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… by and large analysis is for those who want it, need it and can take it. When I am faced with the wrong kind of case I change over into being a psychoanalyst who is meeting needs, or trying to meet the needs of that special case (Winnicott, 1965, p. 217).
I find this statement of Winnicott's particularly useful as an introduction to Riefolo's work. Riefolo is a psychoanalyst and a psychiatrist who for many years has been a director in the mental-health division of the Italian health service.
In his book, starting from the viewpoint of psychoanalytical observation, he suggests paying careful attention to the changes that are characterising the Italian health service, in particular those relating to mental health. He focuses, paradoxically, on the possibility of reorganisation out of the crisis that is affecting the service in general. It is worth remembering that cultural and political changes in Italy in the 1970s culminated in Law No. 180,2 which deinstitutionalised patients in psychiatric hospitals. This provided for the institution and distribution of mental-health services, at the local community level, which were intended for the prevention, treatment and rehabilitation of the mentally ill. This reform transformed the work of the mental-health services, encouraging paying more attention to the reasons for psychic disturbance, their possible interpretation and treatment of the disturbance.
Now in Italy a new phase of transformation in health policies is evident, which, even though a long way from American-style privatisation, has introduced the ‘business ethic’ into health services, confronting staff with a different way of using resources, and different parameters of evaluation, such as measuring by targets, the use of time indicators, and efficiency and effectiveness measures in methodology