In practice, it is a “brief psychotherapy”, with a maximum of 12 interviews. It has also been tested in Italy. The most famous experiment carried out by Professor Solano della Sapienza in Rome, involved clinics in Lazio and Umbria: psychologists accompanied the general practitioner of the clinic over three-year cycles. In the ASLs that provided the data, an estimated annual saving on pharmaceutical expenditure was recorded of 14% (-55,000 euros) and 17% (-75,000 euros) respectively. In Veneto, the experimentation of the basic psychologist within the territorial organization of primary care physicians is provided for by a resolution of May 2014. The objective, integrating the two figures, is to activate early interventions, before the discomfort becomes structured and to guarantee direct access to a psychologist for the entire population. The experiment was conducted in two Ulss – 4 Alto Vicentino and 7 Pieve di Soligo – with reference to an identical catchment area, 18 thousand inhabitants, distributed in the first case over three municipalities (Schio, Torrebelvicino and Santorso) and six in the second (Cappella Maggiore, Colle Umberto, Montaner, Sarmede, Cordignano and Fregona) with the partnership of two integrated medicine groups made up of primary care physicians and a few psychologists and psychotherapists. The results speak of 174 care, mostly women, especially between 31 and 50 years old, most of them are employees, but there is no shortage of retirees. The disorders detected ranged from anxiety to depressive aspects, through family crises, bereavement, problems at work but also abusive access to emergencies. Pharmacological interventions were avoided in 47% of cases (82 of 174) and related prescriptions with economic savings and more. Psychological interviews, modulated according to needs, were an alternative to medication which, depending on the symptoms of the patients, would have found justification. Another important fact is that in 21.8% of cases (38 out of 174) the doctor did not refer the patient to local servicesthus avoiding increasing the waiting lists of the same and offering a quick and punctual response. Out of 174 reports, 66% of the interventions were declared concluded at the end of the experiment, 25.8% are in charge of psychologists and 8% of the subjects voluntarily interrupted the course by not showing up for one of the agreed appointments. In relation to the 115 cycles completed, 83.4% of the cases were declared resolved, in 6.9% of the cases they were referred to psychotherapy and in 9.5% they were referred to other services.
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March 15, 2022 (change March 15, 2022 | 8:25 PM)
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