The extraordinary Basaglia’s experience has shown how the total institutions, and the knowledge that justify them, are inevitably based on the systematic violation of human rights and on the denial of fundamental freedom. The word “dignity” appears today in international conventions and in the treaties that protect these rights. The closure of the psychiatric hospitals; that the Law 180 made possible, has led back to people the primogenital right, that is the right to have a life worth living. If life has no meaning or value, if the person is denied, then everything becomes an object and any abuse is possible.
Law 180 has been a milestone for the affirmation of equality for people with mental disorders, as citizens, starting from the right to health and to receive adequate care, through voluntary treatment in the enjoyment of citizenship rights (Article 32 of the Italian Constitution) and the centrality of the person (Article 2 of the Italian Constitution).
This happens through the total transformation of the institution and the asylum system into a network of community services, and the reduction of the conditions in which compulsory treatments are used and the reduction of their length. Law 180 is based exclusively on the ground of mental health, avoiding motivations directly related to social control and “dangerousness”.
The sprouting character of the Law 180 as model for different countries, with all the implications of health policy and systems transformation, and with the perspective of a major paradigm shift, is linked to the normative nature of the law, that ensures care respecting rights.
It would be wrong to credit to Law 180 the state of services for the protection of mental health in Italy, which is fundamentally the result of the mental health policies, or better said by their shortcomings.
Added to these shortcomings are intellectual and moral lacks of the technicians; while the experimental implementations carried out in some places, and in all the innovative practices, although small and scattered, have not found adequate understanding and dissemination in a peculiar way in the administrative and political side.
However nothing can replace the power of movements, which in the past pushed the reform law.
All the energies, nowadays, come from people “with lived experience”, and from the strident social inequalities that exist in the periphery of the world and of our societies.
In recent years the rise of protagonism, linked to a new awareness and to important changes of perspective – that is putting the person at the center of his/her recovery pathway – has contributed to the creation of new collective movements which claim empowerment, participation and access to citizenship.
The affirmation and the actual realization of rights is today more and more among the main tools of transformation of the psychiatric field, towards a mental health care “of”, not only “in” the community, also related to the updating of the contents made by the CRPD of UN. This is confirmed by the recent document of the UN Special Rapporteur on the right to health (Article 25 of the CPRD) declaring an open critique of biomedical psychiatric reductionism, and by the dissemination in many countries of the WHO Geneva program WHO QualityRights and the Mental Health Action Plan 2013-2020.
This must be combined with the pursuit of policies and practices that continue the direction of deinstitutionalization, as dimmed by the history, still open in its implications, of the closure of the Forensic Hospitals and the consequent transformation of health systems towards true community-based mental health. The recognition of the need for collective actions on inequalities in health, supported by social factors and quality of life, is now an unspeakable aspect for new territorial policies and actions. This happens with particular attention to the development of transnational laboratories (first of all Europeans ones) for policies of socio-economic development of the communities, of their social capital and of their services, in an inclusive direction, which is able to fight inequalities and exclusion processes towards vulnerable people and minorities, that are subject to discrimination, regarding the rights aforementioned.
What is claimed “here and now” by people going through psychiatry? Which right does exist today to have a place to live, an occupation and a social role, as well as affective and social relationships? It is still necessary to dismantle the fear, the risk of loss of rights, the image and the representation of the illness linked to a dangerousness which comes back and is reaffirmed. For all this there are new practices, that are alternative to old models and inspired by the principles of dialogue, respect and dignity. There are collective subjects and enterprises with social value, which represent responses for young people who risk falling behind.
The topic of democracy, the re-balancing of power towards these people – both individual and collective – also active as “peer” facilitators of these pathways, as well the communities as fundamental elements to support, to involve and to “engage” in forms of participation, is the necessary prerequisite for the development of new practices and new ideas. It is also an assumption for further steps to be taken after the end of the era of total institutions in Italy, which still leaves open issues as freedom from need and from risk of exclusion, as well as from forms of oppression of bodies (restraint) and coercion, that remain constitutive facts of psychiatry.
In the 40th of Law 180, the Italian Law that led to the closure of all the Psychiatric Hospitals in Italy, many parties, including governmental representatives of European and non-European countries, suggested an event to celebrate it, to be organized in Trieste, on the topics of reforms, legislative changes and mental health policies, in the framework of the international activities of the Collaborating Center and in partnership with the WHO headquarters in Geneva and Copenhagen.
The Mental Health Department of Trieste, WHO Collaborating Center for Research and Training in Mental Health, through this event intends to strengthen the network of international collaborations and cooperation carried out in recent years.
These collaborations are aimed at enhancing the acquisitions of the reform processes made in Italy and in other countries.
This event, of international as well as national importance, focuses on the ethical, scientific and overall transformative nature of the Italian Reform Law, and on similar reform processes, as well as on the comparison of legislations aimed at the abolition or containment of coercion in treatments
The issue to be tackled with urgency is the contrast to coercive treatments, towards “ZERO COERCION”, advocated by the CRPD (in this sense the Draft Additional Protocol to the Oviedo Convention on mandatory treatments represents a clear criticality that contrasts with the dictates of Italian law)
This issue involves the transfer and exchange of knowledge, also through cooperation activities, concerning the organization of open-door and no-restrain services, to be carried out through:
- Dissemination and training on good community practices that have applied the dictates of Italian psychiatric reform
- Implementation of consensus actions on “No coercion – no restraint – open door”
- Mapping and study of reforms and legislation in Europe and worldwide, updated on the topic of rights
- Promotion of research activities
- Dissemination of guidelines of WHO programs (mhGAP, QualityRights) and related training.
Trieste WHO Collaborating Centre has involved the best Italian experiences, at various levels and in formal and informal services, to realize a meaningful meeting of all those who care about the paths and steps of the reform, and has made a program that would be shared as much as possible and will include moments of real debate.
It will be important to join and participate, especially for those with lived experience and family members, who will have to intervene in all phases of the meeting. Also with social cooperation as a central element of the new co-production of programs and community mental health projects.
International representation is expected in particular from countries that are embarking on or resuming paths of reform. The WHO QualityRights program which has completed the assessment in 25 European countries, will present the recent outcomes.