Mental health reforms: Some contrasts between Britain and Italy

Recently, there has been substantial debate about the rundown of the old psychiatric hospitals and a shift within the British mental health services towards ‘community care’. Part of the discourse about this shift in provision has entailed psychiatric reforms in Italy being cited as both a dire warning and a model to emulate (e.g. Jones and Poletti; Ramon, 1985a, respectively). The reforms in Italy were formalized in 1978 with the passing of law 180, though many of the changes evident in the country's mental health system had been taking place from the mid-sixties onwards (Basaglia, 1980). During the 1960s, the traditional psychiatric services became the focus of criticism from a number of parties, who eventually formalized their organization in 1974 as Psichiatria Democratica. Basaglia is credited with being the intellectual and inspirational leader of Psichiatria Democratica, and he provided a seminal national model from the time he was appointed as the medical director of Gorizia in 1961.

At first the emerging democratization of Italian psychiatry was associated with two levels of activity. At the intellectual level, the medical model and custodial care were criticized from a social and humanitarian perspective (e.g. Basaglia, 1967). At the practical level, lessons learned from the therapeutic community movement in Britain (Main at Northfield and Jones at Mill Hill) and France (Bovet and colleagues at St Alban) were integrated into Italian asylum care. Between 1968 and 1976, these shifts were associated with a move from a radical protest lobby to a complete reform movement which sought systematically to dismantle institutional care (Crepet and De Plato). Law 180, passed in 1978 following on the success of Psichiatria Democratica, pre-empted new asylum admissions and directed that asylums should be