ENTRAR            

		INTERVIEWS AND REPORTS
		To reflect about the therapeutic interventions Interview to Dr. Giuseppe Riefolo Doctor in Medicine. Psychiatrist. Director of the Mental Health Service of Rome, Member of the Psychoanalytical Italian Society Germán Pacheco Borrella,1 Antonio Pérez Jiménez2 1Doctor in Nursing from the University of Alicante. Mental health nurse specialist. Anthropologist. Director of Presence Journal of Mental Health Nursing. 2Nurse. Anthropologist. PhD in medical-social sciences and clinical documentation, University of Alcalá. Member of Editorial Board of Presence Journal of Mental Health Nursing, Spain Manuscript accepted by 21.5.2011 Presencia 2011 jan-jun; 7(13)
How to cite this document
Pacheco Borrella, Germán; Pérez Jiménez, Antonio. To reflect about the therapeutic interventions. Interview to Dr. Giuseppe Riefolo. Rev Presencia 2011 jan-jun, 7(13). In </presencia/n13/p0170e.php> Consulted by

Presentation

    Dr. Riefolo is a renowned Italian psychiatrist who has published important literary and scientific works. In addition, his passion for film led him to use this medium to publicize both professional interventions as the situation of patients and families, serving in their daily work. Was an invited speaker at the XXVIII National Congress of Mental Health Nursing, held in the city of Tarragona from 13 to 15 April 2011. During his stay in this forum nurse agreed to be interviewed for Presencia.

Question: What is the current state of mental health care in Italy?
Answer: After the momentum brought by Franco Basaglia (through the well-known law 180 or "law Basaglia" 1978), is outside the patient who lived and were treated in psychiatric institutions. The outside institutions were positive, but now we must recognize that we were not fully prepared to give quality care at the community level. Then, these mental patients joined the new patients, who had never entered, and this led to produce a considerable increase in demand. This is a great opportunity for us  although  we were not prepared for such a claim. However, at present, in our mental Health Services we not only treat patients diagnosed with psychosis (as before), but also patients with neurosis, or depression, or personality disorders. The latter, perhaps, are those that cause major difficulties, because they tend not to accept the treatments offered and create problems of social and family life. And despite the resources we have, we have significant economic hardship. So that, in our Department of Mental Health Care in Rome to serve a population of between 500,000 and 600,000 inhabitants, only 28 hospital beds (general hospitals), divided between the Hospital San Filippo Neri (north of Rome) and Santo Spirito (near S. Pietro), in addition to 3 therapeutic communities, 4 day care centers (outpatient), about 10 "family comunity" and 8 Mental Health Services (outpatient, opened 12 hours a day and closed on Sunday). But we advocate the therapeutic encounter in the vicinity of mental patient, family and community.

Q: From your point of view, Dr. Riefolo, What are the challenges facing today?
A: From my point of view, is not giving an adequate response to psychological distress, given that many people who seek help, there is a large increase in demand and supply of care is inadequate. It makes very little psychotherapy. Still insufficient hospital beds to care for patients (acute) in crisis and there is a serious shortage of residential places for patients who have chronic and have no family resources. If to this we add that in Italy there is an excess of bureaucracy, which impedes the autonomy and accountability of professionals, we have made many interventions are useless when it is desirable that every professional should take responsibility for what they do, greater professional autonomy therapeutic responses more effective and efficient to consolidate the therapeutic relationship.

Q: What models of understanding of mental phenomena are still valid?
A: The social model has been highly politicized and, I think, it is in crisis. It has not been able to incorporate other models. In fact, in Italy, other models were rejected for almost 20 years. It has been very rigid. This rigidity has been opposing the psychological model (or psychosocial) and biological, which has led to some conflicts. Yet today, we have the rigidity of the biological model, the supremacy of the pharmaceutical industry who, in turn, is funding scientific meetings of professionals. On the other hand, we have that there is significant separation between mental health services (with a dominance of the biological model) and the university, except in Verona or Bologna or Chieti where there is greater coordination between them. The cooperation with Universities and Mental Healt Departements I think is the best model we could have for the mental healt care without psychiatric hospitals

Q: Do you envision new therapeutic strategies to eliminate or alleviate the psychological suffering?
A: I do not think that in the short term, there are new therapeutic strategies. However, in our mental health service must change the current management model for giving more responsibility to mental health professionals about their work and promote effective teamwork. For example, I can say that the six mental health nurses working in our team, (that is a team in one of the the 8 Mental Health Services in the Mental Health Department) two of them do not make home visits, and cannot be forced to perform.

Q: Are there differences between home care and care in the community mental health center?
A: I think they are different, because at home you must accept the status of the patient and family. But in the patient's home can work their relationship, which enables him to accept the rules and engage in therapeutic treatment process. Relationship is a process that also allows the person to carry from home to outpatient care. To achieve this, the process of authenticity in the relationship is very important. It is not a property of the person or situation, but a process. If you are a true professional, you will have a positive patient response. I understand authenticity as a tool to get the patient to link with community mental health center.

Q: You, also a psychiatrist, is a filmmaker. Has shot some documentary films. How did your interest in film in relation to mental health care?
A: To me, film has helped me and helps me a lot. It is a passion and a hobby. And I think that through film, as in the documents we have planned for this conference, can be transmitted to patients and families the effort made by professionals dedicated to their attention. It also has an educational value, because it serves the mental health professional to assess the achievement of certain interventions, and also can argue a case from a video recording. But for me, the most important thing is that I used to think about what I do, because when you record the activity that takes place usually becomes something special, that allows you to reflect on the therapeutic interventions that you make. It is also true that sometimes, I use pieces of film to explain specific cases or professional experiences in some meetings or to present psychiatric themes to students.

Q: Do you think there is any relationship between film language and the language of madness?
A: I do not know if there is any relationship or not. Although I think the language of cinema and the language of dreams may have some similarity, because you may see images to promote some solutions to the problems of everyday life. See, for example, that when a film opens many people talk about it, but not the same when editing a book or a paper is exposed, not generated the same kind of social debate a film, it is more social importance. Therefore, the film is a good tool to move the minds of social actors, because the picture has and exercises a great power over.

Q: One last question. Do you consider the importance of care provided by mental health nurse?
A: Indeed, the care provided by mental health nurses are very important, above all, by the closeness they have with people with mental disorders. This allows them to take concrete actions to promote mental health patients. However, in Italy, in my opinion, there is still more interdisciplinary work. As I said earlier, the bureaucracy is excessive and we need time to carry out effective coordination between the various professionals who are part of the mental health service.