San Marino Council Rejects Proposal for Psychological Support in Basic Clinics

Council Debates Mental Health Access

The Grand and General Council of San Marino convened on the morning of Friday, September 19, 2025, to deliberate on Istanza n.27, a petition advocating for the introduction of psychological support services within basic medical clinics. The debate highlighted differing views on the accessibility and sufficiency of mental health provisions in the Republic.

Government Cites Existing Services

During the session, Secretary Mariella Mularoni, representing the government, argued against the necessity of the proposed measure. She asserted that comprehensive and free psychological and psychotherapeutic support is already ensured through the Territorial and Social-Health Department. This department operates with a team of 16 professionals integrated into a multidisciplinary network, a structure reinforced by Delegated Decree 171/2024. Consequently, the government's position was that the physical presence of psychologists in basic clinics was not required, and urged the Council to reject the petition.

Arguments for Enhanced Accessibility

Proponents of Istanza n.27 emphasized the need for more immediate and accessible mental health care. Matteo Casali of the Rete Frontale (RF) group argued for establishing easily accessible points for citizens to detect distress earlier, reduce stigma, and expedite referrals. He suggested that a minimal increase in personnel could cover the three existing health centers without significantly escalating costs. Similarly, Carlotta Andruccioli from Democrazia in Movimento – Lista Libera (D-ML) supported the petition as a measure of 'proximity and social justice,' aiming to normalize mental health discussions, decrease the inappropriate use of medication, and simplify access, particularly for young people following the pandemic years.

Diverse Perspectives on Mental Health Strategy

Other council members offered varied perspectives on the best approach to mental health care. Donatella Merlini of the Partito dei Socialisti e dei Democratici (PSD) called for a systemic and multidisciplinary strategy, cautioning that merely adding staff without a broader network involving educational institutions might prove ineffective. Francesca Civerchia of the Partito Democratico Cristiano Sammarinese (PDCS), representing the majority, pointed to already increased resources and noted that many mental health interventions originate from health centers through general practitioners. She stressed that loneliness is a core issue, best addressed through network collaboration rather than solely by increasing staff numbers. Michele Muratori from Libera acknowledged the importance of the topic but viewed the petition's request as excessive within the current framework, though he expressed openness to 'listening desks' and future adjustments. Maria Luisa Berti of Alleanza Riformista (AR) highlighted the functionality of the existing network and suggested that better public awareness of available, free services was more crucial than new physical locations. She also raised concerns about privacy, noting that busy health centers might deter individuals from seeking help due to fear of exposure.

Petition Rejected

Following the extensive debate, the Grand and General Council ultimately voted to reject Istanza n.27. The decision underscores the ongoing discussion within San Marino regarding the optimal delivery of psychological support and mental health services, balancing existing infrastructure with calls for enhanced accessibility and integration into primary care. The Republic's current mental health infrastructure includes the U.O.C. Salute Mentale (Mental Health Unit) of the Istituto per la Sicurezza Sociale (ISS), which provides a range of services including psychiatric visits and psychotherapy, alongside a dedicated Mental Health Helpline and support for youth. Private clinics also offer specialized psychological and psychiatric care, and the national 'Parlare Aiuta' (Talking Helps) campaign promotes open dialogue around mental well-being.