For a community mental health: The issue of services and models

Author/s Roberto Mezzina
Publishing Year 2023 Issue 2023/1 Language Italian
Pages 22 P. 37-58 File size 236 KB
DOI 10.3280/PU2023-001005
DOI is like a bar code for intellectual property: to have more infomation click here

Below, you can see the article first page

If you want to buy this article in PDF format, you can do it, following the instructions to buy download credits

Article preview

FrancoAngeli is member of Publishers International Linking Association, Inc (PILA), a not-for-profit association which run the CrossRef service enabling links to and from online scholarly content.

The issue of which services are necessary for a full enforcement of the Italian psychiatric reform of Law no. 180/1978, critical since its promulgation, is discussed starting from organizational models and institutional contexts of its application. They define the delivery of care as a comprehensive offer for a global alternative to the "asylum-like" institutional psychiatry, e.g., how to achieve not fragmented answers but a real "taking charge", with the active contribution of the per-son to his care, avoiding pathways of social and institutional drift. It is necessary not only to con-sider scientific evidence but also an ethical and value base that takes into account the experience and needs of patients. It is based upstream on cardinal cross-cutting principles as defined by the World Health Organization, among which the realization of human rights stands out, with the abandonment of coercive practices and involuntary treatments, the empowerment of patients, and a multisectoral approach to addressing the social determinants of health. From practice there are indications on the devices, i.e., the 24/7 opening and the continuity and non-fragmentation of care, and a series of basic indicators useful for benchmarking of organizational models of services. From international best practices derive a set of working principles as orientation points, without which the longed-for transition from tout-court psychiatry to community mental health remains unrealistic. Prospects for a paradigm shift, measurable through outcomes on people’s whole life, are outlined.

Keywords: Community Mental Health Centers; Italian Law no. 180/1978 on psy-chiatric reform; Ethics and evidence base; Human rights; Paradigm shift

  1. Australian Government (2010). National Standards for Mental Health Services: --
  2. Basaglia F. (1967). Crisi istituzionale o crisi psichiatrica? Annali di Neurologia e Psichiatria, 61, 2. Anche in: Scritti I, 1953-1968. Einaudi: Torino, 1982, pp. 442-454.
  3. Basaglia F. (1974). L’utopia della realtà. In: Basaglia F., Scritti II, 1968-1980. Einaudi: Torino, 1982, pp. 339-348.
  4. Boldrini L. et al. (2018). Disegno di Legge 391: “Disposizioni in materia di tutela della salute mentale volte all’attuazione e allo sviluppo dei princìpi di cui alla legge 13 maggio 1978, n. 180” -- (
  5. Byrne P. & Rosen A., editors (2014). Early Intervention for Nearly Everything. New York: Wiley.
  6. Comitato Nazionale per la Bioetica (2015). La contenzione. Problemi bioetici. Roma: Presidenza del Consiglio dei Ministri -- (
  7. Commissione delle Comunità Europee (2005). Libro verde “Migliorare la salute mentale della popolazione. Verso una strategia sulla salute mentale per l’Unione Europea”: --
  8. Commissione Parlamentare di Inchiesta sull’Efficacia e l’Efficienza del Servizio Sanitario Nazionale (2013). Relazione finale sull’attività della Commissione, approvata nella seduta del 30 gennaio 2013: --
  9. Conferenza Nazionale Salute Mentale (2019). Diritti, Libertà, Servizi. Roma, 14-15 giugno 2019: --
  10. Davidson L., Borg M., Marin I., Topor A., Mezzina R. & Sells D. (2005). Process of Recovery in Serious Mental Illness Findings from a Multinational Study. American Journal of Psychiatric Rehabilitation, 8, 3: 177-201. DOI: 10.1080/15487760500339360
  11. de Girolamo G., Picardi A., Micciolo R., Fioritti A., Morosini P. & PROGRES Group (2002). Residential care in Italy: National survey of non-hospital facilities. British Journal of Psychiatry 181, 3: 220-225.
  12. de Girolamo G., Barbato A., Bracco R., Gaddini A., Miglio R., Morosini P., Norcio B., Picardi A., Rossi E., Rucci P., Santone G., Dell’Acqua G. & PROGRES-Acute group (2007). Characteristics and activities of acute psychiatric in-patient facilities: National survey in Italy. British Journal of Psychiatry, 191, 2: 170-177.
  13. De Leonardis O., Mauri D. & Rotelli F. (1986). Deinstitutionalization: A different path. The Italian mental health reform. Health promotion, 1, 2: 151-165.
  14. Dell’Acqua G. & Cogliati Dezza M.G. (1986). The end of the mental hospital: A review of the psychiatric experience in Trieste. Acta Psychiatrica Scandinavica, 71, 316 (Suppl.): 45-69. 10.1111/j.1600-0447.1985.tb08512.x.
  15. Dell’Acqua G. & Mezzina R. (1988a). Approaching mental distress. In: Ramon S. & Giannichedda M.G., editors, Psychiatry in Transition. The British and Italian Experiences. London: Pluto Press, 1988, pp. 60-71.
  16. Dell’Acqua G. & Mezzina R. (1988b). Risposta alla crisi: strategie e intenzionalità dell’intervento nel servizio psichiatrico territoriale / Responding to crisis: Strategies and intentionality in community psychiatric intervention. Per la Salute Mentale / For Mental Health, 1: 3-23 e 139-158.
  17. Dirindin N. et al. (2017). Disegno di legge n. 2850: “Disposizioni in materia di tutela della salute mentale volte all’attuazione e allo sviluppo dei princìpi di cui alla Legge 13 maggio 1978, n. 180” -- (
  18. Fulford K.W.M. (2004). Ten principles of values-based medicine. In: Radden J., editor, The Philosophy of Psychiatry: A Companion. New York: Oxford University Press, 2004, ch. 14.
  19. Funk M., Bold N.D. (2020). WHO’s QualityRights initiative: Transforming services and promoting rights in mental health. Health and Human Rights, 22, 1: 69-75.
  20. Gallio G. & Cogliati Dezza M.G., a cura di (2018). La città che cura. Microaree e periferie della salute. Merano (BZ): Alphabeta Verlag.
  21. Harding C.M., Zubin J. & Strauss J.S. (1992). Chronicity in schizophrenia: Revisited. British Journal of Psychiatry, 161, 18 (Suppl.): 27-37.
  22. IMHCN (International Mental Health Collaborating Network) (2017). Whole Life, Whole Community, Whole Systems Approach: --
  23. Jablensky A., Sartorius N., Ernberg G., Anker M., Korten A., Cooper J.E., Day R. & Bertelsen A. (1992). Schizophrenia: Manifestations, incidence and course in different cultures. A World Health Organization ten-country study. Psychological Medicine Monograph Supplement, 20: 1-97.
  24. Jacobson N. & Greenley D. (2001). What is recovery? A conceptual model and explication. Psychiatric Services, 52, 4: 482-485.
  25. Jenkins J. & Rix S. (2003). The Whole Life Programme. London: NHS (NIMHE East Region).
  26. Killaspy H., McPherson P., Samele C., Keet R. & Almeida J.C. (2018). Providing Community Based Mental Health Services Position Paper: --
  27. Marmot M. (2005). Social determinants of health inequalities. Lancet, 365, 9464: 1099-1104. DOI: 10.1016/S0140-6736(05)71146-6
  28. Marshall M. & Lockwood A. (2011). Assertive community treatment for people with severe mental disorders. Cochrane Database of Systematic Review, 4, CD001089. DOI: 10.1002/14651858.CD001089
  29. Martinelli A., Killaspy H., Zarbo C., Agosta S., Casiraghi L., Zamparini M., Starace F., Rocchetti M., de Girolamo G., Ruggeri M. & DIAPASON Consortium (2022). Quality of residential facilities in Italy: satisfaction and quality of life of residents with schizophrenia spectrum disorders. BMC Psychiatry, 22: 717.
  30. Mezzina R. (2005). Paradigm shift in psychiatry: Processes and outcomes. In: Ramon S. & Williams J.E., editors, Mental Health at the Crossroads. The Promise of the Psychosocial Approach. Hants, UK: Ashgate, 2005, pp. 81-93.
  31. Mezzina R. (2014). Community mental healthcare in Trieste and beyond. An “open door-no restraint” system of care for recovery and citizenship. Journal of Nervous and Mental Disease 202, 6: 440-445. DOI: 10.1097/NMD.0000000000000142
  32. Mezzina R. (2015). Tra soggettività e istituzioni: da Franco Basaglia alla recovery. In: Maone A. & D’Avanzo B., a cura di, Recovery. Nuovi paradigmi per la salute mentale. Milano: Raffaello Cortina, 2015, pp. 195-215.
  33. Mezzina R. (2016). Creating mental health services without exclusion or restraint but with open doors, Trieste, Italy. L’Information Psychiatrique, 92, 9: 747-754.
  34. Mezzina R. (2018). Forty years of the Law 180: The aspirations of a great reform, its success and continuing need. Epidemiology and Psychiatric Sciences, 27, 4: 336-345. DOI: 10.1017/S2045796018000070
  35. Mezzina R. (2020a). Basaglia after Basaglia: recovery, human rights, and Trieste today. In: Burns T. & Foot J., editors, From Asylum to Community. Basaglia’s International Legacy. Oxford, UK: Oxford University Press, 2020, pp. 43-67.
  36. Mezzina R. (2020b). Un nuovo welfare comunitario per la salute mentale. Welfare Oggi, 3: 9-22.
  37. Mezzina R. & Vidoni D. (1995). Beyond the mental hospital: Crisis and continuity of care in Trieste. A four-year follow-up study in a community mental health centre. Te International Journal of Social Psychiatry, 41, 1: 1-20. DOI: 10.1177/002076409504100101
  38. Mezzina R. & Johnson S. (2008). Home treatment and “hospitality” within a comprehensive community mental health centre. In: Johnson S., Needle J., Bindman J.B. & Thornicroft G., editors, Crisis Resolution and Home Treatment in Mental Health. Cambridge, UK: Cambridge University Press, 2008, ch. 20, pp. 251-266.
  39. Mezzina R., Mazzuia M., Vidoni D. & Impagnatiello M. (1992). Networking consumers participation in a community mental health service: Mutual support groups, citizenship, coping strategies. International Journal of Social Psychiatry, 38, 1: 68-73. DOI: 10.1177/002076409203800110
  40. Mezzina R., Vidoni D., Miceli M., Crusiz C., Accetta A. & Interlandi G. (2005a). Crisi psichiatrica e sistemi sanitari. Una ricerca italiana. Trieste: Asterios.
  41. Mezzina R., Vidoni D., Miceli M., Crusiz C., Accetta A. & Interlandi G. (2005b). Gli interventi territoriali a 24 ore dalla crisi sono basati sull’evidenza? Indicazioni da uno studio multicentrico longitudinale. Psichiatria di Comunità, 4, 4: 200-216.
  42. Mezzina R., Davidson L., Borg M., Marin I., Topor A. & Sells D. (2006a). The social nature of recovery: discussion and implications for practice. American Journal of Psychiatric Rehabilitation, 9, 1: 63-80. DOI: 10.1080/15487760500339436
  43. Mezzina R., Borg M., Marin I., Sells D., Topor A. & Davidson L. (2006b). From participation to citizenship: How to regain a role, a status, and a life in the process of recovery. American Journal of Psychiatric Rehabilitation, 9, 1: 39-61. DOI: 10.1080/15487760500339428
  44. Mezzina R., Rosen A., Amering M. & Javed A. (2018). The practice of freedom: Human rights and the global mental health agenda. In: Fountoulakis K.D. & Javed A., editors, Advances in Psychiatry. New York: Springer, 2018, pp. 483-515.
  45. Ministero della Salute (2013). Piano di Azioni Nazionale per la Salute Mentale: --
  46. Ministero della Salute (2021). 2a Conferenza Nazionale per la Salute Mentale: “Per una salute mentale di comunità”. Roma, 25-26 giugno 2021: --
  47. Ministero della Salute (2022). Global Mental Health Summit. Skills, Rights, Care. Roma, 13-14 ottobre 2022: --
  48. Ministero del Lavoro, della Salute e delle Politiche Sociali (2009). La Convenzione delle Nazioni Unite sui Diritti delle Persone con Disabilità:
  49. Murphy S.M., Irving C.B., Adams C.E. & Waqar M. (2015). Crisis intervention for people with severe mental illnesses. Cochrane Database of Systematic Reviews, 12, CD001087. DOI: 10.1002/14651858.CD001087
  50. Muusse C. & van Rooijen S. (2015). Freedom First. A Study of the Experience with Community-Based Mental Health Care in Trieste, Italy, and its Significance for the Netherlands. Utrecht, NL: Trimbos–instituut.
  51. Ongaro Basaglia F. & Basaglia F. (1979). Follia/Delirio. In: Enciclopedia Einaudi, Vol. VI. Torino: Einaudi, 1979, pp. 262-287. Anche in: Ongaro Basaglia F., Salute/malattia. Le parole della medicina. A cura di Maria Grazia Giannichedda. Merano (BZ): Alphabeta Verlag, 2012, pp. 119-147.
  52. OECD (Organization for Economic Cooperation and Development) (2018). Mental Health Performance Framework: --
  53. OECD (Organization for Economic Cooperation and Development) (2021). A New Benchmark for Mental Health Systems: Tackling the Social and Economic Costs of Mental Ill-Health. Paris: OECD Publishing.
  54. Picardi A., Lega I., Candini V., Dagani J., Iozzino L. & de Girolamo G. (2014). Monitoring and evaluating the Italian mental health system. The “Progetto Residenze” study and beyond. Journal of Nervous and Mental Disease, 202, 6: 451-459. DOI: 10.1097/NMD.0000000000000144
  55. Ridente G. & Mezzina R. (2016). From residential facilities to supported housing: The personal health budget model as a form of coproduction. International Journal of Mental Health, 45, 1: 1-12. DOI: 10.1080/00207411.2016.1146510
  56. Rosen A., Miller V. & Parker G. (1989). Standards of care for area mental health services. Australian & New Zealand Journal of Psychiatry. 23, 3: 379-395. DOI: 10.3109/00048678909068296
  57. Rosen A., Gill N.S. & Salvador-Carulla L. (2020). The future of community psychiatry and community mental health services. Current Opinion in Psychiatry, 33, 4: 375-390. DOI: 10.1097/YCO.0000000000000620
  58. Rosen A., Mezzina R. & Feldman J.M. (2022). International trends in community mental health services. In: Sowers W.E., McQuistion H.L., Ranz J.M., Feldman J.M. & Runnels P.S., editors, Textbook of Community Psychiatry. Cham, CH: Springer, 2022, pp. 863-889.
  59. Rotelli F. (1988). L’istituzione inventata. In: Rotelli, 1999, pp. 133-141. Anche in: L’istituzione inventata. Almanacco Trieste 1971-2010. Merano (BZ): Alphabeta Verlag, 2015.
  60. Rotelli F. (1993). Ri-abilitare la riabilitazione. In: Rotelli, 1999, pp. 104-113.
  61. Rotelli F. (1999). Per la normalità. Taccuino di uno psichiatra negli anni della grande riforma. Trieste: Asterios.
  62. Segal S.P. (2004). Managing transitions and ensuring good care. Psychiatric Services, 55, 11: 1205.
  63. Sen A. (1992). Inequality Reexamined. Oxford, UK: Clarendon Press (trad. it.: La diseguaglianza. Un riesame critico. Bologna: Il Mulino, 1994).
  64. Starace F. & Baccari F., a cura di (2020). La salute mentale nelle Regioni. Disuguaglianze di sistema. Quaderni di Epidemiologia Psichiatrica, 7:
  65. Starace F., Baccari F. & Mungai F. (2017). La salute mentale in Italia. Analisi delle strutture e delle attività dei Dipartimenti di Salute Mentale. Quaderni di Epidemiologia -- Psichiatrica, 1:
  66. Strauss J.S. (1992). The person-key to understanding mental illness: Towards a new dynamic psychiatry, III. British Journal of Psychiatry, 161, 18 (Suppl.): 19-26. DOI: 10.1192/S000712500029702X
  67. The Economist (Intelligence Unit) (2014). Mental Health and Integration. A Provision for Supporting People with Mental Illness: A Comparison of 30 European Countries. The Economist: --
  68. Tognoni G. (2010). Epidemiologia di cittadinanza. Welfare, salute, diritti. Roma: Il Pensiero Scientifico.
  69. Thornicroft G. & Tansella M. (2009). Better Mental Health Care. Cambridge, UK. Cambridge University Press (trad. it.: Per una migliore assistenza psichiatrica. Roma: CIC, 2009).
  70. Thornicroft G. & Tansella M. (2013). The balanced care model for global mental health. Psychological Medicine, 43, 4: 849-63. DOI: 10.1017/S0033291712001420
  71. United Nations (2017). Report of the Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health. Human Rights Council, Thirty-fifth session, 6-23 June 2017. New York: United Nations.
  72. Weick K.E. (1997). Senso e significato nell’organizzazione. Milano: Raffaello Cortina.
  73. WHO (World Health Organization) (2005). Mental Health: Facing the Challenges, Building Solutions. Report from the WHO European Ministerial Conference. Geneva: WHO -- (
  74. WHO (World Health Organization) (2009). Improving Health Systems and Services for Mental Health: --
  75. WHO (World Health Organization) (2019). WHO QualityRights Module on Transforming Services & Promoting Rights: --
  76. WHO (World Health Organization) (2020). Mental Health Action Plan 2013-2020. Geneva: WHO -- (
  77. WHO (World Health Organization) (2021). Guidance and Technical Packages on Community Mental Health Services: --
  78. WHO (World Health Organization) (2022). World Mental Health Report. Transforming Mental Health for All: --

Roberto Mezzina, Per una salute mentale di comunità: la questione dei Servizi e dei modelli in "PSICOTERAPIA E SCIENZE UMANE" 1/2023, pp 37-58, DOI: 10.3280/PU2023-001005