[SPS Conference June 2009 - Practical training in general health and mental health facilities] - Report 5 – The function of psychology in the hospital context as the competence of thinking about relations: a risk prevention and protection service.

Elena Lisci


The talk I am going to give is about my practical training experience, which lasted two years and is almost over, at the Risk prevention and protection service in the hospital of an Italian town. The Service was created in 1994 in response to Legislative decree n°626 about the protection of workers’ health and safety, which has been updated with the modifications to the law, until the present inclusion of the assessment of psychosocial risk. From a beginning that stressed the structural aspects of risk – it is no coincidence that similar services in other hospitals are managed by engineers – there has been the gradual inclusion, in an increasingly explicit way, of aspects concerning the culture of the organisation. 
The Service has two specificities: it is run by doctors and includes a head psychologist. It is therefore to be remembered that in it there are medical and psychological competences side by side, with their different models. Moreover, in line with the development of interest, from mainly structural aspects to the inclusion of cultural aspects, a transition is taking place from a mainly inspectorial controlling role to a role related to organisational consultancy.  
In this change the psychological competence in the service is taking on a particularly important role. It in fact allows for a response to the law that is not a mere discharge of duty, but performs an assessment of psychosocial risk using models that give real knowledge of the relations in the hospital and an intervention on their dysfunctional components that constitute a risk for people’s emotional and mental health. 
In hospital culture the model of relational organisation that tends to clearly prevail is the medical model. Relations that serve as a framework for the relation between the technical expertise of the doctor and the sick part of the patient tend to be neglected or ignored. This translates into a frenetic, stressful behavior, characterised by the experience of urgency that accompanies work that has not been thought out and is not organised with criteria and strategies, where the numerous cases produced are perceived as being single and exceptional, and at the same time always the same. This culture often calls on psychology to take on the burden of the problematic aspects connected to relating, bringing back unwilling individuals, such as patients, to the relational model serving the medical intervention. Instead of colluding with this demand for intervention with the individual, the psychological function of the Service presents itself as the competence to think about relations and to promote change within them. Relations with patients, but also those between staff members in a working team, or between Operative Units.

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