A Tale of Two Cities: The Exploration of the Trieste Public Psychiatry Model in San Francisco

Abstract

According to the World Health Organization (WHO), the ''Trieste model'' of public psychiatry is one of the most progressive in the world. It was in Trieste, Italy, in the 1970s that the radical psychiatrist, Franco Basaglia, implemented his vision of anti-institutional, democratic psychiatry. The Trieste model put the suffering person-not his or her disorders-at the center of the health care system. The model, revolutionary in its time, began with the ''negation'' and ''destruction'' of the traditional mental asylum ('manicomio'). A novel community mental health system replaced the mental institution. To achieve this, the Trieste model promoted the social inclusion and full citizenship of users of mental health services. Trieste has been a collaborating center of the WHO for four decades with a goal of disseminating its practices across the world. This paper illustrates a recent attempt to determine whether the Trieste model could be translated to the city of San Francisco, California. This process revealed a number of obstacles to such a translation. Our hope is that a review of Basaglia's ideas, along with a discussion of the obstacles to their implementation, will facilitate efforts to foster the social integration of persons with mental disorders across the world.

Jumping off the bandwagon: Does the Basaglian de-hospitalised model work outside Trieste?

“…Franco Basaglia was the charismatic Italian psychiatrist who established the Trieste model in the 1970s, and his disciples still actively promote his legacy (Portacolone et al, 2015). Inspired by the writings of Erving Goffman, Michel Foucault and Jean-Paul Sartre, together with the views of British anti-psychiatrists, R.D.…”

“…As the director of the San Giovanni asylum in the Adriatic port city of Trieste, Basaglia led a movement that promoted patients' human rights, eliminated physical restraint, pioneered 24/7 community mental health centres, established community residential care and finally closed the asylum. These reforms created the 'Trieste model', which is community focused with a single general hospital unit (with six beds for acute stays)the most distinctive feature of the model is this extremely low provision of hospital beds (2.5 psychiatric beds per 100,000 population) (Portacolone et al, 2015).…”

Working on and with Relationships: Relational Work and Spatial Understandings of Good Care in Community Mental Healthcare in Trieste

“…The so-called ‘Trieste model’ of mental health care that has been in constant development since then, was inspired by the ideas of Franco Basaglia (1924–1980), a psychiatrist and leading figure in Italy’s democratic psychiatry movement. Basaglia proclaimed that the person, rather than the mental health disorder, should be placed at the center of the mental healthcare system (Portacolone et al 2015 ). On the basis of his philosophy, the psychiatric hospital was closed and a radical shift started towards care in the community.…”

“…While the community mental health system that has developed since has changed over time, it has maintained its basic principles: no closed doors, no seclusion and a minimum of restraint. The approach in Trieste has also attracted a lot of attention from professional mental health care workers in and outside Italy, raising questions about what one might term the ‘active ingredients’ of deinstitutionalization in Italy (Barbui and Tansella 2008 ), and whether the ‘Trieste model’ can be translated to other countries (Portacolone et al 2015 ).…”

“…But even though reforms were context-bound, developments in Italy—and particularly in Trieste—were an inspiration for the processes of deinstitutionalization taking place in many other parts of the world. Law 180, which called for the closure of psychiatric hospitals throughout Italy, starting by ending new admissions in order to phase them out altogether, was seen as the first deinstitutionalization law and came into force in 1978 (Portacolone et al 2015 ). Its actual implementation varied greatly between the various regions of Italy.…”