The area of transition psychiatry is a topic that is still marginally dealt with in Italy, and, with few exceptions, scarcely discussed at the institutional level. In some European countries, such as Germany, the psychiatric disciplinary debate on this area has developed to such an extent that it leads to the offer of training courses, from which, however, clear clinical, conceptual and epistemological criticalities emerge. This publication will therefore try to highlight the possible contribution of the Birth Theory to overcoming the current limits of transition psychiatry.
The term “transition” has recently emerged in the psychiatric field to indicate the delicate phase of transition from child and adolescent psychiatry to that of the adult with the related problems of coordination and continuity of care.
The transition phase includes an area that extends from adolescence (about 14 years of age) to emerging adulthood (“emerging adulthood”, about 25-30 years. This term was introduced by the American psychologist Jeffrey Arnett in 2000 to indicate the phase of transition from youth to adulthood. Psychiatrists dealing with transition psychiatry are a movement that is still emerging and is not institutionalized, although implementation in the public health system is beginning in many countries.
As known since the dawn of psychiatry and recently rediscovered in the scientific literature, most psychiatric diseases, even severe ones, begin in adolescence. At the same time, the adolescent has high resources and a potential for recovery as well as enormous mental flexibility.
If we consider adolescents with mental illnesses, the transition to adulthood is particularly demanding, since these – during facing important adaptive challenges and relational changes – have on average more social and psychological difficulties of coping as those without psychiatric problems.
In this context, precisely because of the schism inherited from somatic medicine, when becoming 18, adolescents with a mental illness and a continuing need for care are transferred from developmental services to adult mental health services, which lack many aspects compared to the previous one.
In this sense, it would be desirable if the public assistance system were committed to meet the needs and specific problems of adolescence and young adulthood in the best possible ways.
Furthermore, in Germany, unlike Italy, there is fortunately already a branch of psychiatry and psychotherapy for children and young people, separated from both, child neurology and adult psychiatry.
The creation of a third sub-branch can be useful for the mobilization of public and personal funds to optimize assistance. And a more humanizing structural reform in the provision of services is also desirable. However, a critical reflection is needed regarding the risk of a further fragmentation of medical care, in which the idea of adolescents with different and specific needs than other groups is transmitted.
Consequently, a definition of adolescence and adolescence according to the theory of birth could be an important enrichment.
The psychopathology of the depressed patient does not fundamentally change according to age. The therapeutic intervention can be very different, because the different degree of maturity and development, dependence on parents, peers, school, etc. must be taken into consideration, or a series of areas that cannot be excluded and are often directly involved in therapeutic path.
But in daily work, how much influence has the idea that even a very specialized professional has of the human being?
We remember the schizophrenic young man who was the protagonist of “A case history”. What would have happened if he hadn`t met the writer of Death Instinct and Knowledge, who in fact, as we know, brilliantly managed to cure him?
In the interview with Massimo Fagioli on Rai News 24 of January 10, 2001, I read a statement that seems to me the perfect answer to this question.
<< Mental illness is not a brain disease. It is a disease of human relationships, of affections, of images, of identity. It is the mind, the thought that gets ill. And how is this illness to be treated? With psychotherapy >>.
Bibliography
- Fegert, J.M., Hauth, I., Banaschewski, T., & Freyberger, H.J. (2017). Übergang zwischen Jugend- Und Erwachsenenalter: Herausforderungen für die Transitionspsychiatrie, von DGKJP Und DGPPN. Zeitschrift für Kinder- Und Jugendpsychiatrie Und Psychotherapie, 45, 80 -85.
- Fegert, J.M., Streeck-Fischer, A., & Freyberger, H.J. (2009). Adoleszenzpsychiatrie: Psychiatrie Und Psychotherapie Der Adoleszenz Und Des Jungen Erwachsenenalters. Schattauer.
- Fegert, J.M., & Freyberger, H.J. (2017). Adoleszenz – Eine Lebensphase weitet sich aus. Herausforderungen an eine Psychologie und Psychopathologie des Transitionsalters. Psychotherapie im Dialog, 18(02), 16-22.
- Arnett, J.J. (2000). Emerging Adulthood. A Theory of Development from the Late Teens through the Twenties. American Psychologist, 55(5), 469-480.
- Signorini, G., Singh, S.P., Marsanic, V.B., Dieleman, G., Dodig-Curkovic, K., Franic, T., et al. (2018). The Interface between Child / Adolescent and Adult Mental Health Services: Results from a European 28-Country Survey. European Child & Adolescent Psychiatry, 27(4), 501-511.
- De Girolamo, G., Dagani, J., Purcell, R., Cocchi, A., & McGorry, P.D. (2012). Age of Onset of Men-Tal Disorders and Use of Mental Health Services: Needs, Opportunities and Obstacles. Epi-Demiology and Psychiatric Sciences, 21, 47-57.
- McLaughlin, K.A., Green, J.G., Gruber, M.J., Sampson, N.A., Zaslavxky, A.M. & Kessler, R.C. (2012). Childhood Adversities and First Onset of Psychiatric Disorders in a National Sam-Ple of US Adolescents. Arch Gen Psychiatry, 69(11), 1151-1160.
- Wille, N., Bettge, S., & Ravens-Sieberer, U. (2008). Risk and Protective Factors for Children’s and Adolescents’ Mental Health: Results of the BELLA Study. European Child & Adolescent Psy-Chiatry, 17(1), 133-14, n.d.)
- (Clark, C., Caldwell, T., Power, C., & Stansfeld, S.A. (2010). Does the Influence of Childhood Ad-Versity on Psychopathology Persist across the Lifecourse? A 45-Year Prospective Epidemi-Ologic Study. Annals of Epidemiology, 20(5), 385-394.
- Ivi, Nota 5.
- Cleverley, K., Rowland, E., Bennett, K., Jeffs, L., & Gore, D. (2020). Identifying Core Components and Indicators of Successful Transitions from Child to Adult Mental Health Services: A Scoping Review. European Child and Adolescent Psychiatry, 29(2), 107-121.
- Hickie, I.B., Scott, E.M., Cross, S.P., Iorfino, F., Davenport, T.A., Guastella, AJ., Naismith, S.L., Carpenter, J.S., Rohleder, C., Crouse, J.J., Hermens, D.F., Koethe, D., Markus Leweke, F., Tickell, A.M., Sawrikar, V., & Scott, J. (2019). Right Care, First Time: A Highly Personalised and Measurement-Based Care Model to Manage Youth Mental Health. The Medical Journal of Australia, 211(9), 3-46.
- Babajide, A., Ortin, A., Wei, C., Mufson, L., & Duarte, C.S. (2020). Transition Cliffs for Young Adults with Anxiety and Depression: Is Integrated Mental Health Care a Solution? Journal of Behavioral and Health Services Research, 47(2), 275-292.
- Kölch, M.G., Romanos, M., Roth-Sackenheim, C., & Schramm, E. (2020). Angst Und Depression in Der Transition – Desiderate Für Eine Verbesserte Versorgung Und Forschung: Ergebnisse Der Gemeinsamen Task-Force Transition von DGPPN Und DGKJ. Zeitschrift Für Kinder- Und Jugendpsychiatrie Und –Psychotherapie, 48(6), 429-433.
- Schraeder, K.E., & Reid, G.J. (2017). Who Should Transition? Defining a Target Population of Youth with Depression and Anxiety That Will Require Adult Mental Health Care. The Journal of Behavioral and Health Services Research, 44(2), 316-330.
- Fagioli, M. (1972), Istinto di morte e conoscenza (14th. ed.), Roma: L’Asino d’oro Edizioni, 2017, pp. 30-44.
- Di Pasquale, P., Ultim’ora. 10 Gennaio 2001. Intervista, Il Sogno della farfalla, 4, 2017,13-24.
