The Mental Health Department

The Trieste Mental Health Department was established in 1981, and since then has continued to evolve and redefine its own tasks and functions. The first three paragraphs of Art. 1 of the current Regulation, which was approved by the Managing Director of the Local Healthcare Agency on December 29, 1995, clearly define its goals and aims:

• The Department for the safeguarding of mental health is the Healthcare Agency's operational structure responsible for prevention, diagnosis, care and rehabilitation in the area of psychiatry and for the organisation of interventions aimed at safeguarding the mental health of the local population;
• The Department shall work to eliminate any form of discrimination, stigma and exclusion directed at persons with a mental disorder or condition, and shall actively promote the full and complete rights of citizenship of such persons;
• The Department guarantees that the mental health services and structures operating within the Healthcare Agency constitute a single and unified organisational complex; further, the MHD shall take care to avoid the fragmentation or inadequacy of its actions, ensuring the close coordination between its own services and other Healthcare Agency services, especially the District services, in collaboration with the local community and its institutions.

Administration

San Giovanni compound
Via Weiss 5 – 34100 Trieste
e-mail: dsm@ass1.sanita.fvg.it
http://www.triestesalutementale.it

The Administration of the Mental Health Department (MHD) is responsible for the goals, programming, management and verification of the Department's services and interventions. More specifically, the Administration is responsible for:

• Developing the therapeutic, rehabilitation and prevention activities by means of operational models which promote the programmes and goals of the MHD;
• Establishing and verifying the clinical-diagnostic and therapeutic-rehabilitative goals and activities;
• Motivating and evaluating its staff and collaborators through training and creating an atmosphere conducive to productivity;
• Managing the budget;
• Coordinating, supporting and providing goals for the directors/managers of the MHD's various structures and services;
• Collaborating with the Healthcare Agency in planning and implementing forms and models of integration with other public agencies/structures and private accredited partners.

The Administration is made up of the following offices and workgroups:

• Nursing Service - manages, coordinates and supports the interests of nursing personnel, and participates in negotiations with management for work assignments, staff composition and the allocation of human resources in general. Due to the high demand for training by other MHDs in Italy (and in the context of international cooperation programmes), the Service coordinates and carries out training activities, including internships, exchanges and training visits. Such training takes place primarily within the framework of the Mental Health Studies Centre-WHO Collaborating Centre and is carried out for the purpose of reskilling and training personnel.
• Office of analytic accounting and expenses (per service), secretarial coordination and administrative relations - gathers data from the different expenditure/cost centres within the MHD, distributes resources to these centres in accordance with the Administration's decisions and prepares the support documentation for official MHD acts and resolutions.
  It also provides support for official acts regarding personnel management, relations with the Local Healthcare Agency's administration and operational structures, the management of internal/external correspondence and the archiving of printed documentation.
• Data Processing Office - in collaboration with the MHD and in accordance with Administration decisions, gathers, process and archives epidemiological data for institutional purposes and provides support for the MHD's programming and research activities.
• Technical Coordination Committee - a consultancy body, composed of the MHD Director and the directors of the various MHD structures and services.
• Participation Committee - made up of representatives of users and families, community volunteer organisations and MHD staff.

Organisational Structure

In addition to staff organisation, the Trieste MHD is made up of the following Operational Units (OU):

• 4 Mental Healthcare Centres (MHC) - operational 24 hours a day, 7 days a week, with a catchment area of approximately 60,000 each and furnished with 6-8 beds (together with an experimental MHC managed by the University Psychiatric Clinic with a catchment area of 11,500 and equipped with 4 beds). The MHCs are the entry-point to the mental healthcare system and function as the pivotal centre for the coordination of activities and the programming of services and intervention. The MHCs developed out of the original 5 workgroups formed during the deinstitutionalisation period in the 1970s and currently cover the same territory as the 4 corresponding Healthcare Districts.
• Psychiatric Diagnosis and Care Service - located within the General Hospital and furnished with 6 beds. The PDCS works closely with the Hospital Emergency Room in order to treat and filter psychiatric emergencies and, after an initial intervention, refers cases to the competent MHC;
• Rehabilitation and Residence Service - located within the San Giovanni Compound, the RRS, in close collaboration with the MHCs, monitors and coordinates the following rehabilitation activities: residential (which it runs directly or through Type A social coops and/or Associations), individual (Personalised Rehabilitative Therapeutic Plan and Healthcare Budget), Day Centre activities (in collaboration with training agencies) and occupational training/placement programmes (in collaboration with Type B coops).
• University Psychiatric Clinic - located within the San Giovanni Compound, it functions as the facility for university psychiatric specialisation and in addition to providing care and assistance the UPC also performs didactic and research functions. It has a total of 10 beds, 4 of which reserved for community mental healthcare.

Human, organisational and economic resources

The MHD has a total staff of 248, with the following breakdown (December 2005): 28 psychiatrists (including 4 university staff), 9 psychologists, 9 nursing managers, 141 nurses, 9 social workers, 27 social/healthcare operators, 9 rehabilitation specialists and 17 administrative/auxiliary personnel. There are also 20-40 social coop members and educators working in the residences and related rehabilitation programmes (Healthcare Budget). The MHD also hosts numerous interns and volunteers, who often come from other areas of Italy or from abroad.
The MHD also utilises basic services provided by Type B coops (laundry, canteen, cleaning, gardening, transport). Each MHC also has a canteen for users and guests, either within the Centre itself or in a local subsidised restaurant/trattoria, and an average of 4 vehicles (25 total for the MHD) which are used for crisis intervention, home visits, recreational activities and to accompany users.
In 2005, the MHD had a total budget of 16,057,739 Euro (equivalent to ITL 31bn), 734,182 Euro of which was allocated to extra-clinical activities: e.g. occupational training grants, social integration subsidies, recreational and training activies, and contributions to social coops and self-help organisations.

How to access the Mental Healthcare Services

No special procedures are necessary in order to access the Mental Healthcare Services in Trieste: contact with the competent MHC can be made directly by the person needing help and/or by 3rd parties (spouse, family members, relatives, friends, neighbours).
Each MHC has a reception desk and every intervention is carried out in full respect of the primary user's confidentiality and privacy. If the request is made by 3rd parties, every effort is made to have the person in difficulty make the request for care themselves in order to establish the necessary relationship of trust from the very first encounter (family members are encouraged, through their GP, to find the most appropriate way for convincing the person to accept help).
Contact with an MHC can be made in the following ways:

• Walk-in during MHC hours, in order to request an appointment and/or consultation;
• Home visit, in both crisis and non-crisis situations
• Request by telephone for appointment and/or consultation
• Referral by GP.

The initial contact can take place outside of the MHC: in the Local Healthcare District, at home, or in other agencies, institutions or social/healthcare faciltiies. Referral to an MHC by the PDCS involves only those persons who were admitted through the General Hospital Emergency Room, generally in a crisis or emergency situation.
There are no waiting lists and the first consultation generally takes place within 24 hours after the request is made. The request is taken by the operators on duty and the first evalutation is carried out, after the first consultation, by a psychiatrist or psychologist, together with the other members of the MHC team (nurses, social workers).
The various problems involved are evaluated based on how they manifested themselves during the first contact/consultation, and a decision is taken if, how, and with what intensity to continue the therapeutic relationship. The response and therapeutic programme generally corresponds to the special needs and problems expressed by the user; the Service therefore avoids standardised responses and tries to offer responses which are is personalised as possible.
Currently (2007) it is not necessary to pay a "ticket" in order to receive an initial consultation.

The rights of persons who contact the Mental Healthcare Services

Art. 16 of the Mental Health Department Regulation (approved December 1995) is the "Bill of Rights" for persons using the mental health services. The list is reproduced below, not as a useless exercise or repetition of the same rights sanctioned by the Constitution, but in order to stress how very difficult it is for persons with mental disorders to enjoy or access these rights in a real, tangible way. In stressing the "weakness of rights", the Users Bill of Rights commits the services, ie. all of the MHD operators, to find ways of guaranteeing the exercise of these rights on a daily basis.
The following rights are especially important:

• the right to free expression, in every place and circumstance
• the right to have one's moral, religious and political beliefs respected
• the right to have one's sexual preferences respected
• the right to communicate at any time with whomever one chooses
• the right to have one's abilities recognised and reinforced, instead of an exclusive focus on problems and disabilities
• the right to be informed regarding any treatment, and to participate in any decisions effecting one's health or life
• the right to not have one's physical integrity and personal dignity violated (especially by any form of physical restraint)
• the right to have one's basic needs met and to be assisted in the personal search for emancipation
• the right to choose the care team and, within this team, the right to choose specific professional figures
• the right to form groups and associate with others
• the right to choose an operator of the same sex for any treatment/manipulation involving physical contact