The final document of the Consensus Conference on psychological therapies for anxiety and depression is online
08.02.2022
The final document of the Consensus Conference on psychological therapies for anxiety and depression is online on the ISS web site. The Consensus Conference is promoted by the Department of General Psychology of the University of Padua with the patronage of the Istituto Superiore di Sanità.
The Group operated according to the consolidated Consensus Conference model that provides for the formulation of questions, the drafting of a document drawn up by experts in the area and subsequently the evaluation of the work of the experts by a Jury composed of representatives of civil society.
The works of the Consensus to which this volume refers have covered many aspects of assistance aimed at common mental disorders. Without claiming to be exhaustive, it seems that they can be framed within three fundamental areas.
The first area concerns the recognition of disorders and treatment plans. Numerous studies, as mentioned, show that a high proportion of patients with these disorders are not treated or in any case do not receive adequate treatment. Among the factors underlying the lack or inadequate treatment, there is the failure to recognize the presence of disorders due to the difficulty of intercepting them at the onset or in any case at an early stage. In this perspective, ensuring their early identification is an important first step. To this aim, the Consensus suggests that all local health services (including primary care services, family clinics, disability services, general practitioners and family paediatricians) and penitential medicine services should be able to identifying patients with common mental disorders or at risk of developing them. All these health services should be nodes networking with the specialized mental health services: they will be responsible for treatment programs structured by levels of severity, according to a stepped care approach. Within such approach, low intensity could include psychoeducational interventions or self-help groups (which avoid the risk of an excess of medicalization), at a higher intensity psychotherapy (whose indication is also supported by its greater acceptability) and finally the psychological treatment integrated with drug therapy.
The second area concerns access to services and more generally to treatment. The failure to treat people with common mental disorders, not only in Italy, is due also to the low demand related to stigma. Investing in promoting greater knowledge and awareness of these disorders and in reducing the stigma associated with them could be a first answer on the demand side. The recommendations of the Consensus propose to invest in communication aimed at and adapted to the different target groups (health workers, the general population, young people), exploiting the potential of mass media and social networks in strict compliance with scientific assumptions. To facilitate access to care, the use of innovative and more sustainable methods integrated into care pathways, such as tele-psychology, also deserves attention and further research.
The third area of interest concerns academic training and specialization schools. The Consensus underlines the need for literacy courses on common mental disorders in the course of studies of the three-year degree in Psychology and the degree in Medicine as well as in post-graduate courses envisaged for General Practitioners. As regards the degree in Psychology with a clinical orientation, the recommendations pointed to the need of increasing knowledge on symptomatology, levels of severity of these disorders, as well as on evidence-based treatments and the principles and methods of clinical epidemiology in mental health. Finally, the Jury In its concluding remarks underlined the importance and urgency of supporting research in mental health, including that on psychological interventions involving adults, children, adolescents and third and fourth age.
The recommendations of this Consensus come at a time when our lives have changed due to the SARS-CoV-2 pandemic, which will have, among other impacts, possible repercussions on psychological wellbeing. An example of this are health professionals, most at risk of psychological distress, women, young people worried about their future, family members of COVID-19 patients experienced the threat of losing a loved one, and workers whose livelihoods were threatened with consequent critical issues on the economic as well on social inclusion and mental health. It should not be forgotten that several studies show that the loss of work productivity is among the main determinants of poor mental health and there is strong evidence that, in general, the prevalence of mental disorders is higher in those living in socially disadvantaged conditions (unemployment, lack of education, poverty, marginalization). In our country, depression is twice as frequent in the unemployed.
It is conceivable that due to the pandemic, the demand for psychological and psychosocial interventions and treatments will increase in the coming months and years, especially in the most fragile people. The hope is that this Consensus will promote and encourage special attention in developing a response based on coplanning, involving institutions and actors from the health, education, research, work, and welfare sectors. The person with mental disorders and conditions of social fragility must be at the centre of this effort, to define integrated paths to promote the best possible quality of life.
