7.5 Mental health
Mental health interventions are aimed at all citizens, although there has been a strategy to promote mental well-being in children, adolescents and young people adopted with an agreement between the Ministry of Health, regions and autonomous provinces through the national prevention plan, in 2014. The 2014 PNP actions were re-proposed in the 2020-2025 one (Cf. paragraph 7.4).
The 2020-2025 PNP emphasizes that mental health is an integral part of health and well-being and, like other aspects of health, can be influenced by a range of socio-economic determining factors that need to be addressed through comprehensive strategies for promotion, prevention, treatment and recovery. The determining factors of mental health and mental disorders include not only individual characteristics such as the ability to manage thoughts, emotions, behaviors and interactions with others, but also social, cultural, economic, political and environmental factors. Exposure to adversity (eg, poverty, abuse, violence, etc.) at a young age is a preventable risk factor for mental disorders. Depending on the local context, some individuals and groups in society may be at a significantly higher risk of experiencing mental health problems. People with mental disorders have higher rates of disability and mortality. People with severe depression and schizophrenia are,for example, 40 to 60 percent more likely to die prematurely than the general population, due to other health problems that are often not adequately addressed. Many risk factors such as low socioeconomic status, alcohol and substance use and stress are common to mental disorders and other non-infectious diseases.
Improving the mental health of young people
The National Prevention Plan defines the health objectives for the population as well as the actions and actors necessary to achieve them. The plan underlines the need to develop a specific intervention for the childhood and adolescence area, which requires a differentiation of the care pathways with respect to adulthood, identifying eight specific objectives to guarantee the essential levels of care (LEA see 7.2) for neuropsychic disorders in childhood and adolescence:
1. Creation of an integrated and complete regional network of services for the diagnosis, treatment and rehabilitation of neuropsychic disorders of the developmental age;
2. Creation of a regional network of residential and semi-residential therapeutic structures for the out-of-hospital treatment of severe psychiatric disorders in pre-adolescence and adolescence, in close integration with local services;
3. Definition of transition paths towards services for adulthood;
4. Convergence of interventions in the same family nucleus of a minor with neuropsychic disorders and parent/s with psychic disorders and/or pathological dependence;
5. Timely and integrated intervention in severe psychic disorders at onset and in psychiatric acute conditions in adolescence;
6. Early identification of neuropsychic pathologies and consequent prompt treatment;
7. Improvement of assistance in mental disorders of minors subject to criminal proceedings;
8. Structuring of an adequate monitoring system.
Among the specific actions aimed at young people, there are:
Awareness-raising interventions in the area for the early identification of risk signals; regional recommendations aimed at improving the specificity and appropriateness and coordination of interventions in the context of psychiatric acute illness in adolescence, including hospitalization, and their integration and coordination; experimentation of intervention models and/or teams integrated with the Departments of Mental Health, addiction departments, counseling areas in the context of projects aimed at prevention and early intervention in psychosis and severe mental disorders, strongly integrated with the services.
Coordination and integrated management of interventions for the mental health of juvenile offenders; specific and targeted training.
More recently, because of the COVID19 pandemic, the prolonged containment measures have reduced moments of sharing and encounter, spaces for participation, working and socialization. In this unprecedented scenario, young people have been among the most damaged ones: serious consequences have been weighing on their psycho-physical health; severe disorders and addictions; worse inequalities and difficulties in accessing constitutional and guaranteed rights, such as education and health assistance.
In Italy the Centre for Behavioural Sciences and Mental Health of the High Institute for Health (ISS), has been active since the beginning of the pandemic, both through the conducting and participation to studies then with evaluation surveys on the state of services available for the population.
Along this direction many projects and actions have been deployed at different levels. With the decree of the Undersecretary for the State of Health of the 26th of January 2021, the working group on mental health has been established. The group operates within the General Directory for sanitary prevention and lasts for three years. The work of the group is organized in thematic subgroups, like the one related to children and teenager’s neuropsychiatry which is likely to be reinforced to bring the interventions to a more integrated and systemic level.
The group has the following tasks:
Preparing guidelines, instructions and scientific documents, including the deals made within the State-Regions Conference and the United Conference
Verifying the pertinence and quality of the treatments and rehab courses supplied for mental health disease.
Detecting and facing the existence of possible criticalities in local services, taking into account the data of the Information System and elaborating proposal for their overcoming
Proposing operational and legislative actions to support the implementation of the most appropriate models of intervention for the psychosocial diagnosis, treatment and rehab of subjects with psychiatric disorders, finalized atthe reduction of the voluntary and compulsory sanitary treatments (TSO) and of the mechanical and chemical restraints.
For what concerns the ongoing projects coordinated by the High Institute for Health, it’s possible referring to:
- The project “Impact of the pandemic on the mental health of children and teenagers”, lasting three years, financed by the Guaranteeing Authority for Childhood and Adolescence, with the scientific coordination by the High Institute for health. It has been activated on the 2nd of August 2021 and its final aim is to make an epidemiologic study in schools, in collaboration with the Ministry of Education and Merit (age groups 6-10, 11-13 and 14-18) and to implement an action plan, evidence based, to satisfy the psychosocial needs of vulnerable children and teenagers during the pandemic and after the pandemic. More precisely, general interventions for the support of mental health of every minor would be arranged as well as targeted interventions for subjects at higher risk and/or in vulnerable conditions and that would be constantly remodeled according to the general and local evolution of the pandemic.
The project “Middle Term effects of the SARSCoV-2 pandemic on the psychophysical wellbeing of teenagers (2021-2022), in cooperation with the University of Turin and Padua. It envisions a study on a sample of 11-15 years old people to collect information on their psychophysical wellbeing after the COVID-19 pandemic, detecting possible differences in comparison with the same thematic in the pre-pandemic period (comparison made with the HBSC survey of 2018), through an online questionnaire, optimized for different devices.
The project “Monitoring knowledge, risk perception, preventive behaviours and trust to provide information on the response to pandemic” (2021), in cooperation with the European Office of WHO, the IRCCS Fatebenefratelli of Brescia, ASL Modena. The project has received a small funding from the Cariplo Foundation. It includes the survey on a stratified sample of the Italian population from 18 to 70 years old (N=10.000), to obtain relevant data on aspects related with risk perception, adopted behaviours, psychological attitude towards vaccines and with validated indexes of psychological wellbeing etc., that will be compared with the answers provided by other European countries.
Other projects started to investigate the impact of the pandemic on mental health of young people are:
The “I care” research conducted in the University of Palermo, that highlights that during the lockdown period in Italy, between march and may 2020, 35% of teenagers has felt anxiety and discomfort, 32% low levels of optimism and 50% low expectations for the future.
On the same track a study conducted by the Italian Committee for UNICEF in cooperation with the Educational Science Department of RomaTre University on the psychological wellbeing of families during the first lockdown, there is in general more worrying from both parents for sons compared to daughters regarding the range of social withdrawal (male: M=3,4; female: M=2,83) aggressivity (male: M=8; female: M=6) and attention disorder (male: M=5.7; female: M=4.4)
Particularly interesting is also the survey by Telefono Azzurro (the blue telephone) and Doxa, that encapsulates a wider time frame since there have been more collections of data: one during lockdown (April 2020) and another in October 2020. From the first collection it emerged that 30% of parents have noticed an excessive usage of social networks, 25% change in nutrition and in the sleep-cycle, 18% isolation and social withdrawal, and even a higher percentage (25%) where there are pre-adolescent kids. In October 2020 when restrictions came back strong in teenagers’ lives, parents denounced a strong detachment from daily activities in their children (17% of parents of preadolescents, 18% of adolescents), with higher levels compared with April data, indicating the persistence and even the increase in the situation of discomfort over time.
Also, the report “Rewrite the future – Where are the teenagers? The voice of unheard students during the crisis”, published by Save the Children last January, aims to comprehend the opinions, emotional state and expectations of high school students and it gives a critical picture that alarms, also regarding school dropouts. Almost 4 students out of 10 declare to have had negative repercussions on their ability to study (37%). Teenagers say that they are tired (31%), uncertain (17%), worried (17%), irritable (16%), anxious (15%), disoriented (14%), nervous (14%), apathetic (13%), discouraged (13%), in a kaleidoscope of negative feelings they share mostly within the family (59%) and friends (38%), but that in 1 case out of 5 stay with a heavy burden within themselves, without sharing it with anyone (22%).
The interest for this topic touched closely also some regions, like the Lazio Region for example, which was the first Italian region to activate extra support for young people and their families, to contrast the psychological and psychic effect of covid, with the strengthening of “Listening Hubs'', thanks to a 10,9 million fund from the Fund FSE+ 2021-2027. In this way the region introduces a series of actions to be implemented within three years (2022-2025), to answer the problems of young people after the Covid19 pandemic. A plan for integrated and coordinated interventions targeting specifically young people, with particular attention to the most vulnerable and to those with familiar difficulties.