- Approximately 60 million inhabitants, which corresponds to a population density of 200 persons per square kilometer
- Expenditure on health 2008: EUR 110 billion (7% of the gross domestic product, and 1.800 Euro yearly per each inhabitant, less than France, Germany, UK, and more than Spain, Nederland, Greece and Portugal); this percentage is growing in the last two years
- The expenditures incurred by the NHS related directly to mental and behavioral disorders amounted to EUR 5,5 billion, a mere 5% of the whole health expenditures, covering less than 1% of the population, while more than 6% of the same population need some kind of help for mental problems; therefore, a much larger expenditure is incurred by private citizens: only 7.000 psychologists are paid by NHS, while 30.000 work privately as psychotherapists. Costs caused by depression are growing, e.g. suicides per year have rapidly grown from 3.500 to 4.000 in the last few years, now reaching road accidents as the first cause of death in adolescents.
Psychotherapy in the health care system
- Psychotherapeutic healthcare is free of charge when provided by the NHS, and totally reimbursed in the rare cases a private insurance is available (Families of particular employees), Only the full range of inpatient care (hospitals, clinics), is always covered free of charge.
- Psychotherapy is defined as a form of treatment for mental and behavioral disorders classified by the International Classification of Diseases.
- For outpatients, psychologists of the NHS are free to choose the kind of treatment to provide, without restrictions on different psychotherapeutic approaches, for individuals, families and groups.
- The Italian law regulating psychologists recognizes their competence of diagnosis. On the contrary, psychotherapy, both provided by psychologists or by medical doctors, is subject to a specific training of at least four years, provided by University specializations or by private schools recognized by the Ministry of University and research. Pending that condition, patients have free access: no restrictions even concerning indications or the duration of the treatment.
- Psychotherapy is paid for by some insurance companies after approval of an accrediting committee (see www.panelonline.com, on the basis of appropriate guidelines.
- Inpatient care for persons with mental disorder is offered by psychiatric and departments of public hospitals and rehabilitation centers. There are no restrictions regarding the use of different psychotherapeutic approaches in clinics. The average duration can be only influences by the discussion of cases within the team.
- The activity of Psychotherapy is regulated by law. Qualification includes to be graduate in Psychology or Medicine, and a further specialization of a minimum of 4 years of postgraduate training in a School approved by the Ministry of University.
- A specific Commission, established at that Ministry, acknowledges each school on the basis of fixed criteria, and also on the basis of a recognized psychotherapeutic approach (psychodynamic psychotherapy, behavioral therapy, person-centered therapy or family therapy, but many others are accepted in the years)
- The two Chambers, of Medical Doctors and of Psychologists, keep a specific Register of their associates authorized to practice as psychotherapists. There is not an autonomous Chamber for this activity, which is therefore not considered an autonomous profession.
Psychotherapy for Depression
- There is not a specific provision for psychotherapy of depression in the NHS. On the Contrary, the (few and specific) private health insurances easily reimburse the treatments of employees or of their relatives suffering for a trauma (reactive depression).
Desirable Changes to Health Policy
- The density of psychotherapeutic care differs widely across Italy, not because of limitations on licensed Psychotherapists, who are on the contrary too many, but because of public money availability. The Chambers of Psychologists and Physicians proposed law expanding the reimbursement (as by insurances) to all the population, but it did not pass because of budget limits.
- In Italy, every psychological or medical psychotherapist is a compulsory member of his/her Chamber, and also obliged to be registered in one of the two Psychotherapists’ Register. The supervision of occupational standards is among the principal responsibilities of the two Chambers. Therefore, the chambers, which are all members of the CUP, work as public corporations. They have the power to exclude a member from practicing. They also represent their members officially, with the exception of the economic issues, which are dealt by recognized Unions. The scientific societies also have a role in fixing the standers of the continuing professional development, as regulated by the Health Ministry. INPA gathers all these bodies and represents them in Europe.
Dr. Pierangelo Sardi, Psychological Psychotherapist, INPA, Italian Network of Psychologists’ Associations (Italy)
The text above is an excerpt from the paper "Psychotherapy in Europe – Disease Management Strategies for Depression. National Concepts of Psychotherapeutic Care".
You can download the paper here.