Treating Psychiatric and Psycho Affective Disorders in Adolescence
Project location: ITALY, Rome
Project start date: June 2012 - Project end date: May 2013
Project number: 2012-032
Beneficiary: Centro Italiano di Solidarietà
"CeIS don Mario Picchi" 's project's main purpose is to treat and prevent psychiatric illness and its complications in young adolescents between 12 and 18 years. According to the data collected and to the information gathered through clients attending CeIS' services, this health problem looks increasingly spread and it is becoming a real social and health emergency.
The psychiatric illness in "cognitive development" constitutes a large phenomenon. The data available in international literature indicate a prevalence of about 20% of psychiatric problems in this age group (WHO, 2008;). Rutter & Taylor (2002) argue that the presence of psychopathology in the younger population is between 10% and 20%.
Methodological epidemiological studies in literature shows that 40 percent of children and adolescents attending a mental health service has more than one disorder at the same time. In addition, there is a strong presence of psycho-social problems (Besana & Spinelli, 2001). The mental health issues are, in all industrialized countries, increasingly important, because their prevalence shows an increasing trend and because they are associated with a high degree of disability and economic and social costs, which burdens on patients, their families and the community. Report of the World Health Organization (WHO, 2008) reported that within a year 20 percent of the adult population would have one or more mental disorders nosographycally fit. It is known as mental disorders of adults and are preceded by disorders of developmental-adolescent (WHO, 2008;).
In particular, 8% of children and adolescents has a mental disorder, which can result in interpersonal difficulties and maladjustment; we must not forget that suicide represents the second cause of death among adolescents (Morosini et al. PNSM, 2006). In Italian literature there are still scarce studies that indicate an epidemiological documentation on discomfort and psychiatric pathology in adolescence based on a real sampling.
The CeIS don Mario Picchi is a privileged observatory, close to the most common issues related to discomfort and sometimes pathological collapse and related psychiatric situations of marginalization and social exclusion. The organization is witnessing an alarming increase in behaviours that are defined in clinical literature as "cutting".
These behaviours lead to the deliberate alteration of body tissues and lesions and residual scars. The data of direct clinical experience are supported by international scientific literature that finds the same worrying diffusion of the phenomenon. The spread of "cutting" behaviours varies widely in different populations. Taking into account the overall psychiatric population the impact is significant and can vary between 4.3% and 20%. When the population is restricted to adolescent psychiatric incidences goes up dramatically, up to 41% (Darche 1990) and 61/% (Clement and coll. 1991).
Among "cutting" behaviours, it detects: inflicted cuts (80%), but also obtain haematomas, (24%), burning (20%), slamming his head (15%) and biting (7%). But enlarging the category of destructive and self-destructive behaviours, there are also suicide attempts, conducted with self-mutilation and eating disorders.
According to many authors, most individuals with "cutting" behaviours in reality are characterized also by the presence of other aspects of personality disorders. So these behaviours may be a sign of more serious disorders, Borderline Disorders or related to a lack of impulse control.
The over ten years experience in the field of CeIS, coincides substantially with those considerations. Very frequently the youth population that attend our services, presents, from the point of view of their symptoms, traits and aspects of personality, emotional instability, impulsivity, unstable relationships, inappropriate and intense anger, abandonment fears, suicidal behaviour, instability in the perception of identity and, if failure in the examination of reality, chronic feelings of emptiness, transient dissociative episodes. These features are associated with increasingly "cutting" behaviours and physical injuries.
In this regard, one of the most recent reviews on the subject emphasizes that there is an evident co-morbidity between Borderline personality disorder and substance use disorder. (Lieb and Coll 2004) Privileged observatory of CeIS services dedicated to young people, allows a wide prospect of study and intervention on this part of the population that has conducted youth of self-harm and "cutting" behaviours. According to the international scientific literature has pointed out how these types of behaviours are related with intolerable emotional states and a strong tendency to impulsiveness.
In particular, teenagers state:
-increase of tension immediately prior to the act of selfinjury-gratification and sense of immediate psycho-physical relief during the act of "cutting"
- failure to resist the need to injure themselves
-"cutting" is not associated with a suicidary intention, nor it is linked to hallucinatory or delirant states.
A common characteristic for young people who declare, with a certain repetitiveness, self-destructive behaviours, is a humoral state that oscillates between a depressed and anxious condition.
The fact that a destructive behaviour can respond both to the need of having relief and to the need of treating a painful emotional status, from a clinical point of view is quite worrying. Cutting can then become a coping as well as a disadaptive strategy and it helps to manage emotional states otherwise perceived as intolerable. The "cutting" behaviour of self-stimulation or self-sedation becomes a pathological response to self-medication. This might lead to a reinforcement of a kind of behavioural habit or to a veritable dependence. Actually, existing structures on the territory seem inadequate and unprepared to treat teenagers who have these problems. On the other hand existing private structures are very often too expensive for most of the people affected by these problems.
This data shows the need to provide a detailed and integrated activity, able to treat and prevent the complexity and the multiple comorbidities of this type of behaviour.
It is believed that only a complex articulation of clinical intervention, based on multimodal strategies and the integration of professional skills, may attempt to an effective response.
Direct beneficiaries of the project are not drug addicted adolescents from 12 up to 18 years old with psychiatric and psychopathological problems.
In particular the project will focus on those who practise the "cutting".
The project will provide its services and support mainly to the adolescents coming from poor families. All the service provided will be free of charge.
Other beneficiaries of the project will be the families of the young person. Counselling interviews and specific self help groups will be organised to help the families to deal with the problem and to have support and collaboration.
To offer the above mentioned adolescents a semi-residential centre that operates in collaboration with the public and private services, for the treatment and the rehabilitation of this complex category of clients to fight this strong social and health emergency.
• to offer a pleasant space to the young people in crisis.
• to provide a correct and precocious diagnosis.
• to enhance among the young people the experimentation of effective relational models with adults and with the group of peers
• to facilitate the activation of the development resources and the adaptive patrimony to face the crisis.
• to reduce or to eliminate the practice of the "cutting" in teenagers with psychiatric or psychopathological problems .
• to support the young person in the formulation of an autonomous and aware request of help.
• to stimulate the social, scholastic or working inclusion.
• to support the families of the children coming to the Centre.
The existing debate in the psychiatric field has definitely demonstrated the overshooting of models of sequential and parallel processing in favour of the integrated model. The effectiveness in addressing complex issues such as psychopathology, resides in the possibility of structuring integrated and coordinated actions by a mixed staff with different skills and training geared to the treatment of complex disorders. Therefore the project includes the structuring of a reticular system of operations, according to a model of "shared management" or "shared care", in order to overcome polarizations or dichotomies.
The methodology of the service will be based essentially on three criteria:
1) The use of a controlled and not institutionalizing space to activate the development resources and the adaptive patrimony necessary to face the crisis, focusing, from the very beginning, on the healthy aspects of the personality.
2) The structure of space-time. Space: allows the young person to experience a "place" of movements and emotional dynamics; it represents a sort of container where to reappropriate the representative, relational and emotional value of the "staying together with others." Time: the rhythm, the scheduled activities, the temporary nature of the structural aspects of the Centre, reactivate teenagers relational cognitive and emotional-affective processes, through which it is possible to do again the experience of "living within a time". This part of the methodology is based on the belief that aspects of space-time structuring and flexibility are essential for the establishment of a setting within which it is possible for the client to experience normalization and socialization.
3) Relationship with peers and with operators, represents a fundamental therapeutic tool: it allows not only the reacquisition of social skills, but also it strengthens the motivation to "sociality" in a general sense, offering the possibility to experiment himself as a "person" in a protected environment, where the emotional aspect, connected unequivocally to every experience, becomes convertible and usable. These general criteria will build the Service methodology, as an expression of an continuous experiential process seeking therapeutic alternatives, clinical effectiveness and methodological trials.
The team will provide consistent and punctual responses to individuals, who might often be fragmented, multiproblematic, "split" or in crisis situation. Duties and responsibilities will be distributed according to everyone's skills and technical organizational tasks necessary to manage the structure. This methodology is supported by an integrated and multidisciplinary intervention model, in which the specific skills and the different professionalism come together in a unique project proposal.
The service includes the following professional figures:
• 1 Psychologist - Coordinator
• 1 Psychiatrist - consultant
• 1 Psychologist
• 1 Psychotherapeutist for the family
• 1 Psicho-diagnosis specialist
• 1 Social worker specialised in Thai Chi Chuan
• 1 Yoga trainer
• 1 art therapist ( pottery and painting)
• 1 operator for photography and music workshop
• 1 Social worker (volunteer)
The psycho-rehabilitation approach is based on a methodology which refers to systemic-relational, gestalt and phenomenological paradigms. Using integrated groups this approach focuses and it emphasis the emotional components of what it has been experienced.
Main activities proposed are:
• Therapeutic activities (individual interviews, groups, animation group, scholastic and vocational orientation group, balance of the competencies, parents group, elaboration of an individual project for each single young person in collaboration with the personal psychiatrist, if there is one, CeIS don Mario Picchi psychiatric and the eventual sending institution)
• Training and leisure activities (Yoga, pottery and painting workshop, music and photograph workshop, etc )
• Cultural activities (videoforum, sightseeing, parties and celebrations)
Data collection, Monitoring and Evaluation
The headquarter of the service proposed will be in Via Appia Nuova 1251, one of CeIS don Mario Picchi's premises.
It will work five days a week from 9:00 a.m. till 5:00 p.m.
The spot is composed by different buildings inserted in a 11h. green area.
Besides the premise for the project, clients might use a gymnastic hall, an outdoor sport court, a multipurpose room, a library with school books, a room with a stage (theatre), an internet café room.
The area includes a conference hall as well, where the final seminar will take place.
It is served by the public transport, but it has a big parking place, for the parents who will take there their children.
The project, which received a grant from the Nando Peretti Foundation, will have the following achievements and outcomes:
1) a semiresidential service for young people with psychiatric or psychopatological disorders (mainly cutting)
2) support to 40 young people in one year (max 10 per day)
3) support to corresponding families
4) contact with about 100 young people and or referral figures
5) reinforcement of the network with other public and private services
6) final seminar with stakeholders and local, regional and national authorities