One year after the murder of the Pisan psychiatrist Barbara Capovani at the hands of a former patient of his, 503 psychiatrists and mental health professionals subscribe to the reflections of a young psychiatrist, Stefano Naim“Basaglia turns in his grave”, and they transform him into an enthusiast appeal to Mattarella.
They write: “In recent weeks the centenary of Frank Basaglia, psychiatrist and intellectual, inspirer of that law which, half a century ago, changed the approach to mental illness forever in our country, bringing us to the forefront of the world. But what would Basaglia think of the current situation of Italian psychiatric care? Mental health services matter crucial […]. Italy cannot afford to helplessly watch theirs regression, a process that has been underway for years and is close to a point of no return. And we, workers on the front line, cannot afford to remain silent.”
The “withdrawal” of the State – thirty years of cuts, privatizations and disengagement of the public first from the economy, then from services, healthcare first and foremost – generates a more ferocious, unequal, neurotic society. The hardship also affects segments of the population that are not necessarily “poor”, it also involves the professionals like the doctors themselves. Especially those who have not embraced the private logic and choose to remain in a public service that is increasingly under siege and in difficulty in dealing with user requests.
In the case of psychiatry the situation becomes even more dramatic, because the effects of legislative interventions and consequent sentences are added to the suffering from “withdrawal of the State”. First effect: the flight of psychiatric doctors from public healthcare. An example: “[…] even outside of the case of forced hospitalization, the psychiatrist holds a position of guarantee, burdening him with duties of protection and surveillance of the patient in relation to the danger of self-harming conduct” (Criminal Cassation IV, n. 48292/08).
In practice the madman returns to being represented as a danger for society, a subject who must be isolated and contained to prevent him from harming “normal” people. The psychiatrist in charge of the patient can be called into question before the law when the patient commits a crime connected with his condition.
It is the specific application of the art. 40 of the Criminal Code: “(Causal relationship) […]. Not preventing an event, which one has a legal obligation to prevent, is equivalent to causing it.” Thus the patient is equated with a source of danger, the psychiatrist with a guarantor who should neutralize the harmful effects, protecting him from behaviors prejudicial for himself.
Some story: a psychiatrist arranges for a patient recovering from a schizophrenic crisis to be transferred by ambulance to a more suitable facility. During transport the patient attacks the driver and the vehicle ends up off the road. Doctor convicted for the driver’s injuries because, as a further crisis of the patient is foreseeable, had not put in place adequate measures (CP IV 6380/17). The psychiatrist who prescribes pharmacological therapy to a patient who does not follow it can be held accountable for her criminal acts. And so on.
Head doctor and doctors of a public hospital convicted for homocide negligent: a patient who had voluntarily admitted himself with a ban on leaving told the nurse that he was going to get a coffee from the vending machine on the upper floor. There He committed suicide throwing himself out of a window (Cp IV 48292/08). Doctors who had allowed the issue of a gun license to a patient suffering from serious mental problems were convicted of complicity in the murder of doctors. With a revolver he had shot four passers-by, killed his partner and a co-owner and then commit suicide.
A psychiatrist can be accused of abandonment, even when the patient runs away from the facility where he was staying and commits crimes and/or suicide (CP IV 35814/15), even when it involves open structure which must balance respect for individual freedom with the protection of the person. He can also be convicted of threats when he intervenes in an emergency condition and puts the patient face to face with the alternative between Tso and voluntary intake of sedatives.
There are many judicial stories, even more clinical ones, but the discomfort grows. So much so as to cause the abandonment of many psychiatrists. “Too many physical attacks and complaints, I resign. It is not possible to work like this. The well-known doctor leaves the profession. In the space of a year alone in Genoa three notices of guarantee to good colleagues”, so the well-known Genoese psychiatrist Ciliberti in announcing the abandonment of public service. Less than a month ago: “Doctor from the ASP of Messina attacked by a patient: she lost two teeth”. Just scroll through the reports and interventions on Royal Psychiatryalways well documented by one of the animators, the Messina specialist Antonio Milici, to feel the malaise and the anger which circulates in the world of public psychiatry and demands attention and laws more in line with the rest of Europe.
So I return to the cry of pain from Naim and his colleagues: “Basaglia would speak […] of a new mental hospital, made of disinvestment and disinterest. It would explain to people why if they go to the emergency room, or to a mental health center, they find a young person who isn’t even specialized. […] taken on a one-off basis, as a “token” […]. It would explain that this system produces disease. And it makes cannon fodder for those who oppose its sick functioning. […] Who knows what he would do to combat this desertification. Maybe he would report it. He would say “I won’t sign”. Something like that. I, who am nobody compared to him but I understand that either I get sick or I give up, in the meantime I report. Maybe he would like it. I hope so”.
Tags: appeal Mattarella psychiatrists healthcare Basaglia talk mental hospital
