by Marco Pingitore
25 JUN – Dear Director,
in 2022, emergency room admissions for mental health problems represented a significant percentage of overall emergency room activity in Italy:
1. Total Accesses: Mental health cases represented 3.2% of total accesses to the national emergency room, with a number of 547,477 accesses.
2. Hospitalization Outcomes: 13.8% of these visits resulted in hospitalization, with more than half of the patients admitted to psychiatry departments.
3. Types of Disorders: 39.4% of accesses involved diagnoses of neurotic and somatoform syndromes.
4. Discharge to Home: 72.3% of admissions for psychiatric problems resulted in a discharge to home.
Ministerial Decree 77 represents a milestone in Italian healthcare, in particular with regards to mental health. This decree laid the foundations for a more effective and humanized management of psychiatric disorders, with a particular focus on community assistance.
Mental Health Centers (CSM) are key institutions in the field of local mental health assistance. Ministerial Decree 77 strengthened their role, promoting a more integrated and less hospital-centric approach. These centers operate at a local level, providing prevention, diagnosis, treatment and rehabilitation services for people with mental disorders.
One of the biggest challenges in the mental health sector is overcrowding in hospital emergency rooms. Many people with acute psychiatric disorders turn to the emergency room due to a lack of immediate alternatives. CSMs, strengthened by Ministerial Decree 77, play a crucial role in offering an accessible and timely alternative, which can significantly reduce the burden on emergency rooms.
Therefore, access to CSM should be direct without the need for a medical referral so as to create an essential measure to improve the management of psychiatric emergencies. This accessibility can prevent people with mental health emergencies from needlessly turning to hospital emergency rooms.
In healthcare facilities where access to Mental Health Centers (CSM) is only possible through a medical prescription from the General Practitioner (GP), an obstacle could be created to the professional autonomy of psychiatrists and psychologists. This is because every clinical assessment and therapeutic decision made by these specialists should be subject to the approval of the GP, who could also decide to interrupt the patient’s treatment path at the CSM.
Let’s take a concrete example: a patient undergoing psychotherapy, in order to continue his therapeutic journey, should repeatedly request a medical prescription from his GP (which can vary from 1 to 8 sessions). The GP, at his sole discretion, may decide that the treatment is no longer necessary or useful, discontinuing it.
The current system of access to Mental Health Centers (CSM), which often requires referral from a General Practitioner, can hinder the decision-making autonomy of psychological well-being specialists and limit timely access to care for patients.
To guarantee effective psychiatric and psychological assistance that respects professional skills, it is essential to review the methods of access to CSMs, simplifying them and making them more direct. In this way, we could not only improve the quality of care offered, but also reduce the burden on emergency rooms, which often become the only resource for people in crisis.
Marco Pingitore
Director of Psychologist CSM Mesoraca (ASP Crotone)
June 25, 2024
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