Return to the asylum: the search for clients with enduring mental health problems in Italy

Abstract

Deinstitutionalization and community care were the most influential movements in the field of mental health in the last 30 years. In 1978 Italy was the first country to pass laws that would eliminate mental hospitals and replace them with community-based services. Italian ideas about community care provided inspiration for care in the community legislation when this was introduced in the UK. In order to be able to fairly assess and describe the benefits of Italian mental health care, the author visited a range of care facilities in a prescribed region in the north of Italy. In the course of investigation, the author sought to discover if the implementation of what were regarded by some as radical community attitudes in the care of people with mental health problems had led to innovative approaches when dealing with patients/clients requiring long-term care and treatment. Although the Italian approach is enlightened in many areas of care, the system still has to face up to the problems presented in caring for clients/patients with enduring mental health problems. The circumstances relating to care were unexpected and caused the author to revise his opinion of the Italian approach to community care.

Residential Care in Italy: Critical Issues and Future Perspectives

“…In a paper published in 2004 [30], Sharp outlines a sadly truthful panorama, stressing that in Italy the care of psychiatric patients with chronic problems has been forgotten. Difficult patients with chronic and highly debilitating illnesses are actually "stored" in isolated environments, managed by staff limited in number and skills.…”

“…However, it is not always predictable and achievable, posing the problem of determining the drivers of change and how RFs generally work. While structural and organizational aspects of RFs are well described, less attention has been paid to the description of the factors related to a successful conclusion of residential treatments [30]. For instance, even in the face of data showing the effectiveness of residential structures, in both the clinical and psychosocial rehabilitation, treatment goals are often not clear, or at least not well explicated [5,6,24].…”

“…In summary, the application of L.180 has not been able to prevent the chronicity, but merely allocated elsewhere chronic patients. These considerations are derived from a study conducted by the author in Ferrara, a city placed in one of the most virtuous regions in social, economic, and local policies [30].…”