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The “new” asylums | International Health

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The “new” asylums |  International Health

Benedict Saracen

The violence in Foggia, within the Don Uva institution, is not an isolated case. Violations of rights are widespread not only to the detriment of patients in psychiatric services but also, and perhaps above all, to the detriment of all those people who, due to disabilities and vulnerabilities, are guests in residential facilities of various kinds.

On the night of January 23, the carabinieri and NAS of Foggia carried out a precautionary measure against thirty health workers (nurses and auxiliaries) of the Don Uva institution of Foggia. The operation involved eight employees of the facility, sixteen social and health workers from the Universo Salute company, three social and health workers employed by the Etjca spa company, two professional educators employed by the Universo Salute company and a cleaner from La Pulisan srl. Some of these operators have been put in prison, others are under house arrest and the rest are being investigated without coercive measures. The disputed crimes are those of aggravated ill-treatment, kidnapping and sexual violence against twenty-five female patients.

But what is the Universo Salute company that employs almost all the suspects? Well, the don Uva institution, which is an old acquaintance of private psychiatry with an agreement with its offices in Bisceglie, Foggia and Potenza, no longer exists from an administrative point of view. A new societyprecisely the Universo Salute born in 2015, took over the Congregation of the Handmaids of Divine Providence in the property of Don Uva. Universo Salute operates under the regime of institutional accreditation with the Health Service of the Puglia Region and the Health Service of the Basilicata Region in the offices of Bisceglie, Foggia and Potenza. The complex of health care facilities in Foggia deals, among other things, with disabled people and people with dementia, and offers a variety of services, structures and rehabilitation, socializing, work, play, sports and recreational spaces. The website reads: «A community where you are surrounded by a family atmospheresharing the problems of those who suffer and where the Guest finds the appropriate answers to the recovery of their autonomy.

It is therefore Universo Salute that employs all these operators who, writes the investigating judge: “have shown particular contempt for the condition of vulnerability of patients” and they did so through multiple physical and psychological harassments (“I’ll shoot you in the mouth” or “… I have to smash your head”). Furthermore, during the night many patients were locked up in their rooms (defined by one of the suspects as “the stable”) and during the day locked up in the living room. The Property and the top management of Universo Salute have offered full collaboration in the investigations into the very serious abuses: “We are awaiting the details of the work carried out by the judiciary in collaboration with our Administration which – declares the CEO of Universo Salute Luca Vigilante – since day one , has worked for the protection of patients, especially those who are more mentally fragile, asking all trade union organizations and all workers for authorization to install video cameras in the rooms as well”.

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On the other hand, already in 1997, the fact-finding investigation by the Senate of the Republic on the state of implementation of the program for the abolition of the residual asylum structures and the creation of alternative psychiatric assistance structures, stated in its final document: “During the inspections, however, the Commission found a strong willingness on the part of the managers of the two most important affiliated psychiatric assistance networks – the San Giovanni di Dio Fatebenefratelli and the Opera Don Pasquale Uva casa della Divina Provvidenza, which represent, respectively in the north and in the south, the great majority of the private institutions having an agreement – to collaborate with the public sector to lend their activity in the field of assistance territorial » (1) .

So, everything is fine madam la marquise: a gigantic rehabilitation institution that stumbles over the criminal behavior of some operators, maximum collaboration with the judiciary and a tradition of collaboration with the public health service that comes from afar. But, in reality, this is not the case.

First of all, it should be emphasized that the violence in Foggia is not an isolated case of a violent and perverse operator but are the result of the criminal behavior of 30 operators who act continuously against the laws of the republic, ethics and humanity. Secondlyeven if the doctors and the heads of the institution are not being investigated, however, it is legitimate to ask and above all to ask how it is possible that such continuous violence by so many operators has not been detected by medical personnel and managers. We recall that the audio-visual surveys of the carabinieri had been activated since July and this tells us that for months those violence and abuses had been carried out not by one but by numerous operators. More generally, it is good to consider the Foggia affair as an alarm bell and not as an unfortunate, albeit serious, hiccup.

In fact, violations of rights are widespread not only to the detriment of patients in psychiatric services but also, and perhaps above all, to the detriment of all those people who, due to disabilities and vulnerabilities, are guests in residential facilities of various kinds. Therefore, the victims are the mentally disabled, the physically disabled, the intellectually disabled and also, simply, the institutionalized elderly. Violence, harassment, more or less heinous abuses ranging from isolation to the deprivation of privacy and all forms of dignity.

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We recall, once again if there were any need, that physical restraint is widespread and often also documented (2) despite the Court of Cassation V section, sentence of 20 June 2018, having established that the restraint does not have the nature of a “medical act” as the latter has the purpose of achieving a “health benefit”. Mechanical restraint, affirms the Court, instead implements a “restrictive measure of personal freedom which has neither a curative purpose nor materially produces the effect of improving the patient’s health conditions”. This means that doctors who routinely use mechanical restraint “subject the patient to an illegitimate deprivation of personal freedom”, configuring the crime of kidnapping, pursuant to art. 605 CP” (3). Therefore, the United Nations Convention on the Rights of Persons with Disabilities (signed and ratified by Italy, and therefore state law) is ignored, not applied and systematically violated in many social and health structures, especially private and/or affiliated.

Therefore, the law 180 instead of being foolishly attacked must simply be fully applied everywhere and in any case.

In 2018, Matteo Salvini, then Minister of the Interior, wrote: “We are working for a better Italy. I am thinking of the absurd reform that has left thousands of families with psychiatrically ill relatives in misery” and denounced, without providing any factual basis: “There is an explosion of assaults this year because of psychiatric patients”. We need to think carefully about those words of the former minister because they are not only the expression of the cultural, scientific and moral ignorance of the worst minister that our country has ever had, but they are the manifestation of a widespread ignorance of the facts, evidence and realities about the psychiatric reform advocated by law 180 and the rights in general of the people who are in social-health institutions. This ignorance, made up of disinformation and often also of bad faith, also feeds a schematic and very crude narrative that denies the extraordinary progress of Italian psychiatric assistance thanks also to the law 180. What should worry us is that that combination of ignorance, disinformation and bad faith , progressively but inexorably allows the beneficial effects of the law to be dismantled, mental health services de-funded, staff reduced.

This is the theme, and it goes far beyond the necessary complaints and just sanctions against the violent operators of Foggia: it is a question of defending the Italian psychiatric reform, promoting the application of law 180, promoting the application of the United Nations Convention and providing the urgently needed human and financial resources to public mental health services. The progressive impoverishment of public mental health services fuels the absurd and scandalous recourse to tokenistic doctors who, with three shifts on duty in a diagnosis and treatment service, earn as much as their colleagues in the public service in a month. But, above all, it fuels the progressive privatization of health care and the use of affiliated structures and cooperatives of operators who, in an opaque market, sell welfare services to a struggling public service. It is urgent to address once and for all the question of the structures and private cooperatives with special agreements which too often operate with public money, offering poor quality services and employing poorly qualified operators.

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Marcello Veneziani, a very modest leading right-wing intellectual who writes for the newspaper La Veritàspeaking of Basaglia and his work spoke of “neuro-communism” and of an “ideological aberration of this (of Basaglia, ed) pernicious philanthropy” and, in contrast to Basaglia, Veneziani recalls that “Don Uva understood how much suffering he harbored behind those grates. So after thirty years of managing psychiatric hospitals (which were a national scandal, ed) designed the post-asylum village (i.e. the return to the asylum organization of the early twentieth century, ed) : it would have included a farm, pastures, stables, vegetable gardens, vineyards and orchards, laboratories and pasta factories, cinema-theater and cafés, clubs and billiard halls, sports facilities…”(4).

We gladly do without the legacy of Blessed Don Uva. Instead, the legacy of the “pernicious philanthropy of Basaglia” is welcome, which has created humane, competent and effective mental health services in many Italian realities and has had the recognition of the excellence of the Trieste model by the World Health Organization.

A legacy, that of Basaglia, which has taught us that every man, woman or child, however disabled and affected by the most serious motor, cognitive and affective deficiencies, always remains, in any case and everywhere, a subject, producer of meaning, holder of rights, equal citizen among equal citizens.

Benedetto Saraceno, Secretary General, Lisbon Institute of Global Mental Health

Bibliography

  1. Senate of the Republic, Hygiene and Health Commission, 101st session, 15 July 1997.
  2. Of Judge G. And you untie him immediately. Alphabeta Editions, 2021 Merano.
  3. Saracen B. (2021). International conventions and denied rights. International Health. 24 maggio.
  4. Veneziani M. Basaglia, liberate madness. Democratic Psychiatry and Neuro-communism. AdHoc New August 29, 2020.

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