The Trieste Mental Health Department

In describing the, by now, thirty-year experience in Trieste, we would like to deal in very practical terms with the question of “what to do” in those places where there exists the problem of superseding the psychiatric hospital and building a network of community services able to serve the needs of the population. In our view, the therapeutic promise inherent in the transformation process of closing the psychiatric hospital and in the progressive creation of community services, which in Italy is sanctioned by the Psychiatric Reform Law of 1978, risks remaining unfulfilled if the theoretical and practical experience of deinstitutionalisation is not recognised as the fundamental pre-condition for such a transformation. In nearly every instance, the community services are without history and are subordinated to the institutions of clinical psychiatry, as if community psychiatry were merely a detached and independent fragment of those same institutions intended for different and separate users. The deinstitutionalisation phase defined as the mobilisation of institutional actors, the transformation of power relationships, the reconstruction of personal subjectivity, radical alternatives to internment, the critical reformulation of the various forms of professionalism involved, and the re-conversion and use of resources, including those which are not strictly psychiatric or health-related – is missing nearly everywhere. These transformations, due to their very real and practical nature and in recognising the fact that there exists a strong link between organisational methods and the therapeutic work (as we experienced most definitely in the psychiatric hospital), have laid the groundwork for building organisations which are fully capable of both receiving the demand and providing adequate therapeutic responses to it.