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A. epidemiological and statistical data
Given the importance, in order to build up more reliable risk maps, of having data divided into sex, recommendations to all the European countries to adopt the following measures are necessary: - standardization of data surveying procedures concerning the personal and social typology of the women who come to mental health services; - collection of data divided into sex, and presentation of the results according to above distinction.
B. etiological and risk factors
Recommendations apt to integrate the gender point of view in the research evaluation criteria are considered necessary. Highly reliable is considered research: - using case-control samples; - including patients of both sexes; - relating the different variables to the sample divided by sex. It is right to adopt measures to implement researches apt to offer better results in the perspective of primary prevention.
Researches aimed to: a. the analysis of risk factors in daily life and in the environment; b. standardization of the main pre-morbid risk factors in female mental illness, particularly the risk of: family work overload, stress and violence; c. elaboration of a survey protocol for the gathering of risk factors of mental illness; d. development of a multicentric European programme on the interaction of the main psycho-social risk factors.
C. Pharmacology
In this field, it is necessary to acknowledge the difference between women and men in pharmacodynamics, and in pharmacokinetics. Pharmacological research should assume the goals to improve the efficacy and the safety for women of pharmacological products through: a. removal of the obstacles to the inclusion of women in clinical and pharmacological trials; b. data collection trough mix male and female samples; c. analysis of data divided by sex.
D. New diagnostic criteria and tools
It is necessary to modify the diagnostic criteria about the measurement of the social seriousness of discomfort by including the gender point of view. More precisely, the evaluation of seriousness of mental disease could be done on the basis of the perception of impairment and not only on the basis of objective evaluation in terms of social dysfunction.
The integration of the gender point of view should be assumed also in the research of new methodologies and new therapeutical tools. New and specific therapeutical tools for women are necessary, focusing on the link between illness and everyday life, and particularly on the following conditions: a. the external as well as family work; b. the use of verbal, psychological and physical violence in both external and family relationships; c. the educational training to pattern of dependence.
It is necessary to predispose sex specific protocols for pharmacological treatment. Evidences on weight and pharmacodynamic difference between female and male consumers suggest caution in dosages, lower dosages for women compared to men. Moreover, as long as research is not carried out on both sexes, it is important to investigate, directly from woman, about the side effects produced by pharmaceutical products.
The treatment should take into account the evidences brought up by research and in particular of psycho-social risks. It should put the woman to the centre with her every day life difficulties. All types of intervention should take into account two main factors: - many women suffer in daily life of: loneliness, poverty, unemployment, lack of economical supports , children burden, violence, etc. - and many women suffering of anxiety, depression, don't speak about their everyday life difficulties, and don't recognize oppression, violence, fatigue and tiredness.
So it is necessary to work out protocols apt to: - guide health care providers in singling out the causes undervalued by women themselves; - give suggestions apt to help women to lighten the burden of responsibilities that benefits others and to assume styles of behaviour more suitable to the individual wellbeing (and benefits herself).
Moreover, homogeneous groups should be set up they should be made up of women sharing, with different symptoms, common life problems, such as: teen agers and post-teen ages, married women with children, separated women etc.
The psycho-social rehabilitation action should be organized around women's needs. The experience with women suggests that these groups may be successfully oriented toward the re-discovery of abilities, skills and desires for long years set asides and that, instead, can be recovered and included in a personalized and creative social rehabilitation programme.
Training programmes must fit women’s needs. Such programmes will keep gender differences into account in terms of the greater incidence of mental disease and in terms of educating the 'medical professionals' to identify psycho-social risk factors in women’s everyday life. Training of mental health providers must not be supported mainly by the pharmaceutical industry, for this industry has a concrete interest in pharmacological treatment, and a law interest in promoting other treatment and prevention.
The training must be focused on acknowledgement of environmental and social-relational factors. These are factors on which it is possible to intervene before that the overload of pressures becomes a psychic pathology. We consider important to organize a specific training programme on behalf of general practitioners, psychiatrists, psychologists and other social-health workers, aimed at:- reducing drug-abuse; - stimulating a medical and psychological approach apt to explain the connection between illness and everyday life (house work and violent pressure from the family context). The training must give a correct and wide information on the processes involved in becoming ill and, in the opposite direction, on the protecting factors. The training must oriented medical professionals in helping woman to: - combat stress and other pathological problems linked to female role; - change the pattern of subordination and dependence; - know that the absence of reaction to violence is linked to illness and others psychological troubles; - modify life styles leading to mental illness
Services
It is necessary to direct health services towards: - preventing and therapeutic activities for women; - offering women specific services The main thing is all health care providers work with a gender perspective.
Three types of activity or service for these women:
1. The first type attends to prevent specific situations of distress. The main goals are to give correct information on links between daily life and mental disease and to transfer means to: - fight stress, fatigue e tiredness before they become a pathology; - overcome the pattern of subordination and dependence; - react against family violence and psychological maltreatment.
In These services could be organized: a. the listening-centres, the training-stages, the social and psychological support-groups, ecc. Each initiative would be addressed to women with specifical problem: - Women who have given up working after maternity, - Women having difficulties in social relationships, in organizing both housework and extra-familiar work; - Women ill-treated, abused, alcoholic women, etc. b. Programmes for health education with a view to: - Increasing women ability to communicate and express themselves emotionally; - Increasing the ability of analyzing their life-style; - Improving their image and their self-esteem; - Reducing the risks of symptoms of mental pathologies.
2. The second type of service is addressed to women who have already begun to develop an illness and manifest symptoms, and who have already had psychiatric treatment. There women could be encouraged to understand the way in which their daily lives have led them to illness. Work method should be different from that traditionally adopted in psychiatry. The specialised services should offer practical help and necessary support by creating a concrete alternative to hospitals and to psychiatric cures. These services have the following goals: - to reduce or to eliminate the use of specific therapeutical means, such as hospitalization, drugs, or any other strategy that tends to impede or delay the comprehension of the concrete and tangible causes of their illness; - to consider the symptoms of mental illness as signs of unbearable life conditions; - to create a new life-style for women's benefits in keeping with their interests, aptitudes and emotions.
3. The third type attend to setting up "women's refuges" Today, in spite of hospitalization, it his right to consider as a therapeutical tool non medical care places for women with psychological problems. They could go there spontaneously for receiving psychological support in their daily lives. So they could make as stop of daily life stressors.
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