Il Trattamento Sanitario Obbligatorio spiegato da uno Psichiatra

Dott. Valerio Rosso

27 Oct 201809:05

Summary

TLDRThe video discusses the controversial topic of mandatory health treatment, focusing on its legal framework and ethical considerations. It clarifies misconceptions about involuntary psychiatric treatment, explaining the conditions under which it can be lawfully applied in Italy, as per the Law 180/1978 and Law 833/1978. The video emphasizes that such treatment is a last resort, only used when a person presents with acute mental health issues and refuses voluntary treatment, posing a risk that necessitates urgent intervention. It also outlines the rights of the individual undergoing treatment, including the right to communication, legal assistance, and being informed about the nature of their treatment. The video concludes by mentioning the possibility of less drastic alternatives like the obligatory health check, known as ASO.

Takeaways

📢 The video aims to clarify the controversial topic of mandatory health treatment in the context of mental health.
😷 Mandatory health treatment, also known as TSO (Trattamento Sanitario Obbligatorio), is a legal measure that compels a person to undergo medical treatment against their will.
🏥 TSO is primarily used in the psychiatric field and is a measure rarely and often inappropriately applied outside of clear psychiatric pathology.
🔍 TSO can only be enacted when three conditions are met: urgent psychiatric intervention is needed, the person refuses voluntary treatment, and no other timely and suitable measures outside the hospital environment are available.
⚖️ The law 180/1978, also known as the Basaglia Law, and law 833/1978 regulate TSO, with the latter specifying the conditions and procedures.
🏛️ The mayor, as the chief health authority of the municipality, orders TSO upon agreement by two doctors, one of whom must be a psychiatrist from the national health service.
🕒 TSO is initially valid for 7 days and can be renewed if the conditions persist.
🚨 Law enforcement may be involved in the application of TSO, and at least one doctor should be present during the procedure.
📝 Patients under TSO retain most of their rights, including communication and visitation rights, and the right to be fully informed about their treatment.
🤝 TSO should not be used lightly by medical professionals as the ultimate goal is to establish a strong therapeutic alliance with the patient.
📞 Individuals can appeal TSO decisions, and legal representation is possible to contest the measure.
🤔 Alternatives to TSO, such as the less drastic ASO (Accertamento Sanitario Obbligatorio), are often considered as preliminary steps to establish a medical patient relationship.

Q & A

What is the main topic of the video?
-The main topic of the video is the compulsory health treatment, also known as the 'trattamento sanitario obbligatorio' (TSO), in the context of psychiatry.
Why is the topic of compulsory health treatment controversial?
-The topic is controversial due to the spread of misinformation and the lack of accurate knowledge about when and how compulsory health treatment is applied, as well as concerns about individual rights and the potential for misuse.
What are the three conditions required for a TSO to be implemented?
-The three conditions are: 1) The presence of mental alterations requiring urgent therapeutic interventions, 2) The person's unwillingness to voluntarily undergo treatment, and 3) The absence of conditions that would allow for timely and appropriate extraordinary measures outside the hospital environment.
Where can a TSO be enforced?
-A TSO can be enforced at the psychiatric diagnosis and treatment service (SPDC) in the area where the person resides or where the measure is being implemented.
Who has the authority to order a TSO?
-The mayor, as the highest health authority of the municipality of the person's residence or the municipality where the measure is being implemented, orders the TSO with a provision when two doctors agree that the person meets the three conditions described.
What are the rights of a patient undergoing compulsory health treatment?
-The patient retains all their rights except for the right to refuse treatment. They have the right to communicate with anyone they wish, to be visited by family, and to contact a lawyer. They also have the right to be fully informed about the nature of the therapies they are undergoing, including the risks and benefits.
What is the role of the police or other law enforcement in the implementation of a TSO?
-The police or other law enforcement may be involved to assist in the application of a TSO, especially in cases of immediate urgency or when the person's behavior poses a risk. However, the use of physical restraint should be exceptional and only for the shortest necessary time.
Is it possible to oppose a TSO?
-Yes, an individual or anyone concerned about the person can appeal a TSO. The mayor is obliged to respond within ten days, and if the appeal is negative, the case can be taken to the criminal judge or the court directly for a review.
What is an alternative to a TSO?
-An alternative to a TSO is the 'Accertamento Sanitario Obbligatorio' (ASO), which is often less drastic and can serve as a preliminary measure to establish a therapeutic relationship with the patient.
How is the TSO physically implemented?
-The TSO is implemented with the involvement of law enforcement, and at least one doctor must be present. It can involve verbal techniques or the use of psychopharmacological treatments to address any immediate behavioral emergencies.
What is the ultimate goal of compulsory health treatment?
-The ultimate goal is to help the person in need, with the aim of establishing a strong therapeutic alliance rather than simply enforcing a legal obligation. The focus should be on effective patient-doctor relationships and treatment.

Outlines

00:00

🏥 Understanding Mandatory Health Treatment

This paragraph discusses the controversial topic of mandatory health treatment, particularly in the psychiatric context. It emphasizes the importance of accurate information and the legal basis for involuntary treatment, known as the 'psichiatrico obbligatorio' (PSO) in Italian law. The speaker expresses regret over the lack of proper information and the spread of misinformation, especially in online videos. The paragraph clarifies that involuntary treatment can only be ordered when three specific conditions are met: the presence of urgent psychiatric needs, the patient's unwillingness to voluntarily undergo treatment, and the absence of alternative measures outside the hospital environment. It also addresses misconceptions about the criteria for involuntary treatment, such as perceived danger to self or others, and emphasizes that it should be based on a clear psychiatric pathology, not just behavior.

05:02

🚨 Implementation and Ethical Considerations of Mandatory Health Treatment

The second paragraph delves into the practical implementation of mandatory health treatment, highlighting the dramatic nature of such interventions. It outlines the process, including the involvement of the mayor as the primary health authority, the role of medical professionals in proposing and validating the treatment, and the duration of the treatment. The paragraph also discusses the ethical aspects and rights of the patient, including the right to communication, visits from family, and legal assistance. It stresses that involuntary treatment should not justify the use of physical restraints or violence and that patients have the right to be fully informed about their treatment. The speaker mentions the possibility of appealing the decision and the importance of respecting the dignity and freedom of the individual. Finally, it suggests that mandatory health checks (ASO) might be a less drastic alternative to involuntary treatment, encouraging a therapeutic alliance rather than a legal obligation.

Mindmap

Keywords

💡Obligatory Health Treatment

Obligatory Health Treatment, also known as TSO or 'trattamento sanitario obbligatorio' in Italian, refers to a legal measure that compels an individual to undergo medical treatment against their will. This is typically applied in the psychiatric context when a person's mental health is deemed to be in acute distress and poses a risk to themselves or others. The video emphasizes that such treatment can only be ordered when specific conditions are met, including the presence of urgent psychological alterations, the patient's unwillingness to voluntarily seek treatment, and the absence of alternative measures.

💡Psychiatry

Psychiatry is the medical specialty devoted to the diagnosis, prevention, and treatment of mental health disorders. In the context of the video, psychiatry plays a crucial role in the implementation of obligatory health treatments, as it is usually in psychiatric settings where such measures are deemed necessary. The video clarifies that involuntary treatment is a last resort when a patient's mental health is in acute crisis and they pose a risk that cannot be managed outside of a hospital setting.

💡Mental Health Crisis

A mental health crisis refers to a situation where an individual's psychological or emotional state is severely compromised, often leading to an inability to function normally or to cope with daily life. In the video, the concept of a mental health crisis is central to understanding when obligatory health treatment might be necessary, as it is one of the conditions that must be present for TSO to be considered.

💡Legal Authority

Legal authority refers to the power or right granted by law to make decisions and enforce rules. In the context of the video, the legal authority for ordering obligatory health treatment rests with the mayor, who acts as the primary health authority for the municipality where the individual resides. The mayor issues the TSO order based on the assessment of two physicians.

💡Patient's Rights

Patient's rights are the legal entitlements that protect the dignity, autonomy, and interests of individuals receiving healthcare. The video emphasizes that while obligatory health treatment inherently limits a patient's autonomy, they retain other rights, such as the right to communicate with others, be visited by family, and be informed about the nature, risks, and benefits of the treatments they receive.

💡Ethical Considerations

Ethical considerations involve the moral principles and values that guide decisions and actions, especially in the context of healthcare. The video discusses the ethical implications of TSO, including the balance between the need for treatment and the respect for a patient's rights and dignity. It highlights the importance of non-violent and respectful treatment, even when physical containment measures are necessary in exceptional cases.

💡Mental Health Services

Mental health services encompass the range of programs and interventions designed to promote, maintain, or restore mental health. In the video, the mention of mental health services is related to the provision of care for individuals who may require obligatory treatment, emphasizing the importance of specialized psychiatric care and the role of mental health professionals in assessing and treating mental health conditions.

💡Medical Assessment

Medical assessment refers to the process by which healthcare professionals evaluate a patient's health condition to determine the appropriate course of treatment. In the context of the video, medical assessment is critical for determining whether an individual meets the criteria for obligatory health treatment, as it involves the judgment of two physicians who must agree on the presence of specific conditions.

💡Legal Appeal

A legal appeal is a formal request to a higher authority to review or overturn a decision made by a lower authority. In the video, the concept of legal appeal is relevant as it allows individuals or their representatives to challenge the decision to implement TSO, seeking a review of the situation within a legal framework.

💡Healthcare Professionals

Healthcare professionals are individuals trained to provide medical services, including doctors, nurses, and other specialists. In the video, healthcare professionals play a pivotal role in the assessment and potential implementation of TSO, with the involvement of both general physicians and psychiatrists in the decision-making process.

💡Mandatory Health Examination

A mandatory health examination, also referred to as ASO or 'accertamento sanitario obbligatorio', is a less intrusive alternative to TSO. It is a legal procedure that may be used to assess an individual's health status and determine the need for treatment. Unlike TSO, ASO does not necessarily involve involuntary treatment but is a preliminary step that can lead to establishing a therapeutic relationship with the patient.

Highlights

The video aims to clarify the controversial topic of mandatory health treatment.

Mandatory health treatment is a medical act that forces a person to undergo medical care against their will.

Law 180 of 1978, also known as the Basaglia Law, introduced the concept of mandatory health treatment.

Mandatory health treatment can only be ordered when three specific conditions are met: urgent psychiatric intervention is needed, the person refuses voluntary treatment, and no other suitable measures can be taken outside the hospital environment.

Mandatory health treatment is not based on a person's perceived danger to themselves or others, but on the presence of a mental illness and the three mentioned conditions.

Treatment can only be enforced at a psychiatric diagnosis and treatment service (SPDC) in the area where the person resides.

The mayor of the municipality, as the main health authority, orders mandatory health treatment based on the agreement of two doctors, one of whom must be a psychiatrist.

Mandatory health treatment can initially last for 7 days and can be renewed if conditions persist.

Law enforcement may be involved in the application of mandatory health treatment, often accompanied by a psychiatrist or a mental health nurse.

In urgent cases, personnel from the 118 emergency service may intervene, potentially using verbal or pharmacological measures to address behavioral emergencies.

Patients undergoing mandatory treatment still retain most of their rights, including the right to communicate and be visited by family or a lawyer.

Patients have the right to be fully informed about the nature, risks, and benefits of the treatments they receive.

Physical restraints are only to be used exceptionally and for the shortest necessary time, with respect for the person's dignity and freedom.

Individuals can appeal the mandatory health treatment decision to the mayor, and if necessary, take the case to court.

Mandatory health treatment is never ordered lightly by doctors and psychiatrists, as the goal is to establish a strong therapeutic alliance with the patient.

Health authorities often opt for a less drastic alternative to mandatory health treatment, such as a mandatory health examination (AO).

The video encourages viewers interested in psychiatry and neuroscience to subscribe to the YouTube channel for more information.