CONCLUSIONS

As a conclusion of our work pathway, we would like to make a few remarks on the impact of the work done within the PSYCHO RESCUE project, and propose some suggestions about the possible future developments of the project. The functions and the curriculum of the Community Mental Health worked out within PSICHO RESCUE project, have got an empirical ground, as they are based on 3 years of trans-national research activity, carried out by the agencies of the partner countries involved in the project. Nevertheless, in our idea, the proposed list of functions and training pathway have not to be considered as a definitive result, but as a prototype which needs to be tested on operating level. Therefore, our work has to be considered as something different than a mere mapping of functions and related items. Our main objective, consistent with the philosophy of the project, is to contribute to the improvement of the effectiveness of practices in psychiatric care. So, the main target of the project is the organizational level of mental health systems. The main field of application of PSICHO RESCUE is the context of professional organizations and associations. Within this field, the aim should be to develop the mapping of expected competences related with each specific vocational profile, at the different level of working roles, tasks and responsibility. One more possible development area is represented by proposing the PSYCHO RESCUE toolkit to state and private agencies which work in the field of vocational training, developing performance indicators to test the tool and evaluate the effectiveness in terms of applicability So, we are going to reflect on possible effect of our work on care and vocational systems in the field of mental health. To do that we need to reassume some critic point arisen out of context and need analysis. From SWOT analysis arise out two main opportunity areas, where is possible to plan interventions in the short and medium term. The first one is related to the quality of the services and the development of community-based approach. Within this application area the range of interventions is very wide . That is because the heterogeneity of mental health systems brings with it different matters related to each country. In some country (Latvia) the matter is to conform the system to the current EU policies or to implement the transformation process, began in the form but still lacking in politic interventions and fund used (Czech Republic). In other countries (i.e. Greece) the matter is to give an additional stimulus to the process of transformation, and to put in evidence existing good praxis which have not still officially recognized. In situations where the process of reform have been fully accomplished (Italy, Scotland, Netherland) the matters are the development of a integrated system of state and private services and the full involvement of the users in the process of care and recovery. In these advanced situations very important critic point is the need of face with emerging phenomena as the lowering of standards of quality of the services (related to market cutthroat competition) and the risk of reinstituzionalization (I). At last, one more important matter is the need to improve the competence of psychiatric workers, through suitable training programs, and bring within the workforce involved a culture of care which distinguish between “the place where the care is provided” and “the process of care itself”. Saraceno says that “We need a radical change of paradigm: from a model based on the “spatial location” of provider (hospitals, outpatient services, ecc.) to a model based on “temporal dimension” of the user. “Acute” and “severe” are “conditions”. They are not “spaces”. So we can imagine that severe and acute diseases can be faced within the community instead of hospital settings”. The second area of opportunity is related to the need of updating basic training and, at the same time, to diffuse a culture of lifelong learning. Even in this area there are various situations and different possible impact on different countries. In some country there is the need to provide to the workforce tools suitable with scientific evidences and official guidance (Latvia and Czech Republic). Anyway, there is a common data related to the need to settle suitable standard of admissions, praxis of lifelong learning and fix suitable standard of quality (Greece and Italy); also there is the need to extend lifelong learning to other professionals categories (Czech Republic, Netherland and Italy). In Scotland situation is different: in one hand there are well definite and tested vocational standards; in other hand emerges the need to make higher vocational standards trough the improvement of professional qualifications. Therefore, we can imagine that in the medium term a concrete project action can contribute to fill the lacks between the different countries, towards a common and shared level of updating in workforce training, improvement of the quality of the services and promotion of Community-based approach. The need of updating training programs has been confirmed by field research which has involved mental health workers and users of the services. Even if quantitative data should be always analysed with a critical eye, it is evident the widespread perception of a lack of training. These data can be generally referred to all the context and the worker categories and are consistent with WHO analysis , with context analysis we have done and with the outcomes of focus group of service users. The Project, as has been already said, has got the ambitious aim to support the development of a European web of vocational training and updating of community mental health workers, making easier the spreading and sharing of knowledge and methodologies. We are aware that such aim is subject to the influence of politic, social and cultural factors, which are peculiar in each context. The lacks in legislations and the scarce farsightedness of local policies, jointly with financial and bureaucratic limitations, are barriers which not easily can be overcame in a short time by a single project action. Nevertheless we believe that the philosophy of “the peddle in the pond” can represent a real possibility.