Deinstitutionalization, another way: The Italian mental health reform

The article describes the Italian experience of deinstitutionalizationin psychiatry, a reform which has attracted international recognitionas being the only instance of an industrial society eliminatingdetention in a mental hospital from its range of mental healthagencies and services. The first part of the article highlights the differences betweenthe Italian experience and psychiatric reforms in Europe andthe US, where deinstitutionalization has been reduced to dehospitalization.The problems and failings of these reforms are examined. The second part describes the operation, very different in contentand method from the above quoted experiences, of the Italianform of deinstitutionalization. Starting from a critique ofthe rationalistic problem-solution "paradigm" in psychiatry,it has developed as a complex social process which: a)involvesall its subjects as active participants, b) transforms the powerrelationship existing between the patient (and citizen) andthe institution, c) creates mental health services which completelyreplace detention in mental hospitals by deconstructing themand reconverting the material and human resources found in them. An example of this reconversion is given in the way in whichmental health services have been organized in Trieste. The fourth part examines the reform law arising from the deinstitutionalizationprocess and the characteristics of its implementation, in orderto show how this process continues through implementation. In the light of these considerations, deinstitutionalizationis no longer perceived as an aspect of the "welfare crisis",but rather as a significant pointer to new post-welfare socialpolicies.