Psychology must be placed at the center of the Health System

by Maria Antonietta Gulino, Saverio Proia

The pandemic has generated a significant increase in requests for psychological services. Many people today need to rediscover inner certainties and lay new foundations on which to set up the near future. Up to now in Italy the activities of psychology and psychotherapy have too often played only an additional function, almost a luxury and non-essential good, favoring the biochemical component of health.

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24 NOV

Because psychology must be placed at the center of the Health system, both on the users’ side and on that of the healthcare professionals: it was with this aim that the session on the “Guidelines for the Function of Psychology in the NHS”.

A discussion table on national health issues of today and tomorrow, in which as the National Council and Order of Psychologists of Tuscany we underlined how much psychological well-being should play a key and transversal role in the near future. A valuable opportunity for discussion, with interventions and reports from the Ministry of Health, the director of Agenas, the president of Federsanità, the federations of health orders, regional politicians, to guarantee an integrated and organized approach to personal care, both in biological component and in its psychological component.

There are still many issues to reflect on: the document drawn up by the working table of the Ministry of Health, which will be studied in depth in the unified State-Regions Conference, sets itself the objectives of optimizing the skills and role of the Psychology in the public service, guaranteeing multi-professional integration and specificity of intervention. A public system that provides for a punctual organization of the Corporate Psychological Department guarantees a better preventive and treatment response to the discomforts of the population and a better relationship between costs and benefits for society.

The pandemic has generated a significant increase in requests for psychological services. Many people today need to rediscover inner certainties and lay new foundations on which to set up the near future. Up to now in Italy the activities of psychology and psychotherapy have too often played only an additional function, almost a luxury and non-essential good, favoring the biochemical component of health. Scientific literature and current citizenship requests (see the huge number of requests for the Psychological Bonus), demonstrate that these two paths must move at the same level.

In addition to fairness in the diffusion of the psychology service, it was reaffirmed at the Risk Management Forum in Arezzo, it is necessary to offer an appropriateness of the answers. We cannot forget that helping the psyche means making a valuable contribution to people’s lives: risk behaviors, disturbances and discomforts are prevented, lifestyles and stress are intervened, management of chronic situations is made more effective. It is therefore necessary to accompany psychological well-being with somatic well-being: two elements that must be integrated to preserve the person’s full health, as indicated by the WHO.

Psychology needs to take on a transversal and structural-organisational guise, thanks to a coordination between the functions and services of the healthcare companies, which moves from home environments to hospital environments in order to be able to respond to individual and collective needs. It is necessary to structure ourselves, like other areas of health, and thus be in a position to be able to also carry out monitoring of the results of psychological activities in order to identify the best methodologies and create progress in treatment and prevention. Let’s develop that network of public psychology today demanded by people for a cultural change that can no longer be postponed.

The contents of the document were framed by the Health Director of the General Directorate of Health Professions of the Ministry of Health, Francesco Gilardi and in order to elaborate the guidelines, the Ministry of Health has started the activation of a working table for psychology.

The purpose of the ministerial table was to indicate the strategic ways to implement, in a logic of appropriateness and maximum integration, the objectives assigned to the psychological-psychotherapy profession in the legislation in force and in the PNRR system for the NHS, through:

– organizational optimization and maximum integration of psychological skills and activities with the overall activities of the NHS in a “network system” logic;

– maximum contribution to the enhancement of a system centered on the real needs of the person, on a preventive, proactive approach to promote resources, and on the home as the first place of care, proximity and continuity between the different levels of the system (from the home to the community to the hospital);

– enhancement of the role of psychology for an integrated (multidisciplinary and multiprofessional) approach to the person and as a bridge between health and social aspects, also to generate savings and enhance the cost-benefit logic through more appropriate and effective interventions.

The purpose of this ministerial Table was to indicate and propose, through the elaboration of these Guidelines, the programmatic and strategic choices as well as the organizational typologies to promote and ensure this transversal mission of psychology through an operational-organizational coordination at company level, which in December 2020, with law 176 (art.20 bis), Parliament indicated a single corporate “functional area”, with the following tasks:

ensure individual and collective health and psychological well-being

ensure psychological services, including at home, to citizens and health professionals,

optimize and rationalize the professional resources of employed and contracted psychologists

guarantee the activities envisaged by the essential levels of assistance (LEA).

Underlined the Director of the South East Tuscany Psychology UOC, Margaret Pope that psychology in health systems must respond to the question of appropriately and effectively addressing the evolution of psychological needs. It is therefore necessary to have a direction to define the needs, costs, benefits and evaluation criteria. A management, as can be the corporate function, which addresses the critical issues represented by the heterogeneity of the offer of services on the territory, the implementation of the Lea in all areas, the dispersion of personnel in various contractual forms, the identification of uniform indicators for monitoring of activities and results.

While the UOC Director of Psychology ASST Bergamo, Maria Simonetta Spada reiterated that, starting from an inclusive, broad and dynamic concept of health, the complexity of the context within which psychology moves was highlighted, which interfaces with multiple questions from different subjects and interlocutors. The importance of moving along a continuum that goes from health promotion to specialist intervention, rather than responding to organizational logics, today collides with psychology organizations that are too often fragmented and with configurations that depend more on the history of individuals than on the needs of the population. The phase we are going through, coming out of the pandemic, calls for the construction of policies and practices to promote support for everyone’s health by intercepting the discomfort and discomfort of individuals and groups as purely as possible and avoiding paths destined to become chronic.

The Corporate Psychology Function has been well defined by the President of the CNOP, David Lazzari clarifying that it is an organizational method of the Health Trusts voted by the national Legislator with a very large majority tending to rationalize and optimize the professional resource of psychologists independent of their location within the departments in which they are operationally located.

This organizational method, the legal nature of which will be identified by each Region or Healthcare Company, whether departmental area, UOC, UOSD or UOS, also in relation to strategic choices and the number of psychologists employed and affiliated, is not new in healthcare legislation. Apart from the pharmaceutical service/UOC, the anesthesia service now includes the services of the nursing and midwifery professions (sometimes separate services for midwives), the professional social service, obviously single-professional and also the services of the technical health professions, the services of rehabilitation professions and those of the prevention professions, certainly the latter are not single-professional but include homogeneous professions.

After all, it would not be conceivable to include the hierarchical and functional competence of all psychologists employed and affiliated with the DSM, given their location in different company areas, all the more so as provided for by the PNRR and Ministerial Decree 77/2022.

As for the other professions mentioned above, the corporate function of psychology cannot be an obstacle to interprofessional work since it is not a closed structure but a “control room” for the best valorisation and optimization of professional psychological intervention, rather it becomes a driving force for implementation of the integrated work of an interprofessional team.

In the context of a fruitful interprofessional working relationship and collaboration between their institutional representatives, they brought their greetings and positive contribution to the FNOMCeO Robert Monacofor the FNOPI Pierpaolo Pateri and for the FNO TSRM PSTRP Francesco della Gatta.

The President of the Health Commission of the Tuscany Region also spoke, Henry Sostegni proponent of the regional law on basic psychologists approved a few days ago; the national President of FEDERSANITA’-ANCI Tiziana Frittelli spoke, underlining, among other things, how the tragedy of the pandemic has enhanced and relaunched the role of psychology and psychologists as a fundamental component in the protection of health, finally, concluded the event the General Manager of AGENAS Dominic Mantovan highlighting the importance of the role of the psychologist in the professions of the Community House and the strategic need to implement the corporate psychology function for a presence of psychological skills articulated at hospital and territorial level.

Marie Antoinette Gulino President of the Order of Psychologists of Tuscany

Xavier Proia
Gutenberg Foundation Scientific Committee

November 24, 2022
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Psychology must be placed at the center of the Health System


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