Eating disorders represent a problem that is quickly exacerbating worldwide. In Italy, 5% of the population has an eating disorder: a worrying percentage if we consider that many people suffering from this do not ask for help and are thus not diagnosed. The pre-teen and adolescent band represent the most frequent age of onset: even when the request for help comes in adulthood, in the path of care it clearly emerges that symptoms were already present in adolescence, not welcomed or not listened to.
ED are serious, multifaceted conditions affecting physical, psychological and social functions and include anorexia, bulimia, binge eating and obesity. Among psychiatric diseases, anorexia is the syndrome with the highest mortality rate: 1.8% in childhood, 10% in adult age. To understand the gravity of a phenomenon that represents a real social emergency, it is enough to state that in Italy eating disorders are the second cause of death for adolescents, right after road accidents.
However, while the number of people suffering from these diseases has sharply increased, especially during the pandemic, the funds dedicated to the issue are being cut, in the midst of a national health care system crisis.
The National Fund for the Contrast of Eating and Nutrition Disorders included 25 million of euros for the years 2022 and 2023. The money was meant to finance and improve the still insufficient system of regional assistance measures, based on the empowerment of prevention initiatives and specialized clinics which provide interception, specialized therapy and family inclusion. Now the fund is not being renewed, as the government budget law for 2024 shows. Without the funding, many of the specialized centers are going to shut down this November. This would affect especially those patients coming from regions where the hubs are already scarce, especially in the South and in the islands. For example, hubs in the regions of Molise, Abruzzo, Marche, Campania, Puglia were only able to employ experts to work thanks to the fund. Now that the costs are not covered from the State it will be impossible to renew their contracts.
Territorial mapping of the centers dedicated to the treatment of Disorders of Nutrition: intensive or semi-residential outpatient.
Not only will it be harder to reach out to new patients and treat them in a center near their residence and family, but many current patients will see their care interrupted. Especially considering their fragile condition, the disruption of the therapy would represent a breach in the trust built between them and the doctors and may cause relapses.
Let’s understand which are the levels of support offered by the facilities and why they cannot be delivered by any hospital.
The basic level is the general practice service, during which patients take blood tests, an electrocardiogram and a psychiatric evaluation. The patient agrees on a dietary plan and follows psychotherapy sessions with the family’s involvement. These sessions last between three and four weeks.
The second level is day service. It consists of five or seven days a week and provides for assisted meals, psychotherapy, food psychoeducation activities and counseling groups for parents.
The third level of care is rehabilitation residences, targeted for more intensive treatment. The length of stay varies from a few months to a year and welcomes patients with organic complications, psychiatric conditions, prone to bone fractures or in artificial nutrition.
The fourth type is hospitalization, when the vital signs (respiratory rate, heart rate, blood pressure) are altered and the patient may be in danger of life. Regions that lack structures for the previous levels have a higher hospitalization rate.
After the budget cut news spread, protests sprung in many cities of the peninsula, guided by the Lilac Ribbon Association.
Demonstrators argue that the 10 million the government promised to introduce starting from April are not sufficient. They won’t be enough to support the centers and will force patients to choose between the non-specialist treatment in hospitals and the expensive care in private residential facilities.
The government said it will establish “Essential Levels of Care”: common minimum standards for Italian regions, that will however have autonomy in the management of its public health.
This is just one of the many dimensions of the current crisis within Italy’s health care system, characterized by insufficient personnel and public funds. It remains to be seen if the new reduced budget will be efficiently allocated or if, as many suspect, it will be the cause of the closure of many facilities, leaving patients without the proper care and support.
American Psychiatry Association: https://www.psychiatry.org/
Disturbi alimentari, rete di cura più fragile: la Legge di Bilancio cancella il Fondo di 25 milioni, Jessica Muller Castagliuolo, La Repubblica: https://www.repubblica.it/
Disturbi alimentari,10 milioni per rifinanziare il Fondo, Barbara Gobbi, Il Sole 24 Ore: https://www.ilsole24ore.com/art/disturbi-alimentari10-milioni-rifinanziare-fondo-AFmSUmNC
Piattaforma Disturbi Alimentari- Istituto Superiore di Sanità: https://piattaformadisturbialimentari.iss.it/