Community Mental Health Services in Italy

Abstract

In 1978, in Italy, approval of Basaglia’s reform law marked a shift from an asylum-based to a community-based mental health system. The main aim of the reform was to treat patients in the community and no longer in psychiatric hospitals. Following the Italian model, similar reforms of mental health care have been approved worldwide. The community-based model aims to promote integration and human rights for people with mental disorders on the basis of their freedom to choose treatment options.

By 2000, all psychiatric hospitals had been closed and all patients discharged. Mental health care is organized through the Department of Mental Health, which is the umbrella organization responsible for specialist mental health care in the community; this includes psychiatric wards located in general hospitals, residential facilities, mental health centres, and day-hospital and day-care units.

Approval of Law 180 led to a practical and ideological shift in the provision of care to patients with mental disorders. In particular, the reform highlighted the need to treat patients in the same way as any other patient, and mental health care moved from a custodialistic to a therapeutic model.

Progressive consolidation of the community-based system of mental health care in Italy has been observed in the past 40 years. However, some reasons for concern still exist, including low staffing levels, potential use of community residential facilities as long-stay residential services, and a heterogeneity in the availability of resources for mental health throughout the country.

Keywords

mental health care / community mental health system / mental health centres

References

[1] Catanesi R, Manna A, Ventriglio A. Community mental health services and responsibility of psychiatrists in Italy: Lessons for the globe. Int J Soc Psychiatry. 2016;62(6):501-4.

[2] Ferrannini L, Ghio L, Gibertoni D, et al. Thirty-five years of community psychiatry in Italy. J Nerv Ment Dis. 2014;202:432–9.

[3] Castaldelli-Maia JM, Ventriglio A. The impact of Basaglia on Brazilian psychiatry. Int J Soc Psychiatry. 2016;62(5):411-4.

[4] Mezzina C. Forty years of the Law 180: the aspirations of a great reform, its successes and continuing need. Epidemiol Psychiatr Sci. 2018;27(4):336-345.

[5] Munizza C, Gonella R, Pinciaroli L, Rucci P, Picci RL, Tibaldi G. CMHC adherence to National Mental Health Plan standards in Italy: a survey 30 years after national reform law. Psychiatr Serv.. 2011;62(9):1090-3.

[6] Barbui C, Papola D, Saraceno B. Forty years without mental hospitals in Italy. Int J Ment Health Syst. 2018;(1):12:43.

[7] Ministero della Salute. Rapporto sulla Salute mentale anno 2015. http://www.salut e.gov.it/porta le/news/p3_2_1_1_1.jsp?lingu a=itali

[8] Fiorillo A, Ventriglio A. The legacy of Italian psychiatry. Int Rev Psychiatry. 2018;30(2):118-119.

[9] Pingani L, Fiorillo A, Luciano M, Catellani S, Vinci V, Ferrari S, Rigatelli M. Who cares for it? How to provide psychosocial interventions in the community. Int J Soc Psychiatry. 2013;59(7):701-5.

[10] World Health Organization. Mental health atlas 2017. Geneva: World Health Organization; 2018.

[11] de Girolamo G, Bassi M, Neri G, Ruggeri M, Santone G, Picardi A. The current state of mental health care in Italy: problems, perspectives, and lessons to learn. Eur Arch Psychiatry Clin Neurosci. 2007;257(1):83–91.

[12] de Girolamo G, Picardi A, Santone G, et al. The severely mentally ill in residential facilities: a national survey in Italy. Psychol Med. 2005;35(1):421–431.

[13] Del Vecchio V, Luciano M, Sampogna G, De Rosa C, Giacco D, Tarricone I, Catapano F, Fiorillo A. The role of relatives in pathways to care of patients with a first episode of psychosis. Int J Soc Psychiatry. 2015; 61(7):631-637.

[14] Volpe U, Fiorillo A, Luciano M, Del Vecchio V, Palumbo C, Calò S, Piras S, Signorelli M, Filippo D, Piselli M, De Fazio P, Gotelli S, Bardicchia F, Cerveri G, Ferrari S, Mulè A, Ribolsi M, Sampogna G, De Rosa C, Sartorius N. Pathways to mental health care in Italy: results from a multicenter study. Int J Soc Psychiatry. 2014;60(5):508-513.

[15] Fiorillo A, Del Vecchio V, Luciano M, Sampogna G, De Rosa C, Malangone C, Volpe U, Bardicchia F, Ciampini G, Crocamo C, Iapichino S, Lampis D, Moroni A, Orlandi E, Piselli M, Pompili E, Veltro F, Carrà G, Maj M. Efficacy of psychoeducational family intervention for bipolar I disorder: A controlled, multicentric, real-world study. J Affect Disord. 2015;172(1):291-299.

[16] Luciano M, Del Vecchio V, Sampogna G, De Rosa C, Fiorillo A. Including family members in psychoeducation for bipolar disorder: is it worth it? Bipolar Disord.. 2015;17(4):458-9.

[17] Luciano M, Del Vecchio V, Giacco D, De Rosa C, Malangone C, Fiorillo A. A ‘family affair’? The impact of family psychoeducational interventions on depression. Expert Rev Neurother. 2012;12(1):83-91.

[18] Luciano M, Sampogna G, del Vecchio V, Giacco D, Mulè A, de Rosa C, Fiorillo A, Maj M. The family in Italy: cultural changes and implications for treatment. Int Rev Psychiatry.. 2012;24(2):149-156.

[19] Sampogna G, Luciano M, Del Vecchio V, Malangone C, De Rosa C, Giallonardo V, Borriello G, Pocai B, Savorani M, Steardo L Jr, Lampis D, Veltro F, Bartoli F, Bardicchia F, Moroni AM, Ciampini G, Orlandi E, Ferrari S, Biondi S, Iapichino S, Pompili E, Piselli M, Tortorella A, Carrà G, Fiorillo A. The effects of psychoeducational family intervention on coping strategies of relatives of patients with bipolar I disorder: results from a controlled, real-world, multicentric study. Neuropsychiatr Dis Treat. 2018;14:977-989.

[20] Steardo L Jr, Caivano V, Sampogna G, Di Cerbo A, Fico G, Zinno F, Del Vecchio V, Giallonardo V, Torella M, Luciano M, Fiorillo A. Psychoeducational Intervention for Perinatal Depression: Study Protocol of a Randomized Controlled Trial. Front Psychiatry. 2019;10:55.

[21] Fiorillo A, Del Vecchio V, Luciano M, Sampogna G, Sbordone D, Catapano F, De Rosa C, Malangone C, Tortorella A, Veltro F, Nicolò G, Piselli M, Bardicchia F, Ciampini G, Lampis D, Moroni A, Bassi M, Iapichino S, Biondi S, Graziani A, Orlandi E, Starace F, Baronessa C, Carrà G, Maj M. Feasibility of a psychoeducational family intervention for people with bipolar I disorder and their relatives: Results from an Italian real-world multicentre study. J Affect Disord.. 2016; 190(1):657-662.

[22] Fiorillo A, De Rosa C, Del Vecchio V, Jurjanz L, Schnall K, Onchev G, Alexiev S, Raboch J, Kalisova L, Mastrogianni A, Georgiadou E, Solomon Z, Dembinskas A, Raskauskas V, Nawka P, Nawka A, Kiejna A, Hadrys T, Torres-Gonzales F, Mayoral F, Björkdahl A, Kjellin L, Priebe S, Maj M, Kallert T. How to improve clinical practice on involuntary hospital admissions of psychiatric patients: suggestions from the EUNOMIA study. Eur Psychiatry. 2011;26(4):201-7.

[23] Luciano M, De Rosa C, Sampogna G, Del Vecchio V, Giallonardo V, Fabrazzo M, Catapano F, Onchev G, Raboch J, Mastrogianni A, Solomon Z, Dembinskas A, Nawka P, Kiejna A, Torres-Gonzales F, Kjellin L, Kallert T, Fiorillo A. How to improve clinical practice on forced medication in psychiatric practice: Suggestions from the EUNOMIA European multicentre study. Eur Psychiatry. 2018;54(1):35-40.

[24] Morgan C, Knowles G, Hutchinson G. Migration, ethnicity and psychoses: evidence, models and future directions. World Psychiatry. 2019;18(3):247-258.

[25] Forte A, Trobia F, Gualtieri F, Lamis DA, Cardamone G, Giallonardo V, Fiorillo A, Girardi P, Pompili M. Suicide Risk among Immigrants and Ethnic Minorities: A Literature Overview. Int J Environ Res Public Health. 2018;15(7):1438.

[26] Guloksuz S, Pries LK, Ten Have M, de Graaf R, van Dorsselaer S, Klingenberg B, Bak M, Lin BD, van Eijk KR, Delespaul P, van Amelsvoort T, Luykx JJ, Rutten BPF, van Os J. Association of preceding psychosis risk states and non-psychotic mental disorders with incidence of clinical psychosis in the general population: a prospective study in the NEMESIS-2 cohort. World Psychiatry 2020;19(1):199-205.

[27] Bloomfield MAP, Chang T, Woodl MJ, Lyons LM, Cheng Z, Bauer-Staeb C, Hobbs C, Bracke S, Kennerley H, Isham L, Brewin C, Billings J, Greene T, Lewis G. Psychological processes mediating the association between developmental trauma and specific psychotic symptoms in adults: a systematic review and meta-analysis. World Psychiatry. 2021;20(1):107-123.

[28] Fiorillo A, Maj M. The role of psychiatry in modern medicine. Int Rev Psychiatry. 2018;30(2):169-175.

[29] Fiorillo A, Malik A, Luciano M, Del Vecchio V, Sampogna G, Del Gaudio L, Rojnic Kuzman M, Jovanovic N, Nawka A, Volpe U. Challenges for trainees in psychiatry and early career psychiatrists. Int Rev Psychiatry.. 2013;25(4):431-437.

[30] Amaddeo F, Barbui C, Tansella M. State of psychiatry in Italy 35 years after psychiatric reform. A critical appraisal of national and local data. Int Rev Psychiatry. 2012;24(1):314–20.

RIGHTS & PERMISSIONS

Sampogna G., Del Vecchio V., De Rosa C., Giallonardo V., Luciano M., Palummo C., Di Vincenzo M., Fiorillo A.