Gradual closure of all mental hospitals
After Basaglia’s legislative changes in 1978, Italian psychiatry underwent extensive revision, with the gradual closure of all mental hospitals.
Mental Health Care issues in Italy
A nation-wide network of Departments of Mental Health now deliver inpatient and outpatient1 care, but also run semi-residential and residential facilities (residential facilities offer an average of 2.9 beds per 10,000 inhabitants). Hospital care is delivered through small psychiatric units (with no more than 15 beds). There are also many private inpatient facilities operating in Italy, and the number of private inpatient beds per 10,000 inhabitants is greater than the number of public beds; overall there are 1.7 beds per 10,000 inhabitants – one of Europe’s currently lowest numbers. There is marked quantitative and qualitative variation in the provision of out- and inpatient care throughout the country, and service utilisation is also inconsistent. Studies examining quality of life, report a fairly high degree of patient satisfaction, whereas patients’ families frequently bear a heavy burden. In conclusion, the Italian reform law has established a broad network of facilities to meet diverse care needs.
What can be done for improving Mental Health Care?
Further efforts are required to improve quality of care and to develop a more effectively integrated system. Greater attention must be paid to areas such as quality of care and outcomes, public and private sector balance, and the coordination of various resources and agencies.
What main lessons can be learnt from the Italian experience? The first is that the transition from a predominantly hospital-based service to a predominantly community-based service cannot be made by simply closing hospitals. Appropriate alternatives must be provided, and this requires time. The second point is that political and administrative commitment is essential. Community care is not a cheap solution: investments must be made in buildings, staff, staff training, and in back-up facilities.
WARM UP
What sort of problems do you thlnk a famlly may have to face, when one of the members is mentally ill?
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1 An .......................... is a person who stays in a hospital while receiving treatment. An .......................... is a person who goes to a hospital for treatment but does not stay there.
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1 In 2018, in ltaly the proportion of government expenditure on menta I health was half that of Germany or France.