Context
Mental disorders present a significant hurdle for Italy’s National Health Service (Servizio sanitario nazionale), with the average onset age generally falling between 15 and 35, an age range that is (unfortunately) getting younger. The incidence rates have nearly doubled in recent times, including a notable surge attributed to the impact of the COVID-19 pandemic.
The latest Mental Health Report from the Ministry of Health shows a 6.9% increase in individuals seeking assistance for psychiatric issues in 2021 compared to 2020. More than half of these cases (53.6%) were women, and emergency room visits for psychiatric conditions accounted for 3.3% of total national visits. The most common conditions include depression, bipolar disorders, anxiety disorders, and schizophrenia. While personality disorders, substance abuse, and intellectual disabilities are more prevalent among men, neurotic, mood, and anxiety disorders are predominantly seen in women.
Italy has 126 Departments for Mental Health (Dipartimenti di Salute Mentale – DSM) and 1299 local mental health facilities, averaging 2.6 facilities per 100 000 inhabitants nationwide. In 2021, the total staff in public psychiatric units amounted to 29 785 individuals. Among them, medical professionals (including psychiatrists) made up 17.9% and psychologists 6.9%. The nursing staff was the largest group at 42.9%, followed by healthcare workers at 11.6%, professional educators and psychiatric rehabilitation technicians at 8.6%, and social workers at 4.1%. Part-time employees constituted 6.2% of the workforce.
The Ministry of Health’s Statistical Yearbooks (Annuari Statistici del Ministero della Salute) show an overall decrease of 506 psychologists between 2013 and 2017, with the national average declining from 9.5 psychologists per 100 000 inhabitants to 8.5. However, between 2017 and 2020, the number of psychologists working within the National Health Service stabilized, with a decrease in permanent employees and an increase in psychologists working under contractual agreements. In Family Counselling Centres (Consultori familiari), the recommended ratio of psychologists to inhabitants, as set by Law 405/1975 (which established Family Counselling Centres), is 2.38 per 100 000. However, only a few regions meet this standard.
Impetus for the policy measure
The progressive reduction of resources, both structural and non-structural, within the National Health Service, coupled with a substantial increase in the demand for mental health care, has made it increasingly challenging to provide the necessary psychological treatment pathways outlined in the national benefits package (known as the Essential Levels of Care/Livelli Essenziali di Assistenza – LEA). Additionally, the provision of mental health services is unevenly distributed, with patchwork implementation across various regions. Consequently, people are increasingly seeking assistance from the private sector due to the limited availability of these services.
Policy measure and implementation
In this context, the Italian government introduced the “Contribution to support expenses related to psychotherapy sessions” (commonly known as the “Psychologist Bonus”) in December 2021. This measure was initially designed to help people suffering from anxiety, stress, depression, and psychological fragility due to the COVID-19 pandemic and its resulting socio-economic crisis, who are eligible for psychotherapeutic treatment.
To qualify for this fund, individuals seeking help from professionals registered with Italy’s Register of Psychologists must have an ISEE (a calculation of relative household income and wealth) of less than EUR 50 000. Initially introduced with Decree Law 228/2021, this measure only became operational from 25 July 2022.
The funding was set to expire after 31 December 2022, but with the 2023 Budget Law, it has been made permanent, and the maximum amount payable to each recipient has increased from EUR 600 to EUR 1500. However, the number of beneficiaries has been reduced compared to 2022, as the total available resources have been lowered to EUR 5 million for 2023 (compared to EUR 25 million in 2022) and will be EUR 8 million from 2024 onwards.