Training psychiatrists in the community: a report of the Italian experience.

In 1978 a revolutionary mental health act was passed in Italy. By closing large mental hospitals and replacing them with community programs, it required a radical shift in psychiatric practice. The authors discuss the background philosophy, principles, and practical implications of this change. They describe a model program and training design of a 4-year residency in which psychiatrists learn the skills for community work while actually working in the community. The residency differs from most U.S. residencies in having trainees responsible for patients wherever they are being treated (residents are not rotated between services), its strong team orientation, and the value placed on community work.