Is freedom (still) therapy? The 40th anniversary of the Italian mental health care reform

On 13 May 1978, the Italian Parliament approved Law 180, universally known as ‘Basaglia Law’ after the name of the leader of the anti-institutional movement which promoted this radical community mental health care reform. Forty years later, Italian psychiatry still runs a community care system, albeit with degrees of solidity and quality very varied along the peninsula. Mental health care is still an integral part of the National Health System, with liberal regulations on coercion and a lowest number of general hospital and residential facilities beds. Recently, Italy has also closed the special forensic psychiatric institutions and brought the care of the mentally ill offenders within the responsibilities of local Mental Health Departments. Over time, psychiatric deinstitutionalisation inspired policies in other sectors of Italian society, such as those regarding physical and intellectual disabilities, education of children with special needs, drug addictions and management of deviant minors. Furthermore, debate about Law 180 has reached and maintained an international dimension, becoming a term of reference for international agencies such as the World Health Organization and the European Commission, for good and for evil. The overall balance sheet of the Reform process would seem mostly positive, though the last decade has seen many threats challenging the system. Mental health care services have been asked to do much more, in terms of care to a larger population with very diversified needs, but with much less resources, due to the financial consequences of the economic crisis. Although there is no evidence of a trend towards re-institutionalisation, intensity and quality of care may have fallen below acceptable standards in some parts of Italy.

Stigma as an Obstacle to Paradigm Change in Mental Health Care in Lithuania

The paper is based on the data gathered during implementation of the “Project paradigm change of mental health and Well-being in Lithuania: towards empirically valid model”. This project is aimed to contribute to the paradigmatic change by scientific research and evaluation of efficacy of pharmaceutical and psychotherapeutical treatment to psychological and social functioning and to estimate economic burden of treatment and mental diseases. Aim of the research is to analyse stigma as an obstacle for transition from biomedical to bio-psycho-social paradigm. Objectives are as follows: to evaluate manifestations of stigma in mental health care from the point of view of different experts; to discuss influence of stigma on different levels of mental health care; to identify consequences of stigma to mental health care reform. A qualitative experts’ research was implemented in order to reveal professional discourse around stigmatization of mental health and consequences of this phenomenon to mental health care reform. Research data reveal the strong prevalence of stigma on all levels mental health care. Individuals with psychosocial disabilities tend to choose medication instead of psychotherapy. Under influence of stigma, they prefer rapid daily consumption of medication as a substitute to active participation in the process of treatment. Politicians are influenced by stigmatizing attitudes in the society towards individuals with psychosocial disabilities, the persisting pressure to isolate them in closed facilities. Under influence of stigma, the process of reform lingers or obtains a shape reverse to a modern transformation.Disclosure of interestThe author has not supplied his/her declaration of competing interest.