Trattamento sanitario obbligatorio e Accertamento sanitario obbligatorio

Summary

The video transcript discusses the application and legal context of involuntary psychiatric treatments and assessments in Italy, including the Treatment Sanitario Obbligatorio (TSO) and Accertamento Sanitario Obbligatorio (ASO). It emphasizes the importance of understanding these procedures for mental health professionals, especially in the context of exams and legal obligations. The discussion highlights the conditions under which TSO and ASO can be applied, the legal process involved, and the potential impact on the therapeutic relationship and patient's perception of the treatment.

Takeaways

• 📚 The interview discusses two non-strictly psychological practices in psychiatry: TSO (Obligatory Health Treatment) and ASO (Obligatory Health Examination), which are part of the daily routine and examination topics for psychology directorship exams.
• 👩‍⚕️ Maria Antonietta Furio, a psychiatrist, explains that TSO and ASO go beyond the fundamental rights of humans, such as freedom and dignity, and require a legal context for their application.
• 🏥 TSO can only be initiated in a hospital setting when three conditions are met: urgent therapeutic interventions are required, the patient refuses these interventions due to psychological alterations, and no alternative treatments outside the hospital context are available.
• 📝 The procedure for TSO involves two medical doctors (a proposer and a validator), and the local mayor, who has 48 hours to issue an order for obligatory treatment. The patient is then admitted to a hospital, specifically a psychiatric department (SPDC).
• ⏰ The duration of TSO is 7 days and can be renewed if the initial conditions persist, or it can be revoked if one of the conditions no longer applies, such as the patient recognizing the need for treatment.
• 🔍 ASO is an obligatory health examination that is necessary when there is a need to evaluate a citizen with proven psychological alterations who is avoiding evaluation.
• 👨‍👩‍👧‍👦 Family members or neighbors can report a person with suspected psychological issues to psychiatric services, the family doctor, or the emergency medical service, provided there is substantial evidence of the need for evaluation.
• 🏥 With an ASO order, law enforcement and city officials contact the patient and accompany them to a facility where a psychiatric evaluation can be conducted.
• 🤝 The therapeutic alliance and trust within the patient-therapist relationship can be undermined by TSO and ASO due to the compulsory nature and involvement of law enforcement.
• 🌟 Despite the initial trauma and frustration, patients can reevaluate their condition during TSO hospitalization, potentially recognizing the benefit and necessity of obligatory treatment.
• 🔄 The key to maintaining the therapeutic relationship is for the therapist to continue contact with the patient even during TSO, acknowledging the personal and professional challenges this situation presents.

Q & A

What is the main topic of the video interview?

The main topic of the video interview is the explanation of two non-strictly psychological practices in psychiatry: TSO (Trattamento Sanitario Obbligatorio) and ASO (Accertamento Sanitario Obbligatorio).

What does TSO stand for and what is its purpose?

TSO stands for Trattamento Sanitario Obbligatorio, which is a mandatory health treatment. It is used when a patient requires urgent therapeutic interventions that they refuse due to psychological alterations, and no alternative treatments outside of a hospital setting are available.

What are the three conditions that must be met for TSO to be initiated?

The three conditions for initiating TSO are: 1) the presence of psychological alterations requiring urgent therapeutic interventions, 2) the patient's refusal of these interventions due to their psychological state, and 3) the absence of conditions to implement alternative therapeutic measures outside the hospital context.

Who evaluates the conditions for TSO and what is the legal procedure following the evaluation?

The conditions for TSO are evaluated by two physicians: a proponent and a validator. After the evaluation, the physicians issue certificates that are sent to the mayor of the municipality where the treatment is to be performed. The mayor has 48 hours to assess the conditions and issue an order for mandatory health treatment.

How long does a TSO last and is it renewable?

A TSO lasts for 7 days and it is renewable if, at the end of the seven days, the three conditions mentioned earlier still exist. It can also be revoked earlier if one of the three elements no longer applies, especially if the patient recognizes the need for health treatments, thus removing the necessity of the TSO.

What is ASO and when is it applied?

ASO stands for Accertamento Sanitario Obbligatorio, which is a mandatory health examination. It is applied when there is a need to evaluate a person who is avoiding evaluation due to proven psychological alterations that necessitate an assessment.

Who can request the implementation of ASO and what is the process?

Family members, neighbors, or healthcare providers can request the implementation of ASO when they become aware of a person's psychological alterations. The request is made to any doctor or healthcare service, and if the conditions are met, a mandatory health examination can be initiated.

What are the potential outcomes of ASO?

The outcomes of ASO can be negative if no subsequent treatment is needed, or positive if the patient requires treatment, which could lead to voluntary health treatment or hospital-based treatment.

How have the conditions for mandatory health treatment evolved over time?

The conditions for mandatory health treatment have evolved from focusing on social danger in the early 1900s to addressing the lack of awareness of illness in mental health disorders, which may lead to the worsening of the condition and the denial of the right to health care.

What are the most common psychopathological conditions that require mandatory health treatment?

The most common conditions are major disorders, including severe behavioral alterations and psychotic episodes, where there is a lack of awareness of the nature of the illness, as well as severe depressions and conditions like severe anorexia where there is a risk to the patient's health.

How can the therapeutic alliance be affected by TSO and ASO procedures?

TSO and ASO procedures can potentially undermine the therapeutic alliance and trust within the patient-therapist relationship, as they involve going against the patient's will and may involve the use of law enforcement, which can be seen as invasive and conflicting.

What is the role of the therapist in managing the patient's perception of TSO?

The therapist's role is to continue contacting the patient and maintaining the therapeutic alliance even after TSO has been implemented. It is important for the therapist to visit the patient in the hospital and continue dialogue to help the patient understand and eventually recognize the need for the mandatory treatment.