The end of the mental hospital. A review of the psychiatric experience in Trieste.

This paper describes the closing of the mental hospital in Trieste and the establishing of a comprehensive community mental health service, over a period of 13 years from 1971. In 1971 the hospital had 1058 patients. By 1975 there were 656 patients, 403 of whom were guests, in effect ordinary citizens who had nowhere else to live. The paper describes this dramatic and innovative transformation, the rearrangement of wards, the abolition of shock therapies, the establishment of many flats and group homes, the starting of a cleaning cooperative employing ex-patients to do the work they previously did as "ergotherapy", the first mass exodus of the patients into the city. The paper goes on to describe the opening of 7 mental health centres between 1975 and 1977 and the present existing network of services. At this time the hospital buildings were converted into a variety of uses for the benefit of the local people. It describes in greater detail the philosophy and practice of one of these centres at Barcola and how the dialectical relationship between staff and client works to create a flexible and responsive service. It ends by repeating the assertion that the closure of the mental hospital is a first necessary step towards an improved mental health service for everyone.