Deinstitutionalization in Italian psychiatry – the course and consequences

Part I. The course of deinstitutionalization – the activity of Basaglia’s group.

Psychiatric reform in Italy consisted of the implementation of legislative changes derived from anti-institutional experiments conducted by Franco Basaglia and his group in the 60’s and 70’s of the 20th century. The activity of Basaglia’s group was an integral part of the European reform movement of that time, which profited from the economic, cultural and political prosperity for changes in psychiatry. Italian antipsychiatry has led to the most radical experiment in deinstitutionalization in history. It involved the whole public sector of psychiatry and across a quarter-century resulted in a grand social debate on the situation of the mentally ill and the need for systemic change of their treatment and care. Inspired mainly by phenomenological analysis, Basaglia opted for close emphatic contact with the mentally ill. While the British, French and American anti-psychiatrists contested the psychiatric care system as such, the Italian radicals made an approach to disassemble it from the inside and successfully gained social support for the process of deinstitutionalization. Basaglia promoted his ideas across Europe, including the World Health Organization (WHO) forum.

Part II. The consequences of deinstitutionalization.

The Italian mental health care is based on Law 180 (it. Legge 180), also called Legge Basaglia, from the name of the author of the reform, Franco Basaglia. It was adopted on May 13th 1978. The new legislation resulted from the actions of a strong anti-psychiatric movement and it brought about a major change in the organization of psychiatric care. The reform and its consequences were widely studied by the researchers, especially in the United Kingdom and the United States of America. The authors point out many successes of the reform, especially in its beginning. They seek the sources of its failure in a faulty and incomplete implementation. Legge Basaglia completely changed the structure of mental health care in Italy, finally bringingpsychiatry back to medicine and the general hospitals, as well as promoting community-based psychiatry. Deinstitutionalization in Italy was not related to an increase in compulsory psychiatric hospitalizations, suicide attempts by the mentally ill, nor did it raise the number of crimes committed by them. It also did not cause common trans-institutionalization, with the transfer of patients to the private sector, as predicted by its opponents.

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