A homeless with psychiatric disorders, in Catania, forced to live in a cabin Enel abandoned, vacated and later even fined for damaging a public place. " Another homeless man, in Milan, suffering for years from severe schizophrenia, rebound from one hospital to another. Two dramatic cases that occurred this summer, the opposite ends of the peninsula in the face of such agencies and institutions have played a daunting downloaded. Two cases that raise the same question: who has to deal with the madmen who live on the street?
child of any
The answer, strictly speaking the law, it would be simple: the homeless psychiatric accept responsibility first of all mental health services, the only structures in the health system hinged national professionals with able to diagnose and prepare medicines. Then some psychiatrists will benefit aid of social workers and educators to meet the material needs (food and home) of these people who are not only ill, sometimes seriously marginalized. But never in this case the theory is far from reality.
"The best thing that can happen to a psychotic homeless is to finish, if there is room in the hospital, psychiatric services for diagnosis and treatment, and then return after 15 days on the road again-sustaining Ernesto Muggia, honorary president of UNASAM, the body which brings together 150 associations of relatives of the mentally ill. "Because the truth - he adds sadly - is that this system does not work even for those who a house and a more or less close relative has it. Imagine if you are able to deal with those who are alone and do not even have a place to stay. " In short, a trenchant opinion. But how is the system organized? And it is true that it is so inefficient?
The legislation requires each health agencies set up the Department of Mental Health, the top of the organizational structure, deputy to coordinate a wide network of services. In fact, however, in Italy the DSM are only 210. For the 167 area of \u200b\u200bjurisdiction coincides with that of actual local health, but 103 (49%) serve a population of up to 250 thousand inhabitants and other 20 (9%), the catchment area is over 500 000 residents . Three Dsm even serve a population of over one million people. The view is therefore very uneven. If we go down the branches of the organization, the situation becomes even more complicated. At the next lower step there are mental health centers (or Psycho Social Centers, PSC, in Lombardia), which is the most important basic services. The CSM 707 are distributed throughout the country. With the exception, however, Molise where they have never been activated. But this would only be a small mole. "The real issue is that the CSM operate very differently from each other" warns Giovanna Del Giudice, a psychiatrist of the team of Trieste Dr. According to a study made by the Department of Mental Health in Trieste, one of the few so complete and exhaustive "The standards required by law are met in a small part of Magistrates Italians." Things are going well in Friuli Venezia Giulia, in the Campania and Sardinia. Here, according to research, CSM are open 24 hours a day, 7 days a week and are available for accommodation of persons with whom they come into contact between 6 and 8 beds. But I'm happy isles. Elsewhere, however, hours of public access may also be of 2 hours per day. Not only that. In 1993 CSM should be the doctor's prescription, in 452 you have to pay a ticket. Not to mention waiting lists. "A person who feels they need a specialized non-emergency contact must wait an average of almost eight days, but it can happen that aspects also have 2 ½ months. Also according to the survey of students Basaglia only CSM on three carries out home visits. In a system built in this way the homeless with mental illness not only does not fit, but can not even knock on the door, that door because he simply does not exist. "Having lost their home, the homeless also lose the right to basic medical attention, unless the City does not recognize a registered residence, as required by law is known widely rejected by local authorities in our country - said Raffaele Gnocchi of the severe marginalization of Caritas Ambrosiana -. So even if the homeless were not so aware to understand who has a problem and needs to ask for help, could not have access to all the other services. " In short it out in the first round. Moreover, not even participate in the league. And like him, in fact, are excluded hundreds of other citizens in social conditions far more favorable.
"Over 30 years ago, the reform desired by Basaglia rightly introduced the freedom to care for the sick with the intent to overcome the logic of mental constrictive - Paolo Soncini notes charge of the mental health of Caritas Ambrosiana -. This established principle in practice has become an alibi. Except in very rare cases, psychiatrists health services mental expect patients immediately of them, very few, however, come out of their surgeries to provide help to those who need it. In this way, however, the result is that they are left to themselves not only homeless but also the families of those who reject all suffering psychological care. " The departments of mental health advocate arguing that not enough resources. And they are certainly right if it is true that in our country there is only one operator each 5 thousand inhabitants, instead of one every 1,500, 30% fewer words than he had expected the psychiatrist in Trieste reform that bears his name, as stressed his students this year at a conference Julian in the city. "But the issue is also cultural, because where it is wanted, the way you act is found," says the
It was in Milan, for example, thanks to the appeals of the then Archbishop Carlo Maria Marini, at the beginning of the 2000s it was possible to bring the specialized and professional assistance to homeless people with psychiatric disorders where they were. Even today, the Diogenes project is one of the few interventions of psychiatry has still operating in our country is recognized both the World Health Organisation as a pilot project for taking care of the homeless with mental health problems. Each week two units consist of a street educator and a psychiatrist give at least two nights out in city areas where most cases of severe alienation: wayside station on the sidewalks of downtown.
In the three years of experimentation operators Diogenes, thanks to the collaboration other operators in the House of Charity, Caritas Ambrosiana, doctors of the Department of Mental Health and the Niguarda hospital in San Gerardo di Monza, have offered help to 130 people, more than half suffering from psychosis, and psychiatric disorders by the most serious. "Our biggest achievement was to show that you can cure people also standing in the street," says the head Casavola Life, operator of the House of Charity.
The shortcut Tso
model Milan, however, had no rivals. In the rest of the Peninsula there are only small steps due in large part only on the goodwill of a few priests and a few small volunteer organization often linked to Caritas. Projects as small and local that it is difficult to review. In a landscape so bleak, it is no coincidence that periodically resurface the temptation to rely on coercive measures. The Committee on Social Affairs of the House bill that lies a unifying other projects introduces the TSOP: required prolonged medical treatment. In practice, the person who refuses treatment would be required to undergo therapy for at least 6 months in an ad hoc structure. "While today we can speak with admissions forced only in the acute phase of the disease, with the necessary medical treatment or TSOP we also take care of chronically ill patients who often precisely because of untreated illness become homeless "says the deputy head of the Committee, Congressman Charles Greaves determined to bring the text into question by the end of the year. The proposal, however, does not convince a large majority of psychiatrists, who question the therapeutic value of care required, and do not even like, with few exceptions, the associations of family members, advancing the suspicion that behind this reform is hiding a gift to nursing homes private.
"I think a shortcut in the hands of mayors sheriff can become very dangerous, "says Paul Pezzana , president of the federation of organizations for the homeless. The risk of abuse is not so strange, if a few weeks ago the mayor of Rome Gianni Alemanno called "medical treatment actually required to turn off the city streets of vagrants." All vagabonds, of course, whatever their sanity.
