From “The Small”
by Roberto Mezzina
The tragic fate of a good psychiatrist, her perhaps premeditated murder, in addition to the pain, horror and outrage it aroused, cannot and must not become yet another pretext for questioning what our country has achieved since an epoch-making law, law 180. Calling it the ‘Basaglia law’ does not do justice to the collective effort of so many others who contributed to writing it and to the many experiences that made it credible and possible, and to the unity of the political forces that wanted it, not without resistances and reactions. It should be remembered here that for twenty years lack of funding, absence of alternative services, attempts and proposals to go back, up to the irreversible act of the final closure of all the asylums at the end of the previous century thanks to Minister Bindi. Only then did Italy finally invest something more in mental health, but only for a few years: immediately after, with the 2011 crisis, the definancing began which brought us to the lowest level in OECD countries (2.75% of national health fund). In the second decade of our century, even the question of judicial psychiatric hospitals (former criminal asylums) finally came to the attention of the President of the Republic Napolitano, thanks to the Marino Parliamentary Commission. Which, incidentally, had traveled all over Italy identifying the need for strengthening in Mental Health Centers open 24 hours such as in Friuli Venezia Giulia, equipped with resources and individual rehabilitation, work and housing pathways, thus countering the growing bad practice of tethering in hospital services and the abandonment of users and their families. The construction of the residences for the execution of the security measures, the so-called Rems, instead left all this behind; certainly it allowed the closure of the OPGs, but without the ancient pillar of the Penal Code that governed them, the non-imputability due to mental infirmity, being reviewed and repealed. The ‘sanction’, the limit to individual behavior, as for every citizen, must not be implemented by psychiatry, but by the law.
Worldwide, the WHO calls for respect for the human rights of patients, also recognizing their duties before the law. But Italy has done nothing except vague government proposals to abolish contention, without a plan for training and strengthening local services. With the juggling and confusion of roles between justice and psychiatry that we are witnessing today, even in this region: people guarded in the Hospital Psychiatric Services put under pressure, Mental Health Centers weakened, requests for further Rems, while it is not understood how the same Planned Rems have not been completed as in Udine, going from 6 to 10 regional beds. In the past legislature, a national law proposal asked for the abolition of articles 88 and 89 of the Penal Code which regulates non-imputability, not confusing the question of the penalty with that of treatment. People with mental disorders must be judged and, if necessary, go to prison, or have alternative sentences, but they must be followed within the places of punishment by mental health services, managed by public departments, which ensure the necessary continuity of care and the prevention of further crime.
At the same time, the dramatic shortage of adequately trained human resources needs to be addressed. Another bill, filed in two legislatures but never reached the parliamentary debate, calls for the implementation of what the Parliamentary Commission had asked for, ‘really’ applying the reform. What is looming instead is the increase in places in Rems, perhaps privatized, and in hospital services. This means not tackling the root of the problem, but only increasing the restrictive measures that worsen the relationship between users and services, turning operators into jailers and oppressors rather than allowing them to treat while respecting people’s fundamental rights and freedoms. Not abolishing the 180, but fully realizing it, this is the right direction to take.
* psychiatrist, former director of the Mental Health Department of Trieste, Vice-President of the World Federation of Mental Health