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REGIONE
CAMPANIA
“Azienda Sanitaria Locale Napoli 1”
(Local Health Unit)
WOMEN’S MENTAL HEALTH PREVENTION CENTRE
Clinical Psychology, Psychotherapy,
Research and Training Centre
director: E. Reale
Lecture:
Strategies
for Implementing GBA
in mental health field
By
Elvira Reale and Vittoria Sardelli
Introduction
Magnolia
Centre
Our
out-patients Centre is a public health care Centre specialized in women's mental
health problems.
The
team is made up of psychologists, a psychiatrist, a medical doctor specialised
in homeopathy, a sociologist, nurses. The Centre exemplifies the possibility of
carrying on, within the Public Health System, activities of gender oriented
Prevention, Treatment, Research and Training.
We have been treating
women for more than twenty years.
Up
to now, about 6.000 women have been treated in our mental health service, and
1503 women have been treated in the last five years (1996-2000).
From
an epidemiological point of view, this population corresponds to the general
female population of Italy. It consists mainly of adult married women, with
children.
Main
symptoms are anxiety, depression, and/or psychosomatic troubles. In recent years
the demand for care has been growing, also from younger women, aged between 15
and 44.
Our
statistics are consistent with international ones.
International
Data on Depression and other mental disorders
Research
has highlighted that children's mothers and girls are at the highest risk of
depression. The prevalence rates, in depression are between 2 and 3 times higher
in women than in men.
Female
adolescents run a much higher risk of disease compared to boys, and in some
cases, like eating disorders, the rate for women goes up to 9: 1 (90% of the
total cases).
Why
do so many women suffer from mental disorders?
The answer from the traditional
medical world
¨
In terms of research, even though it
is difficult to prove genetic, hormonal and personality structure hypotheses the
research is mainly oriented to evaluate the correlation among women's mental
pathologies, particularly depression, hormonal, biological and personality
factors.
These research projects are carried out with large
financial support and with the contribution of pharmaceutical industries, which
are profit oriented. The out comes of psychosocial research lead to a different
explanation of the higher morbidity in women compared to men, but this kind of
research does not have adequate
financial support.
The traditional projects do not yet study the
interconnection of many relevant factors: being married and having children;
lack of trust toward the partner; lack of social support; low self-esteem;
violence, battering and dependency.
¨
In clinical practice we find sexual
prejudices: the fact that mental illness, particularly depression is more
widespread among women, is considered by the majority of psychiatrists
as related to female biology (hormonal fluctuation and so on) and
personality traits (passivity, low self-esteem, dependency).
Treatments for women, compared to those for
men, are more traditional: pharmaceutical treatment is prevalent, at times
associated with psychotherapy.
Treatments in a mixed environment (both in
or out clinic) do not fulfill women’s needs: often they are involved in an
abusive relationship with a violent male, for they do not appreciate sharing a
common therapeutic space with men.
Women, compared to men, are objects of
longer medical and pharmaceutical treatments, and run a high risk of becoming
chronic cases.
This data on longer therapies for women
might be due to a lower effectiveness of pharmaceutical treatment, which seems
to miss the goal more frequently compared to men in terms of improving women’s
health.
¨
About prevention, existing studies
have not developed indications for acknowledging risk factors and protective
factors in everyday life, to be used in prevention campaigns.
Prevention should have priority in any
health system, for any pathology, yet in the field of mental illness we notice a
lack of interest in developing studies and indications toward primary
prevention. Such a lack of interest damages women in a special way, since they
get mentally ill more frequently than men and are much more exposed to
risk factors in their environment.
Inappropriate prevention (often overlapping
treatment) is connected to the recommendation to begin drugs assumption as early
as possible, i.e., at the first symptom, even during adolescence; to avoid
interruptions and to continue psychodrugs assumption for long periods of time.
¨
As for the organization of services
few Mental Services are focused on women: most services ignore women’s health
needs in this field and are not equipped to deal with them. In health programmes
there are no indications to lower female rates of mental illness; there are no
gender-oriented health activities for risk groups such as adolescent girls or
employed women with family commitments and children (overload).
In synthesis: mental health services seem
to correspond to men’s needs. They are oriented toward “returning the person
to his activities, in order to take up interrupted activities” without
observing if these interrupted activities are the very cause of discomfort and
disease.
Gender based Analysis (GBA)
Proposal
v
In the field
of Mental Health Research the GBA highlights
the necessity of:
-
collecting data by sex, and showing
the results according to this distinction;
-
using case-control samples;
-
including patients of both sexes;
-
relating the different variables to
the sample divided by sex.
In the field of pharmacological research, it is necessary
to acknowledge the biological difference between women and men.
In the field of clinical research it is necessary to set
up new and specific therapeutical tools for women focusing on the link between
illness and everyday life.
v
Clinical Practice
It is necessary to integrate and modify
the traditional ways of working by the elaboration of :
-
diagnostic protocols able to point
out the pathogenic pathway which leads to mental illness.
-
Sex specific protocols for
pharmacological treatment and recommendations that suggest caution in dosages
for women. Particular Recommendations against psychodrugs assumption in the
years of growth.
-
Treatment protocols apt to:
-
guide health care providers in
singling out the causes undervalued by women themselves;
-
give suggestions apt to help women
to lighten the burden of responsibilities and to assume styles of behaviour more
suitable to individual wellbeing.
v
Prevention
According to GBA, primary prevention
should focus on environmental and social-relational factors. These are factors
on which it is possible to intervene before the overload of "pressure"
becomes a psychic pathology.
Prevention should be gender sensitive
and mainly addressed to the most vulnerable subjects: female adolescents and
women (in the range 15-44).
ü
Preventio
1. In Adolescents
·
Early adult role playing for
supporting mother
·
Study and hobbies lowering
·
Peer relationship reduction
·
Trust only in parents
·
Skills unrecognised
·
Conditioned planning for the future
·
Feeling unwell.
2. In adult women
§
Increasing family work (work characterised by care for
others and lack of self-care) connected to lack of “gratitude”
§
Unrecognised tiredness as connected
to family work
§
Decreasing personal interests and activities
§
Decreasing/lack of support
§
Lack of confidence in extra-family relations
§
Low
self-esteem connected to undervaluation by others (family-social context).
v
Mental Health Services
It is necessary to direct health services towards:
-
prevention
and therapeutic activities for women;
-
offering women specific services.
Three types of activity or services for
women:
1.
The first type relates to preventing
specific situations of distress.
2.
The second type of service is addressed to women who have already begun
to develop an illness and manifest symptoms, and who have already had
psychiatric treatment.
3.
The third type relates to setting up "women's refuges" (women in
distress and violence situations).
Strategies
for GBA Implementation
Until now we have evidenced bias and
gaps in the mental health field (research, clinical, prevention, services)
and we have also evidenced in the light of GBA the corrective actions for
women friendly psychiatry and psychotherapy.
Really the actions to modify scientific theories and clinical practice
cannot be led by single persons, alone, or by gender oriented single groups. It
is necessary involve in this plan Women Associations, University Researchers,
professionals who treat women with
mental disorders in different European Countries.
For these reasons we propose a new
European network on women mental health made up of gender oriented technical
groups and women/consumers associations.
These groups will be able:
to
collect in each country and exchange epidemiological and clinical data,
critical observations on gender bias, sexual prejudices and
inequalities presently
in existence in research and clinical practice (medical, psychological and
psychiatric);
to analyse the data pointed out by each
group, and to elaborate the synthesis on which the consensus will be
reached;
to develop
Indications, Recommendations, Guide-lines, for the inclusion of
gender point of view in research and clinical practice in the field of
mental health;
to exert pressure on mental health
orientation of decision making European Institutions;
to propose to E.C. (European Commission) the funding
a project on the network's organization.
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