Deinstitutionalization, another way: the Italian mental health reform.

The article describes the Italian experience of deinstitutionalization in psychiatry, a reform which has attracted international recognition as being the only instance of an industrial society eliminating detention in a mental hospital from its range of mental health agencies and services. The first part of the article highlights the differences between the Italian experience and psychiatric reforms in Europe and the 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 content and method from the above quoted experiences, of the Italian form of deinstitutionalization. Starting from a critique of the rationalistic problem-solution "paradign" in psychiatry, it has developed as a complex social process which: a) involves all its subjects as active participants, b) transforms the power relationship existing between the patient (and citizen) and the institution, c) creates mental health services which completely replace detention in mental hospitals by deconstructing them and reconverting the material and human resources found in them. An example of this reconversion is given in the way in which mental health services have been organized in Trieste. The fourth part examines the reform law arising from the deinstitutionalization process and the characteristics of its implementation, in order to show how this process continues through implementation. In the light of these considerations, deinstitutionalization is no longer perceived as an aspect of the "welfare crisis", but rather as a significant pointer to new-post-welfare social policies.