A model of public mental health in Italy that receives global acclaim. Now it faces its downfall: NPR
An old psychiatric hospital located in Trieste’s San Giovanni Park. This establishment closed over 40 years ago, but its lipstick booths are still open.
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An old psychiatric hospital located in Trieste’s San Giovanni Park. This establishment closed over 40 years ago, but its lipstick booths are still open.
Sylvia Poggioli / NPR
TRIESTE, Italy – A former psychiatric hospital located in Trieste’s San Giovanni Park along with a rose Garden stretched up a hill in the city. This establishment closed over 40 years ago, but its lipstick booths are still open.
In a building, Radio Fragola (Strawberry Radio) broadcasts news and public service information. Next door is Il Posto delle Fragole (Strawberry Patch), a coffee shop and rendezvous point. (Their name is a mark of Ingmar Bergman Raspberry movies.) Down the hall, workers are busy sewing ties, bags and clothes.
Helping employees with these activities, as well as cafes, museums, libraries and other workplaces across the city, are mentally ill in a social cooperative called La Collina (hill).
This is all that is known as the Trieste model, an approach that dates back to the 1960s, which is recognized by the World Health Organization is one of the most advanced community-based mental health care systems. Unlike in the past when psychiatric patients were incarcerated in institutions where they faced abuse, the Trieste model set out the goal of treating people with mental illness fairly, including themselves. in the community and in daily activities.
“Freedom is treatment,” claims a slogan from the movement painted on a former hospital building.
But now, medical experts decry that freedom is under attack. The region’s right-wing leadership is beginning to disrupt the publicly funded community system.
A sewing room is located at the old psychiatric hospital, part of a social cooperative that connects people with mental illness with jobs.
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The patient is locked up
According to Renzo Bonn, a psychiatrist and former director of mental health services in the nearby city of Udine, the old psychiatric hospital in Trieste used to be a place to keep people inside.
“You [would] lose all your citizenship. You cannot have votes. You cannot receive inheritance. You can’t get married,” he said.
Some patients were locked in cages, tied up in tight shirts and subjected to freezing cold water baths, electrocuted and contracted plantar fasciitis.
If the patient is not released within 30 days, Bonn said, detention could last indefinitely. “The result is people who have been in a mental hospital, their whole life in a mental hospital,” he said.
A revolution in mental health begins
All that changed in the late 1960s with the psychiatrist Franco Basaglia, who believe that old mental hospitals are used as dumping grounds for the poor and heretical.
“When patients are tied up, subdued and confined, I don’t believe that any kind of therapy can help them. I don’t see a cure without free communication between the patient and the doctor. doctor,” he said in 1969. TV interview.
Basaglia revolutionized the asylum: He broke down walls, removed the bondage of patients, and encouraged them to take control of their lives.
Before long, patients weren’t just running an on-site cafe and making money doing real work – they were organizing hospital-wide patient groups.
When jazz came to Trieste
Pantxo Ramas, curator of the hospital’s archives, says it has become a cultural hub – including a memorable 1974 concert for the patients of an American jazz master. “And Ornette Coleman said it was the most profound freestyle jazz concert he did in his life,” Ramas said.
Ramas recounted that shortly before the performance, a 50-year-old patient named Rosetta Lojacono walked onto the empty stage and started playing her harmonica. Coleman joined her and their date lasted more than an hour.
“He lost his sense of who was the musician, who was the audience,” said Ramas, “who is the doctor, who is the artist, who is the listener. And I think that was a moment of poetry. And I felt that way. see that this is a poetic place.”
Interviewed later by one of the concert organizers, saxophonist Coleman said, “I feel completely at ease, very normal. … I like that feeling, we are all free. . .. Music can do that because sound is the science of feeling.”
Italy abolishes asylum, but right-wing backlash
Basaglia’s reforms eventually led to a 1978 law abolishing all Italian mental institutions. He died in 1980, but his work continues, and the Trieste model of publicly funded mental health care has been modeled in several regions of Italy and more than 40 countries, according to Roberto Mezzina , one former director of Trieste’s mental health services.
But now, it is dismantling of the regional government of Friuli-Venezia Giulia led by the far-right Northern League and other far-right parties.
Mezzina, now Vice President of the World Federation of Mental HealthFor decades, the goal of right-wing politicians in the region has been to end the Trieste model and move towards privatization.
He said the model was “a symbol of something created in the field of social rights, human rights, and seen as part of leftist culture.”
In early October, the regional government announced plans to close seven of the 22 community mental health centers of Friuli-Venezia Giulia and reduce working hours at the remaining centres. It also plans to cut the number of senior psychiatrists and department heads, while keeping many staff positions unfilled.
Regional health authorities did not respond to NPR’s repeated requests for comment.
The international medical community is pushing back
Renowned international psychiatrists have signed petition to save one of the world’s leading public mental health services from being handed over to the private sector.
Allen Frances, professor and emeritus chair of psychiatry at Duke University, says that instead of using compulsion and medication as the solution to every problem, there is humanity and community spirit behind the Trieste model.
“Community is valued when it considers the mentally ill not as a nuisance to be banished to hospitals or in prisons and prisons or abandoned on the streets, but as potential citizens,” Frances said. very useful capabilities who deserve the attention and resources of the city and can make meaningful contributions to it. ”
A patient recalls confinement and electric shock
One patient who has experienced a mental health revolution is Giordano Vascotto, 75.
“I came here when I was 9 years old, it was 1955, I remember October,” he said, describing the Trieste mental hospital. “The windows were locked, the doors were also locked. Then they gave me an electric shock. Years went by.”
After about 20 years in captivity, Vascotto was released.
“I came here when I was 9 years old, it was 1955, I remember October,” Giordano Vascotto describes of Trieste mental hospital. “The windows were locked, the doors were also locked. Then they gave me an electric shock. Years went by.”
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“After the asylum, I rolled up my sleeves and went to work – first at the cemetery, then as a garbage collector and a doorman. Years passed, and now I’m retired,” he said.
Like other patients, Vascotto may frequently have mental health centers open 24/7
like clubs that provide meals and where always ready to listen.
Mezzina, a former health official in Trieste, says that the city’s rates of suicide, drug addiction, hospitalization and homelessness have fallen dramatically over the past 15 years.
But he stressed that the coronavirus pandemic has shown weakness
of private hospitals – pointing to many care homes for the elderly in Italy where the virus spread uncontrollably, causing a record number of deaths.
The pandemic itself has increased mental health problems, he added.
“Common mental disorders, anxiety and depression, and post-traumatic stress,” says Mezzina.
In a call to write for the British medical journal FingertipsFrances of Duke University says saving Trieste is not just a local Italian problem.
Frances told NPR: “When Trieste dies, it will certainly kill the inspiration for other places to copy it.
He also compared the situation to the United States, where he said cuts to community services and hospital beds over the past decades have resulted in large numbers of psychiatric patients being homeless or incarcerated.
If Trieste does not provide appropriate services to people with mental illness, he adds, it will end up paying more to police, emergency rooms and prisons.
