Psychiatric reform in Italy is the reform of psychiatry which started in Italy after the passing of
Basaglia Law
Basaglia Law or Law 180 ( it, Legge Basaglia, Legge 180) is the Italian Mental Health Act of 1978 which signified a large reform of the psychiatric system in Italy, contained directives for the closing down of all psychiatric hospitals and led to ...
in 1978 and terminated with the very end of the Italian state mental hospital system in 1998.
Among European countries, Italy was the first to publicly declare its repugnance for a mental health care system which led to social exclusion and segregation.
The psychiatric reform was also a consequence of a public debate sparked by
Giorgio Coda's case and stories collected and analyzed in
Alberto Papuzzi's book ''Portami su quello che canta''.
Aims
The reform was directed towards the gradual dismantling of the psychiatric hospitals and required a comprehensive, integrated and responsible community mental health service.
The object of community care is to reverse the long-accepted practice of isolating the mental ill in large institutions, to promote their integration in the community offering them a milieu which is socially stimulating, while avoiding subjecting them to too intense
social pressure
Peer pressure is the direct or indirect influence on peers, i.e., members of social groups with similar interests, experiences, or social statuses. Members of a peer group are more likely to influence a person's beliefs, values, and behavior. A g ...
s.
Course
Since the late 1960s, the Italian physician
Giorgio Antonucci
Giorgio Antonucci (Lucca, 24 February 1933 – Florence, 18 November 2017) was an Italian physician, known for his questioning of the basis of psychiatry.
Biography
In 1963 Antonucci studied psychoanalysis with Roberto Assagioli, the founder ...
questioned the basis itself of psychiatry. After working with Edelweiss Cotti in 1968 at the Centro di Relazioni Umane in
Cividale del Friuli
Cividale del Friuli ( fur, Cividât (locally ); german: Östrich; sl, Čedad) is a town and ''comune'' in the Province of Udine, part of the North-Italian Friuli Venezia Giulia ''regione''. The town lies above sea-level in the foothills of the e ...
– an open ward created as an alternative to the psychiatric hospital – from 1973 to 1996 Antonucci worked on the dismantling of the psychiatric hospitals ''Osservanza'' and ''Luigi Lolli'' of
Imola
Imola (; rgn, Jômla or ) is a city and ''comune'' in the Metropolitan City of Bologna, located on the river Santerno, in the Emilia-Romagna region of northern Italy. The city is traditionally considered the western entrance to the historical re ...
,
and the liberation – and restitution to life – of the people there secluded. In August, 1971,
Franco Basaglia
Franco Basaglia (; 11 March 1924 29 August 1980) was an Italian psychiatrist, neurologist, professor who proposed the dismantling of psychiatric hospitals, pioneer of the modern concept of mental health, Italian psychiatry reformer, figurehead a ...
became the director of the provincial psychiatric hospital located in
Trieste
Trieste ( , ; sl, Trst ; german: Triest ) is a city and seaport in northeastern Italy. It is the capital city, and largest city, of the autonomous region of Friuli Venezia Giulia, one of two autonomous regions which are not subdivided into provi ...
.
With a group of young physicians not yet influenced by traditional psychiatry —as well as psychologists, volunteers and students— Basaglia started an intense project for the theoretical-practical criticism of the institution of the asylum.
At that time, there were approximately 1,200 patients in the San Giovanni psychiatric hospital, most of them were under compulsory treatment.
From 1971 to 1974, the efforts of Franco Basaglia and his equipe were directed at changing the rules and logic which governed the institution, putting the hierarchy in question, changing the relations between patients and operators, inventing new relations, opportunities and spaces, and restoring freedom and rights to the inmates.
In the hospital being transformed, guardianship was substituted by care, institutional abandonment by the full assumption of responsibility for the patient and their condition, while the negation of the individual through the concept of illness-danger was replaced by the conferring of importance and value to individual life histories.
Any form of physical containment and shock therapy was suppressed, the barriers and mesh which had enclosed the wards were removed, doors and gates were opened,
compulsory hospitalizations became voluntary and definitive ones were revoked, thus the patients regained their political and civil rights.
Main characteristics
Michele Tansella
Michele Tansella (2 October 1942 – 1 March 2015) was an Italian psychiatrist known for his work in epidemiological psychiatry. He was the founding editor-in-chief of the academic journal '' Epidemiology and Psychiatric Sciences'', which he founde ...
specified the main characteristics of the Italian experience:
* community care as the principal component of the system;
* a relatively low dose of inpatient care, avoiding treating any new patients in mental hospital;
* a very careful integration between the various facilities within the geographically based system of care, the same team providing outpatient as well as inpatient and community care.
The closure of various hospital settings became possible because of constant reduction of in-patients number which in the course of years had the following dynamics:
Estimations
Giovanna Russo and Francesco Carelli state that back in 1978 the Basaglia reform perhaps could not be fully implemented because society was unprepared for such an avant-garde and innovative concept of mental health.
Thirty years later, it has become more obvious that this reform reflects a concept of modern health and social care for mental patients.
The Italian example originated samples of effective and innovative service models and paved the way for deinstitutionalisation of mental patients.
See also
*
Basaglia Law
Basaglia Law or Law 180 ( it, Legge Basaglia, Legge 180) is the Italian Mental Health Act of 1978 which signified a large reform of the psychiatric system in Italy, contained directives for the closing down of all psychiatric hospitals and led to ...
*
Deinstitutionalisation
Deinstitutionalisation (or deinstitutionalization) is the process of replacing long-stay psychiatric hospitals with less isolated community mental health services for those diagnosed with a mental disorder or developmental disability. In the late ...
*
Giorgio Antonucci
Giorgio Antonucci (Lucca, 24 February 1933 – Florence, 18 November 2017) was an Italian physician, known for his questioning of the basis of psychiatry.
Biography
In 1963 Antonucci studied psychoanalysis with Roberto Assagioli, the founder ...
*
Giorgio Coda
References
External links
* {{cite web , author=Del Giudice G. , year=1998 , url=http://www.triestesalutementale.it/english/doc/delgiudice_1998_psychiatric-reform-italy.pdf
, title=Psychiatric Reform in Italy , publisher=Trieste: Mental Health Department , access-date=5 Oct 2010
Giorgio Antonucci speaks about Franco Basaglia(in Italian)
* Pervasive Technology Lab (CIC) (2011)
Technology for Mental Health
Archive Giorgio Antonucci
Health care reform
Mental health in Italy
History of psychiatry
Deinstitutionalisation in Italy
Reform in Italy