Roberto Mezzina

Azienda Sanitaria Universitaria Integrata Trieste, Italy · Dipartimento di Salute Mentale / WHO Collaborating Centre for Research and Training

La questione di quali Servizi siano necessari per una piena applicazione della riforma psichiatrica del 1978, costruendo un'alternativa istituzionale globale, viene discussa a partire dai modelli organizzativi e dai loro contesti applicativi, che definiscono l'offerta complessiva di cura. Nel realizzare la presa in carico vanno considerate non solo...

This chapter will provide summaries of the state of community mental health in some countries around the world, allowing readers to compare and contrast the nature of services and to further understand the successes and challenges of innovative programing. While certainly not exhaustive, we will describe examples from countries of which we have the...

Resumen: El artículo describe el proceso de reforma que tuvo lugar en Italia con el cierre de los seis hospitales psiquiátricos judiciales del país y su sustitución por pequeñas unidades forenses. El uso de los hospitales judiciales se regía por la exclusión de los juicios de las personas con enfermedades mentales graves que dificultaban el ejercic...

Covid-19 is referred to as a “syndemic,” i.e., the consequences of the disease are exacerbated by social and economic disparity. Poor housing, unstable work conditions, caste, class, race and gender based inequities and low incomes have a profound effect on mental health and wellbeing. Such disparities are increasing between, among and within count...

These recommendations from the Technical Advisory Group (TAG) on the Mental Health Impacts of COVID-19 in the WHO European Region represent the work of the TAG between February and June 2021. At its second meeting on 23 March 2021, the TAG agreed to frame the recommendations across three key areas of impact: general population and communities; vuln...

Background: This paper outlines the need for a health systems approach and rapid response strategy for gathering information necessary for policy decisions during pandemics and similar crises. It suggests a new framework for assessing the phases of the pandemic. Method: The paper draws its information and conclusions from a rapid synthesis and tran...

Aim: To summarise commonalities and variations in the mental health response to COVID-19 across different sites and countries, with a view to better understanding key steps not only in crisis management, but for future systemic reform of mental health care. Method: We conducted a Rapid Synthesis and Translation Process of lessons learned from an in...

Any epidemic of infectious disease such as the present one that we are witnessing puts a strain on both the individual and the community. The very basis of physical and emotional health, dependent as it is on the body and social networks, is threatened. Existing inequalities in society get accentuated, and systemic responses that provide succour to...

Basaglia anticipated, more than 50 years ago, the paradigm shift from ‘illness’ to the ‘person’—a shift that the recovery movement proposes today, both from a theoretical and a practical point of view. Mental illness can be seen as an artefact, shaped by the institution, and can be defined as a double that conceals human experience. Deinstitutional...

We are living in the age of the coronavirus (Covid-19). This emergency has put everything else in the background, conditioning and changing most aspects of our lives. As widely reported, health services in many countries are under enormous pressure and face unprecedented challenges. They are engaged in a heroic struggle but still suffer high death...

Italian Law 180 of 1978 is probably the most radical Mental Health Act ever passed. It forbade the admission of any new patients to mental hospitals forthwith and called for the rapid closure of such institutions. The Law crowned the work of the charismatic Italian psychiatrist Franco Basaglia and his ‘Democratic Psychiatry’ movement. The Italian r...

Mental health experts, social scientists and academics from across the world look at mental health aspects of the Covid-19 pandemic, exploring health, humanitarian and existential concerns.

Background Dual diagnosis (DD), as the co-occurrence of a substance use disorder and a psychiatric disorder, is underestimated, under-diagnosed and often poorly treated throughout the world, although it is highly prevalent in people suffering from a mental disorder. Aims and methods This review analyzed 48 studies from a PubMed and PsycINFO databa...

Aims To examine the extent and nature of coercive practices in mental healthcare and to consider the ethical, human rights challenges facing the current clinical practices in this area. We consider the epidemiology of coercion in mental health and appraise the efficacy of attempts to reduce coercion and make specific recommendations for making ment...

In the long history of human rights advocacy in psychiatry, the Convention on the Rights of Persons with Disabilities (CRPD) sets an important balancing point between the right to adequate care and all human rights and fundamental freedoms and draws on cross-cutting themes including empowerment, citizenship, recovery and community living as a viabl...

Purpose Too often people with complex mental health needs do not find their way out of the mental health system or find satisfactory solutions that enable them to live a full life. In 2015 the Mental Health Department (MHD) of Trieste established the Recovery House pilot project to address this concern. The paper aims to Investigate the project....

Aim Italy pioneered deinstitutionalisation over the past 60 years and enforced a famous mental health (MH) reform law in 1978. Deinstitutionalisation has been completed with the very closure of all psychiatric hospitals over two decades. Methods After 40 years of implementation, this article presents the main achievements and challenges of the Ita...

The city of Trieste is an internationally known experience that started in 1971 under the direction of the great figure of Franco Basaglia, and resulted in the first closure of a psychiatric hospital in Europe more than 35 years ago. The Mental Health Department has been recognised as a WHO collaborating centre for many years and it is considered a...

Over the last decade there have been significant efforts to scale up mental health services in resource-poor countries. A number of cost-effective innovations have emerged as a result. At the same time, there is increasing concern in resource-rich countries about efficacy, efficiency and acceptability of mental health services. We consider two spec...

Background The Quality Indicator for Rehabilitative Care (QuIRC) is an international, standardised quality tool for the evaluation of mental health facilities that provide longer term care. Completed by the service manager, it comprises 145 items that assess seven domains of care: living environment; treatments and interventions; therapeutic enviro...

During the deinstitutionalization process in Trieste, an array of different residential facilities were identified and used for different purposes in the course of time. They were integrated in the Mental Health Department and operated in close connection with 24-hour Community Mental Health Centres. Over the last decade, a steady decline in reside...

According to the World Health Organization (WHO), the "Trieste model" of public psychiatry is one of the most progressive in the world. It was in Trieste, Italy, in the 1970s that the radical psychiatrist, Franco Basaglia, implemented his vision of anti-institutional, democratic psychiatry. The Trieste model put the suffering person-not his or her...

Since Franco Basaglia's appointment in 1971 as director of the former San Giovanni mental hospital, Trieste has played an international benchmark role in community mental health care. Moving from deinstitutionalization, the Department of Mental Health (DMH) has become a laboratory for innovation on social psychiatry, developing a model that can be...

Objective: To evaluate the efficacy and feasibility of actions intended to implement or improve patients' social network within the Italian National Health Service community mental health services. Methods: We conducted a randomized clinical trial through a network of 47 community mental health services on patients with a diagnosis in the schizo...

Background: The Quality Indicator for Rehabilitative Care (QuIRC) is a staff rated, international toolkit that assesses care in longer term hospital and community based mental health facilities. The QuIRC was developed from review of the international literature, an international Delphi exercise with over 400 service users, practitioners, carers a...

A global survey of community-orientated mental health reforms and services is presented. We cannot hope to provide an exhaustive international survey in such a short space, so we will describe examples of which we have first-hand knowledge, focusing on some leading edge aspects of community mental health service innovations or systems reforms in di...

Introduction. The objective of this study, carried out in close cooperation between the Local Health Unit n. 1 "Triestina" and the Faculty of Medicine and Surgery of the University of Trieste, was the survey of prescriptive policies of antipsychotic drugs in mental health services. Material and methods. A cohort of 587 subjects suffering from schiz...

Results of inter-rater reliability testing.

Despite the progress over recent decades in developing community mental health services internationally, many people still receive treatment and care in institutional settings. Those most likely to reside longest in these facilities have the most complex mental health problems and are at most risk of potential abuses of care and exploitation. This...

There are remarkable parallels between the vision of the Italian Mental Health Reform of the 1960s and 1970s and the vision of "recovery" being promoted around the globe. Most importantly, they share a fundamental conviction in the right of individuals with mental illnesses to "a life in the community", arguing that the basic rights of social inclu...

A proportion of people with mental health problems require longer term care in a psychiatric or social care institution. However, there are no internationally agreed quality standards for institutional care and no method to assess common care standards across countries. We aimed to identify the key components of institutional care for people with l...

This study aims to build a measure for assessing and reviewing the living conditions, care and human rights of people with longer term mental health problems in psychiatric and social care institutions. Protection of their human rights is imperative since impaired mental capacity secondary to mental illness can make them vulnerable to abuse and exp...

In Trieste, Italy, intensive community management of crises is one element of the comprehensive service delivered by 24-hour community mental health centres (CMHCs). This chapter describes the local strategy for crisis intervention, which integrates crisis management into the work of these CMHCs, allowing maintenance of continuity of care and flexi...

Relationships have a tremendous impact on how people recover from schizophrenia. Previous research has focused on the role of clinicians in these supportive relationships, but the current study finds that these relationships can occur within the mental health system, the family, or out in the community. Regardless, it is very important for people i...

We analyzed informant narratives in terms of the benefits of spending time within various community arenas, including service user organizations, advocacy agencies, the bowling alley, and universities. Themes contributing to recovery from severe mental illness included the understanding and acceptance infromants both gave and received from others,...

This article analyzes the role of social factors in recovery from psychosis, which can be helpful as well as hinder the process of recovery. Informants found their roles as psychiatric patients constituted a major barrier to social adaptation. They experienced stigma both within their natural social networks and mental health services, which often...

This article provides an interpretation of the key issues that emerged from the research, attempting a possible synthesis of the different themes described in the other papers and beginning a map of recovery as an ongoing interpersonal and social process. From a subjective point of view, there is a dimension of ‘social experience’, which implies th...

Expanding on the introduction to the multinational study described in the first article, this article briefly reviews informants’ contexts of treatment across Italy, Norway, Sweden, and the United States, and provides a cursory description of each informant, organized according to her or his respective country. The informant descriptions are follow...

Informants in the present study identified poverty, unemployment, substandard living conditions and homelessness as being among the major struggles they faced within their recoveries from psychosis and depression. In considering the benefits of material resources, many informants discussed the notion of having a home, referring to it as a place for...

As part of a growing literature describing processes of recovery in psychotic disorders, this report presents findings of an intensive, international study. Open-ended qualitivite interviews were conducted in Italy, Norway, Sweden, and the United States with a total of twelve individuals who have experience of recovery in psychosis. All interviews...

As they began the journey of recovery from psychosis, informants described the importance of making their own initial decision to get well and maintain their physical and mental health. Developing a sense of self-control in their lives by managing their symptoms, determining how they spend their time, developing their own ways of defending themselv...

A sample group of 39 new patients with acute and severe crises underwent a 4-year follow-up study at the community mental health center in Trieste (CMHC). The CMHC is a full-time service, open 24 hours a day and 7 days a week, and is fully integrated into a network of services which has completely replaced the preexisting mental hospital. Evaluatio...

The opinion and level of satisfaction of the users of three different mental health services are presented as a way of evaluating the outcome of institutional and community approaches to psychiatric services. The information was collected in the cities of Concepcion (Chile), Sheffield (England) and Trieste (Italy) interviewing a sample of the users...

An attempt is presented to measure and compare attitudes to and ideas about psychiatry and mental health services in Concepcion, Sheffield and Trieste. These cities have in some respects comparable populations but very different mental health services. Questionnaires in English, Italian and Spanish were used to assess the views of professional work...

Consumers' and family members' involvement was indispensable to create social support networks promoted by the comprehensive mental health services resulting from the closure and subsequent complete reconversion of the mental hospital in Trieste. Despite long term consumers' disabilities and the families' heavy burden the individuals' positive skil...

The experience in Trieste proposes a comprehensive definition of rehabilitation as a program of restitution and (re)construction of full rights (political, civil, social) and citizenship for individuals disabled by mental illness, and the material construction of these rights. This implies an articulated approach that aims at: a) the legal recognit...

Introduzione. Lo studio, realizzato dall'ASS n.1 «Triestina» e dalla Fa-coltà di Medicina e Chirurgia dell'Ateneo triestino, si propone di rilevare le pratiche prescrittive degli antipsicotici nei servizi di salute mentale. Mate-riale e Metodi. È stata individuata una coorte di 587 soggetti, affetti da schizofrenia (89%) o da sindrome bipolare (11%...