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The most historical reform in mental health

16 Sep 2016

Italy is considered to be one of the best countries in terms of addressing mental health and mental disorders and catering well to them. However, this was not always true. The mental health scenario of Italy has undergone a major change and has improved their approach toward mental health.

The transformation that is being talked about came to the realm in 1978 when all the specialized mental hospitals of Italy were closed down, preceded by a law passed by the Italian Parliament. Sounds absurd, doesn’t it? Well, the shutting down of all mental hospitals gave way to opening up of various different community structures for catering to the mentally ill. Deinstitutionalization, which refers bringing in lesser cut-off and more welcoming community health services instead of long-stay psychiatric hospitals, occurred.

The replaced model believed in treating the mentally ill with dignity and ensuring their freedom and rights to live as usual citizens. The mental care revolved around the person and not just her/his illness, thereby improving their interpersonal relations and living conditions substantially. The patients were treated no differently than other people and it was often difficult to tell them apart from visitors, staff, or even doctors.

The term ‘asylum’ paints a gloomy picture in our minds while the term ‘community centres’ seems like a cheerful place. The Community Centres lived up to their name and were creatively designed and attractively furnished.

A healthy environment was created with the involvement of the community, and hence Community Centres were established where there were ample services for sports, trips, exercise, and art and theater workshops. Opportunities ranging from social to rehabilitation and recreational to work were provided. Cooperatives, workshops, youth groups, and self-help acted as aids.

The perfect example is of the town of Trieste where the closing of 1,200 mental hospital beds was followed by 24-hour community centers providing housing, home care, social clubs, work coops, and recreational prospects. The model worked so well that Trieste with a population of about 240,000 does not have any specialized mental hospitals for over 35 years.

Dr. Mario Colucci, a psychiatrist from Trieste, says “The Trieste approach is based on five principles: individualized care plans through active negotiation; ensuring comprehensive responsibility of Community Mental Health Centers in all phases of treatment; working with and on the environment and the social fabric; supporting individual freedom and strengths; and fostering service accountability toward the community.”

The closing of hospitals was followed by the opening of society. The patients from closed units were now being embraced by the community. They managed to bring out the best in their patients through a modified approach.

This is seen as a landmark in the mental health scenario. Italy’s example was followed by The United States. However, deinstitutionalization did not work as well In the US except a few places, as it did in Italy. The implementation was improper and the results were futile. In some cases, the closing down of mental hospitals and lack of opening and management of Community Centres caused the patients ending up in prison or the streets.

The theory behind the deinstitutionalization in Italy is absolutely amazing but the case of the US serves as an example too.

If implemented appropriately, is the approach in Italy it the way to go for achieving superior mental health conditions in every nation? Or is the failure of the model in the US a lesson to continue on the same path as before? Or is there another alternative?




Tags: Italy Mental Health Act