This feature by the Italian Society for DBT (SIDBT) Executive Board (Lavinia Barone, Donatella Fiore, Paola Pazzano, Monica Marchini, Lisa Polidori, Pietro Ramella, Ilaria Riccardi, Rossana Spotti, and Michele Sanza, with Past President Cesare Maffei) is Part 2 of 2 in a series about DBT in Italy. In the first part, they talk about the origin of DBT in Italy. Here in part two, they address some considerations on the National Health System of Italy.
In the first part of this blog, we addressed the connection between DBT implementation and the National Health System (NHS) – mental health network – in Italy. The Italian healthcare system offers many facilities that accept patients for no cost (for the client), which is a strength for DBT implementation and, at the same time, a challenge. In Italy, treatment for mental disorders is provided by multi-professional units in the Departments of Mental Health, which mainly focus on care pathways for outpatients. Hospitalization is rarely offered and just for patients with acute disorders. In addition, an extended network of rehabilitative units offers middle-term residential treatments. In this second and final part of our blog, we would like to share some data and considerations on this mental health system given that the NHS is a key feature of our plan for delivering mental health support.
We must address two main questions: 1) Is the NHS suitable for an adequate and effective DBT implementation? 2) Are NHS facilities a model for a “tailored” use of DBT interventions?
The NHS in Italy has a universalistic mandate, i.e., each patient looking for support must be accepted and treated. Despite this mandate, many challenges showed up in its implementation, making the mandate a mostly medical-oriented model. Pharmacotherapy was one of the most common interventions delivered, and, therefore, the effect was that borderline and emotionally dysregulated patients were left behind or overtreated with drugs. The dialectical tension here presented as a polarization between the need to accept a significant number of patients by treating them in a cost effective way by administering a primarily pharmacological treatment AND the need to treat a target population that requires intensive psychological treatment, thus calling for further resources.
DBT arrived into this tension and offered a dialectical solution: Fulfill the universalistic mandate by accepting patients AND targeting specific populations by implementing evidence-based interventions. The “grassroots” work we mentioned in the first part of the blog describing how DBT came and spread out in Italy was also present in the DBT dissemination in the Italian NHS. DBT became an elective way to treat borderline and highly emotionally dysregulated patients in many Italian mental health facilities in about ten years. The medical model was gradually integrated with a psychological evidence-based model able to guarantee effective outcomes for a reasonable investment.
No surprise if the current statistics on the DBT Italian Society website includes about 70% of public mental health facilities offering DBT treatment!
What are the future challenges now? First, we are very interested in better understanding what works for whom and if “DBT skills training only” could constitute a suitable treatment for at least a part of the patient population. Second, effective treatment must show long-lasting effects to become a reliable model. Research is still needed to better contribute to addressing this issue.
Our vision and hope for the future is that curiosity and motivation would foster facts and solution analysis for a flexible and suitable DBT implementation “tailored” to contexts requirements and constraints.
Interested to read more about DBT around the world? Read here for this blog about DBT in Brazil.
SIDBT Executive Board: Lavinia Barone, Donatella Fiore, Paola Pazzano, Monica Marchini, Lisa Polidori, Pietro Ramella, Ilaria Riccardi, Rossana Spotti, and Michele Sanza, with Cesare Maffei (Past President)
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