Improving treatment for the severely mentally ill: implications of the decade-long Italian psychiatric reform

Recent reviews of the results of the important Italian Psychiatric Reform have been unusual in that they have ranged from very enthusiastic to very negative. No recent report has focused on extrapolating from the Italian experience the pluses and minuses that might be applicable to the U.S. system of delivery of mental health services so as to improve the care of the seriously mentally ill. In this paper I will summarize my observations and clinical research during 6 months in Italy, emphasizing what has not been reported by others; I will analyze the impact of the Italian changes on Italian practice and try to identify in a balanced way any inferences that can be drawn from the Italian experience that add to ideas now current in the United States about treatment of the severely mentally ill.