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FAMILIES NEED AN INDIPENDENT AUTHORITY FOR THE MOST SERIOUS PERSONAL AND FAMILY PROBLEMS OF THE MENTALLY ILL
The creation of a special Authority for the safeguard of patients and their families is necessary because:
a) institutions are insufficient and often lacking in coming forth to help the most severe cases;
b) there are no laws to make sure that the recommendations of P.O. 1998-2000 are followed;
c) there are no penalties for those who do not comply.
Both patients and their families can apply to the Authority in case of urgent necessity for the patient to be taken in charge, when treatment is delayed or refused to the patient or even when the patient himself, despite every effort being made, refuses to be treated.
The right to apply to the Authority is given to patients' families as well, because the law recognizes their active role in caring for their sick relative and their economic and legal obligations.
Because of this opportunity, families make sure that patients receive appropriate treatment, thus preventing a worsening of the illness, in the interest of the family itself and of other persons.
It should therefore be possible to prevent straitened circumstances and abandonement and also to restore earlier patients to a sort of mental well-being; the costs befalling society every year for the treatment of the mentally ill will decrease.
At the audit all parties will be listened to: family members, doctors, operators plus the patient who has the right to be assisted by a lawyer. The patient's present and past life events must be evaluated with care.
It is actually demonstrated that people with violent propensities can easily be aggressive again and the patient's assessment must therefore take into account his past history, for better and for worse.
This need arises from the fact that psychiatrists have too much power in choosing whether to treat, to delay or withdraw treatment.
This arrangement will force psychiatrists and families to find an agreement without struggles and guarantees treatment to patients.
Attainment of the plan and improved assistance can reduce the number of audits, which must nevertheless be organized as a safeguard for families.
EACH SENTENCE MUST BE FOLLOWED BY THE OUTLINING OF A DETAILED REHABILITATION PROGRAMME
Decisions taken at the audit must be followed by families and operators during the treatment.
In particular, operators must work out individual protocols of treatment: each patient must agree to a number of obligations, included a medium-term treatment in an institution.
The psychiatrist must be responsible for the patient within the community and inform the judge if the treatment is discontinued or if it fails.
Law 180, in fact, hinders this type of programme because every single act, even within the community, is made possible only through complex procedures based only upon compulsory admission.
The result is that patients, once discharged from the hospital, are not compelled to receive treatment.
HOW TO ENSURE PATIENTS ARE TREATED
Compulsory home treatment could be taken into account, for instance patients could follow the rehabilitation programme and report daily to the Centre to receive the necessary medications.
If the patient is particularly aggressive or his illness is severe, he can be discharged only if he agrees to be treated out of the hospital and must be admitted again if he discontinues treatment.
Patients whose illness is severe can live within the community only if they follow their protocol of treatment and agree with it: decisions must be made in accord with the afore mentioned precautions.
COMPULSORY OUTPATIENT TREATMENT AND COST REDUCTION
Law 180 does not contain anything of the kind and our proposal is innovatory and has been successfully tried abroad.
Instead of compulsory in-patient treatment, which is very expensive, it is possible to make patients with a given illness follow tailor-made rehabilitation programmes, thus reducing costs:
early treatment for patients with particularly severe illness, with better chances of recovery and reduction of social costs;
treatment and subsequent readjustment to normal life take place sooner;
no delay before treatment is started;
possibility to check progress on a daily basis, acting before recurrences and preventing the possibility of violent behaviour