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Report to the European Commission
on Women’s Mental Health
Luxembourg, 5.7.1994
" Update
on health care in Italy, specially concerning women’s status, and actions perspective
"
In Italy, as much as in other european countries, women are the largest portion of health care services users.
Women,
indeed, are, in most cases, the ones asking for assistance whether the request
concerns themselves or their family members. It’s their chore, by social
expectations, to take concern of the family’s health care needs.
Focusing
on disease and mental health, women think of themselves to be more espoused than
men to mental disorders, e they undergo treatments and pharmacological therapies
more frequently.
In
Italy, like in other European countries, women request, more than men,
the general practitioner help, for theirs or their relatives health
problems; following the general practitioner suggestions, then, they
accept to contact a specialist, in particular a mental health specialist,
and they ask, more than men, hospital treatments for mental, and specially depressive, disorders.
Based
on several epidemiological studies, carried on both men and women users of
mental health care services, in different geographical areas,
as reported in our “1° International Seminar upon Mental Disorders in
Women”, CNR, Roma 1998, we can assume that there is a prevalence in women,
compared to men, in approaching general practitioners or specialists for
psychiatric or psychological help.
We,
also, find that women, more than men, are prevalent in 9 kinds of disorders
typology, with a rate of 5 to 1.
The prevalence of women is evident in disorders like:
psychosomatic, affective and relational,
depressive, but, also, and this is a new data, in the major psychiatric
diseases.
The
presence of this particular risk factor, in women, very clear in the italian
researches, seems to be relievable, at the same extends, in other international
studies.
Just
as it appeared in that International Seminar, which updated conditions of
women’s mental health care in Europe and, in certain studies, in U.S.A.,
Canada and some Latino American countries, there is the necessity to compare the
most advanced experiences in female psychological disorders care systems, but,
most of all, to lead our researches towards a shared network system of studies
upon actions and events, that we consider important to individuate the causes of
female disorders.
These
are the conclusions of international studies and data.
1.
women are the most users of
general and mental health or psychiatric health care services; those, on the
other hand, do not respond to women’s needs and do not take in consideration
women’s daily life;
2.
women, all over the world, live in
worse economical, material and psychological conditions; they die later than men,
but, voiceovers, they experience worse health conditions, either on an objective
(they get ill more and longer) or subjective (they precept sufferance more, they
complain about it and declare it more) perception;
3.
Women suffer in most cases with
depression, which is the new rising pathology in our industrial society;
4.
Because of their central role in
the family contest, women in their problems the other members, and,
particularly in their psychological problems, they involve their children
too.
5.
Women working take seek leave
frequently for psychological problems. This causes damage to their career
besides influencing the costs of work productivity.
These
assignments configure a situation of more sufferance for women and a lack of
correspondent adequate actions aiming to the organization of health care and
prevention specific services.
In
Italy, in particular, the organization of public services for mental health care
is still in process since the law which reformed the psychiatric assistance has
not yet been applied to the whole national territory.
We,
besides, find a shortage in updated data, given by Ministry of Health, about
psychiatric assistance and psychic pathologies development conditions.
At
an international level is clear that the main attention in researches is focused
on the care of disorders as much as pharmacological and diagnostic survey. This
way leads up to an interpretation of psychological disorders according to a
typical medical point of view by which, diseases are classified merely by their
symptom description and their cure
is mainly pharmacological.
The
diagnostic/pharmacological research is the one
which has been developed the most, at an international level, also
because related to the big business of the pharmacological industry.
Those,
in particular, are the ones which have sponsored most of the researches upon
certain problems such as depression.
Also
clinical and epidemiological researches upon genesis and causes of psychic
pathologies, (specially depression and psychosis) have focused on biological
factors.
Because
of the prevalence of the medical and treatment approach, and the amount of funds
devolved to this section, other kind of researches, like the ones focusing on
prevention, have been left a part or assigned to single people or small group
researchers, with shortage of budgets.
Prevention
should be, instead, the main objective of institutions promoting health through
actions aiming to reduce causes of illness; therefore, it should take vantage of
public funds for researches since the final result, improving quality of life,
is not a single person but the whole community vantage.
Researches
for prevention need a large study contest because they concern the whole
population, the ill and the healthy part, and various factors related among
themselves.
We
can achieve such a purpose only if we built a kind of research that relate
researchers together in comparing:
hypotheses, methods and samples; and tends to a network kind of study,
able to individuate those factors which mostly lead to genesis of psychiatric
illness, through the largest work experiences of researchers themselves.
The
lack of exchanges among researchers, till now, has produced repetitive
researches, n one side, and contradicting results, on the other.
In
researches upon mental health, for instance, there have been disagreements on
the following topics:
a.
age and sex classes mostly
espoused to pathology risks;
b.
life conditions particularly risky
: some considered marriage as a protective factor, others as a risk factor. The
same has happened regarding the presence of children and/or a job;
The
imprecision on these and other topics, shows the lack of large and deep studies
upon relationships between daily life and psychic disorders.
A
differently orientated research plan will have to take in consideration this
relationship and find out specific risk factors besides people classes more
espoused to psychological disease risks.
According
to our experience, as confirmed by
results of our survey for the C.N.R. “Stress
conditions in daily life and pathological
answers”, the risk factors to be checked the most are the following: over
or under load of work and responsibilities in familiar and extrafamiliar
contests; absence of social relationships and supports;
lack or failure of individual projects related to a personal perception
of being without resources or alternatives; physical conditions of tiredness not
related to effective condition of stress.
Besides,
categories more espoused to psychological disorders, are, in most cases: women,
adolescents, and all those categories of people experiencing violence and
conditions of outsiders.
The
guidelines we believe should be given today for an appropriate prevention
planning are:
1.
a national and international
institutional effort to acknowledge the growing relevance of mental health, in
particular the women’s one;
2.
a kind of researching which aims
to put in evidence connections between personal psychological experiences and
environmental contest, while studying risk factors;
3.
research planning for prevention
which considers as social groups, espoused to risk, women, adolescents of both
sexes and all those categories of people with special life conditions (such as
experiences of violence) or living in specially “destructurated”
environments.
4.
Training courses to those working
with people suffering with mental disorders;
5.
Sanitary educational programs for
“under-risk population” those who take care
of adolescents (parents and teachers);
6.
Differentiated planning in
psychiatric assistance : one aiming to prevention and the other to treatments,
along with developing different actions and services.
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