RISULTATI RICERCA

Under a conception of community welfare, the "Health home" (Casa della Salute) allows the re-organization of primary care and the implementation of the "initiative medicine" based on the integration and participation of professionals, associations and citizens. Starting from an analysis of the regional laws, the article presents the results of a comparative research on the Health homes of different Italian areas. The organizational analysis is based on structural indicators, functional indicators and process indicators.

Today in service systems there is the need of develop functional skills related to activation, coordination and monitoring of the functioning of the networks, by exercising "pivot" functions at the intermediate level (nor only the apical, nor only linked on the operation to each single case): this view has been identified on the cognitive level in the transition from the Case Manager role to the function of Network Manager. This requires availability and mandates oriented in this direction, as well as investments to create new scientific constructs, but also the creation of new professional identities, more mobile and with a strong centering on the dimensions of connection, communication, co-planning and oversight of related processes.

This paper argues a critical reflection about the dynamics of the Sicilian Health System. The analysis of its internal reforms shows the effort to achieve a gradual decentralization of management and control bodies. It was conceptualized as a de-generalization process, described starting from the von Bertalanffy’s General Systems Theory. This latter allows to fit the concept of complexity to the social systems dynamic’s, characterized by specific rules and standards aimed to an ever new fitting to the environment.

During the new modernity, with the emergence of the question of the democratic deficit in health-care, we have seen the spread of new forms of participatory regulation. However, that this goal has been reached cannot be taken for granted, especially when one considers that these practices are often promoted by dominant players in the field and how they tend to maximise their profit. This article aims to expose the rhetoric of participation in the institutional practice in the Tuscan Region analysing its effects in relation to the redistribution of power in the decision-making process.

The interactions between individuals and institutions become more complicated for many reasons: pressure for subjective recognition grows; polical sites where people can debate on health care issues and on the the values about clinical services are diminishing. In this sense, it is important to plan health care pathways developed with the collaboration between doctors and patients. Therefore citizens’ participation could be considered a way in order to re-think collectively the main structures of the local welfare.

The goal of this paper is to determine the prevalent governance model in regional social and health systems, in the Italian setting. At the end of a long period of institutional reforms, it appears indeed that a model of regulation is emerging based on networks and on the participation of the citizens. However, in analysing standard procedures, one observes the persistence of ordered hierarchies and bureaucracies, in which public institutions are at the centre of decision-making processes, whether on the local level or centralized. This is particularly visible if one analyses the management of financial resources that are meant to support policies.

Starting from the concept of "high communication", in general and within healthcare in particular, the article illustrates and discusses the changes produced at the social and organizational level by the advent of the Web 2.0 and of its most evolved forms, up to the new "My Page" and "My Home" (respectively, the personalized web page of the citizen and of the professional or company), destined to characterize, in the next future, the mutual relationships between citizens, business and public administrations.

This article develops a theoretical and empirical understanding of the governance processes between voluntary organizations and public health institutions in Italy. In theory, governance process allows to mitigate coordination failures between the public and voluntary agencies and to improve service delivery through community engagement. The article shown that governance between public and voluntary sector can produce very different levels of democratization and improvement of health and social programs. In some conditions, it may be that valorizing the voluntary sector can effectively renew and improve health policies, while in others the exact reverse may happen. The article offers an analysis of the main factors that influenced this result.

The welfare systems have been consolidated in the second half of the last century. The transition of post modernity society has incresed the signs of the crisis and pushed for their redefinition. The current changes depend on globalitation, but also by increased local autonomy. This article has tried to take stock of the international dibate on the welfare and health sistems classification. In the second part, this article evidence the differences between regionals welfare system and propose a new classification. The regionals health systems are different from each other, and have characteristics unrelated to the regional welfare systems.

L’Autore commenta criticamente la recensione-saggio di Marcia Angell, intitolata "L’epidemia di malattie mentali e le illusioni della psichiatria", pubblicata in due parti il 23 giugno e 14 luglio 2011 sulla New York Review of Books e tradotta a pp. 263-282 di questo n. 2/2012 di Psicoterapia e Scienze Umane. Le critiche mosse da Marcia Angell trovano valide argomentazioni in una psichiatria che è stata pesantemente condizionata dalle industrie farmaceutiche. Ma ignorano il fatto che gran parte delle prescrizioni di psicofarmaci vengono effettuate da medici non psichiatri e che in psichiatria esistono una pratica clinica e una ricerca che sono libere da questi condizionamenti. È oggi possibile praticare una medicina psicologica in grado di incorporare sia l’approccio farmacologico che quello psicoterapeutico.

Vengono fatte alcune considerazioni sul rapporto tra medicina generale e psicoterapia, sottolineando anche la importanza della formazione dei medici di base tramite il metodo dei gruppi Balint. Questo scritto è una sintesi dell’intervento tenuto al convegno "Psichiatria e medicina di base" (Reggio Emilia, 25 gennaio 1991) Qui è preceduto da una dettagliata nota introduttiva dell’Autore in cui viene ripercorsa la storia del rinnovamento nell’assistenza sociosanitaria, e dell’attenzione allora prestata dalle amministrazioni pubbliche verso la formazione dei medici di base, a Reggio Emilia negli anni 1970-80. Questo rinnovamento, che investiva anche altri settori (welfare, igiene ambientale, psichiatria, medicina del lavoro, ospedali, scuola, ecc.), più tardi subì un arresto, le cui cause vengono qui brevemente discusse.

Vengono fatte alcune riflessioni sul problema del razzismo e della paura dello straniero e del nuovo rispetto alla cultura di appartenenza del soggetto. Questi comportamenti vengono analizzati dal punto di vista psicoanalitico (utilizzando i concetti di proiezione, di identificazione con l’aggressore, ecc.), etnopsicoanalitico e sociologico. L’Autrice inoltre racconta aspetti della storia della sua famiglia, che durante la seconda guerra mondiale viveva sotto occupazione italiana e poi tedesca, e dopo il 1947 apparteneva a una minoranza etnica slovena a Trieste. (Questo testo è una relazione dal titolo "Aprirsi e chiudersi agli altri: patologie di confine", tenuta il 14 marzo 2011 all’interno del ciclo di seminari "Sulla strada", coordinato da Stefano Benni e Alessandro Castellari presso la Pluriversità dell’Immaginazione "Grazia Cherch" di Bologna).

Vengono fatte alcune riflessioni sull’ebraismo e sul dramma della Shoah prendendo spunto dal libro del 1979 di Silvano Arieti Il Parnàs (Milano: Mondadori, 1980), che parla di Giuseppe Pardo Roques, capo (Parnàs) della Comunità ebraica di Pisa, trucidato nella sua abitazione nell’agosto del 1944, assieme ad altre 11 persone, da un gruppo di soldati tedeschi mai identificati. Il Parnàs soffriva di un disturbo psicologico di tipo persecutorio, e la sua malattia viene vista anche come una forma di "premonizione" dei tragici eventi che in quegli anni avrebbero colpito la popolazione ebraica. Il Parnàs è uno degli ultimi libri di Silvano Arieti (1914-1981), uno psichiatra pisano emigrato negli Stati Uniti dove diventerà uno degli psichiatri più importanti del suo tempo.