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A model of public mental health in Italy deserves praise around the world.  Now he faces his demise: NPR


A former psychiatric hospital is located in San Giovanni Park in Trieste. The establishment closed over 40 years ago, but its ocher pavilions are bustling with activity.

Sylvia Poggioli / NPR


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A model of public mental health in Italy deserves praise around the world.  Now he faces his demise: NPR

A former psychiatric hospital is located in San Giovanni Park in Trieste. The establishment closed over 40 years ago, but its ocher pavilions are bustling with activity.

Sylvia Poggioli / NPR

TRIESTE, Italy – A former psychiatric hospital sits in San Giovanni Park in Trieste, next to a large rose garden that stretches out on a hill above the city. The establishment closed over 40 years ago, but its ocher pavilions are bustling with activity.

In one building, Radio Fragola (Strawberry Radio) broadcasts news and information about public services. Next door is Il Posto delle Fragole (Strawberry Patch), a cafe and a meeting point. (Their names are a nod to that of Ingmar Bergman Wild strawberries film.) At the end of the hall, workers are busy sewing ties, bags and clothes.

The staff of these operations, as well as those of cafes, museums, libraries and other workplaces in the city, are helped by people with mental illness who belong to a social cooperative called La Collina (the Hill).

This is all part of what is known as the Trieste Model, an approach that dates back to the 1960s and is recognized by the World Health Organization as one of the most advanced community mental health care systems. . Unlike the past where psychiatric patients were confined to institutions where they were abused, the Trieste model aimed to treat people with mental illness with dignity, including them in the community and in daily activities.

“Freedom is therapeutic” proclaims a slogan of the movement painted on a building of the old hospital.

But now health experts lament that freedom is threatened. Right-wing leaders in the region are beginning to break down the state-funded community system.

A model of public mental health in Italy deserves praise around the world.  Now he faces his demise: NPR

A sewing workshop is located in the former psychiatric hospital, which is part of a social cooperative that connects people with mental illnesses with jobs.

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The patients were locked up

According to Renzo Bonn, a psychiatrist and former director of mental health services in the nearby town of Udine, the former psychiatric hospital in Trieste was forcibly locking people inside.

“You [would] lose all your civil rights. You couldn’t vote. You couldn’t receive an inheritance. You couldn’t get married, ”he says.

Some patients have been locked in cages, tied in straitjackets, and subjected to ice-water baths, electroshocks and lobotomies.

If the patients were not released within 30 days, the lockdown, Bonn said, could last indefinitely. “The result is that people stayed in the mental hospital once, their entire life in the mental hospital,” he says.

A revolution in mental health care has begun

Everything changed in the late 1960s with psychiatrist Franco Basaglia, who believed that old mental hospitals were used as dumping grounds for the poor and deviant.

“When patients are tied up, subjugated and held captive, I don’t think any kind of therapy can help them. I don’t see a possible cure when there is no free communication between the patient and the doctor. “he said in a 1969 television interview.

Basaglia revolutionized the asylum: he knocked down walls, abolished the attachment of patients and encouraged them to take charge of their lives.

Soon, patients not only were holding a cafe in the field and earning a salary in real jobs, but they were holding hospital-wide patient assemblies.

When jazz came to Trieste

Pantxo Ramas, who is in charge of the hospital’s archives, says it has become a cultural center – including a memorable 1974 concert for patients by an American jazz master. “And Ornette Coleman said it was the most profound free-jazz concert he had ever done in his life,” Ramas said.

Shortly before the concert, Ramas recounts, a 50-year-old patient named Rosetta Lojacono walked onto the empty stage and started playing her harmonica. Coleman joined her and their jam session lasted over an hour.

“He lost the sense of who was a musician, who was an audience,” says Ramas, “who was a doctor, who was an artist, who was a listener. And I think it’s a moment of poetry. I feel it’s a place full of poetry. ”

Asked later by one of the concert’s organizers, saxophonist Coleman said: “I felt totally at ease, very normal. … I loved this feeling, we were all free. … Music can do it because sound is the science of feeling. ”

Italy has abolished asylums, but there is a right-wing reaction

Basaglia’s reforms ultimately led to a 1978 law that abolished all psychiatric asylums in Italy. He died in 1980, but his work continued and the Trieste model of state-funded community mental health care was emulated in several Italian regions and more than 40 countries, according to Roberto Mezzina, former director of services. of mental health in Trieste.

But now it is being dismantled by the administration of the Friuli-Venezia Giulia region led by the far-right Northern League and other right-wing parties.

Mezzina, now vice president of the World Federation for Mental Health, said that for decades the goal of right-wing politicians in the region was to end the Trieste model and move towards privatization.

He says the model is “a symbol of something that was created in the area of ​​social rights, human rights and was seen as part of leftist culture.”

At the beginning of October, the regional government announced its intention to close seven of the 22 community mental health centers in Friuli Venezia Giulia and reduce the hours at the remaining centers. It also plans to reduce the number of senior psychiatrists and department heads, while keeping many vacancies.

Regional health authorities have not responded to repeated requests for comment from NPR.

The international health community pushes back

Leading international psychiatrists have signed petitions to prevent one of the world’s first public mental health services from being handed over to the private sector.

Allen Frances, professor and president emeritus of psychiatry at Duke University, says that instead of using coercion and drugs as the solution to all problems, there is humanity and a community spirit behind the model of Trieste.

“The community was prepared to see the mentally ill not as a nuisance to be exiled to hospitals or to prisons and prisons or left homeless on the streets,” says Frances, “but rather as potentially very useful citizens who deserve the attention and resources of the city and could make a significant contribution to it.

Patient remembers confinement and electroshock

One patient who has experienced the mental health care revolution is 75-year-old Giordano Vascotto.

“I arrived here when I was 9 years old, it was in 1955, I remember the month of October”, he says, describing the psychiatric hospital of Trieste. “The windows were locked, the doors were locked. Then they gave me electric shocks. Many years have passed.”

After twenty years of confinement, Vascotto was released.

A model of public mental health in Italy deserves praise around the world.  Now he faces his demise: NPR

“I arrived here when I was 9 years old, it was in 1955, I remember the month of October”, says Giordano Vascotto, describing the psychiatric hospital of Trieste. “The windows were locked, the doors were locked. Then they gave me electric shocks. Many years have passed.”

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“After asylum, I rolled up my sleeves and went to work – first in a cemetery, then in a garbage collector and doorman. Years have passed, and now I’m retired,” he said.

Like other patients, Vascotto can attend mental health centers open 24/7.

which are more like clubs that offer meals and where there is always a listening ear.

Mezzina, the former health official in Trieste, says suicide, drug addiction, hospitalization and homelessness rates in the city have dropped significantly over the past 15 years.

But he points out that the coronavirus pandemic has demonstrated weakness

of private hospitals – pointing to the many Italian residences for the elderly where the virus has spread uncontrollably, triggering a record number of deaths.

And the pandemic itself, he adds, has caused an increase in psychiatric problems.

“Common mental disorders, anxiety, depression and post-traumatic stress. We have numbers that double the number of young clients, for example, in the area of ​​youth mental health, there is a huge increase, ”Mezzina said.

In a written appeal for the British medical journal The Lancet, Frances of Duke University says saving Trieste is not just a local Italian problem.

“When Trieste dies it certainly kills the inspiration for other places to copy it,” Frances told NPR.

He also compares the situation in the United States, where he says the reduction in community services and hospital beds over the past decades has left large numbers of mentally ill patients homeless or incarcerated.

If Trieste fails to provide appropriate services to people with mental illnesses, he adds, it will end up paying more for police, emergency rooms and prisons.

Not all news on the site expresses the point of view of the site, but we transmit this news automatically and translate it through programmatic technology on the site and not from a human editor.