Opinion: The story of an Italian mental health centre
Posted at 6:00am Thursday 06 Feb, 2020 | By Kerry Hand Psychiatric Nurse
In 1978 the Italian Parliament passed Law 180 which, with immediate effect, banned all new admissions to ‘mental hospitals'. Centres were to be set up in each area to provide the total mental health services for that area. The intention was and is to eliminate the isolation from ordinary family and social life that use of traditional psychiatric facilities inevitably entailed.
In Trieste the health service has allocated one psychiatric nurse to every 2,000 population and one psychiatrist to every 10,000 population and has scattered these staff in a series of eight Mental Health Centres throughout the city.
In the decade that the centre had been open the way clients came to the centre had changed dramatically. According to the staff, 10 years ago clients presented much as they still do in New Zealand; they needed to present a major crisis or difficulty that was enough to be seen by the psychiatric services. Nowadays in Trieste the public have become used to the idea that they could gain a psychiatric consultation for their difficulty without having to present a dramatic situation and thus taking a problem to the Mental Health Centre created no great stigma or trauma of itself. The people in the neighbourhoods of the Mental Health Centres seemed to regard the psychiatric consultation as no more a traumatic event than a visit to the family GP.
Anybody who came to the centre was seen by a member of staff, at that time, and frequently standing immediately in the front doorway. Work with a client always started “now” and for many people this meant they frequently had only one consultation with the mental health services.
The service at Barcola operated “Full on” and this meant that as you made your way to the centre with an “ executive stress problem”, two staff members on their way to the local café bar might meet you on the garden path and take you off for an initial consultation over a ‘turkish'. If your difficulty was a little more dramatic, say a family member at home who was exhibiting quite strange behaviour, immediately after the coffee everybody might proceed home to properly assess the situation. All this could take place with a lot of noise.
The staff had a firm ideological commitment at all times to “widen the services” and an “inpatient” approach they saw as immediately “closing the” number of treatment options.