Basaglia Law
Encyclopedia
Basaglia Law is the Italian Mental Health Act of 1978 which signified a large reform of the psychiatric system in Italy, contained directives for the closing down of all psychiatric hospitals and led to their gradual replacement with a whole range of community-based services, including settings for acute in-patient care. The Basaglia Law is the basis of Italian mental health legislation. The principal proponent of Law 180 and its architect was Italian psychiatrist Franco Basaglia
. The Parliament of Italy
enacted Law 180 on May 13, 1978, and thereby initiated the gradual dismantling of psychiatric hospitals. Implementation of the psychiatric reform law was accomplished in 1998 which marked the very end of the state psychiatric hospital system in Italy. The Law has had worldwide impact as other counties took up widely the Italian model. It was Democratic Psychiatry
which was essential in the birth of the reform law of 1978.
, Arezzo
, Trieste
, Perugia
, Ferrara
) between 1961 and 1978. These pilot experiments succeeded in demonstrating that it was possible to replace outdated custodial care in psychiatric hospitals with alternative community care. The demonstration consisted in showing the effectiveness of the new system of care per its ability to make a gradual and ultimate closure of psychiatric hospitals possible, while the new services, which can appropriately be called “alternative” instead of “complementary” to the psychiatric hospitals, were being created. These services include unstaffed apartments, supervised hostels, group homes, day centers, and cooperatives managed by patients.
In the early sixties, a critical factor for development of the new Law was the availability of widespread reform movements across the country led by the trade unions, the working class, university students, and radical and leftist parties. This unique social milieu led to the passing of innovative legislative projects including legislation on rights for workers, abortion, divorce and finally, Law 180.
called Basaglia Law revolutionary one and believed that valuable lessons might be learned from the gradualism intrinsic to the models used in developing the law and from the national health insurance support which implemented it.
In 1993, Italian psychiatrist Bruno Norcio stated that Law 180 of 1978 was and still is an important law. That was the first to establish that the mentally ill must be cured, not secluded; that psychiatric hospitals must cease to exist as places of seclusion; and that the mentally ill must be granted civil rights and integrated into community life.
In 2001, Stefano Carrara wrote that in Italy, the “enlightened” (as per the definition provided by Nobel laureate Rita Levi-Montalcini
) Law 180/78, more known as “Basaglia Law”, gave rise little more than twenty years ago to model of psychiatric care considered so avant-garde in the world that it was put under observation by some countries, such as France
, for its export.
In 2009, P. Fusar-Poli with coauthors stated that thanks to Basaglia law, psychiatry in Italy began to be integrated into the general health services and was no longer sidelined to a peripheral area of medicine.
British clinical psychologist Richard Bentall
argues that after Franco Basaglia had persuaded the Italian government to pass Law 180, which made new hospitalizations to large mental hospitals illegal, the results were controversial. In the following decade many Italian doctors complained that the prisons had become depositories for the seriously mentally ill, and that they found themselves “in a state psychiatric-therapeutic impotence when faced with the uncontrollable paranoid schizophrenic, the agitated-meddlesome maniac, or the catatonic”. These complaints were seized upon psychiatrists elsewhere, eager to exhibit the foolishness of abandoning conventional ways. However, an efficient network of smaller community mental health clinics gradually developed to replace the old system.
Giovanna Russo and Francesco Carelli state that back in 1978 the Basaglia reform perhaps could not be fully implemented because society was unprepared for such an avant-garde and innovative concept of mental health. Thirty years later, it has become more obvious that this reform reflects a concept of modern health and social care for mental patients. The Italian example originated samples of effective and innovative service models and paved the way for deinstitutionalisation of mental patients.
According Corrado Barbui and Michele Tansella, after 30 years of implementation, Law 180 remains unique in the international scenario, taking into account that Italy is the only country in the world where traditional psychiatric hospitals are outside the law.
Franco Basaglia
Franco Basaglia was an Italian psychiatrist and neurologist, professor who proposed the dismantling of psychiatric hospitals, pioneer of the modern concept of mental health, Italian psychiatry reformer, charismatic leader in Italian psychiatry, figurehead and founder of Democratic...
. The Parliament of Italy
Parliament of Italy
The Parliament of Italy is the national parliament of Italy. It is a bicameral legislature with 945 elected members . The Chamber of Deputies, with 630 members is the lower house. The Senate of the Republic is the upper house and has 315 members .Since 2005, a party list electoral law is being...
enacted Law 180 on May 13, 1978, and thereby initiated the gradual dismantling of psychiatric hospitals. Implementation of the psychiatric reform law was accomplished in 1998 which marked the very end of the state psychiatric hospital system in Italy. The Law has had worldwide impact as other counties took up widely the Italian model. It was Democratic Psychiatry
Democratic Psychiatry
Democratic Psychiatry is Italian society and movement for liberation of the ill from segregation in mental hospitals by pushing for the Italian psychiatric reform. The movement was political in nature but not antipsychiatric in the sense in which this term is used in the Anglo-Saxon world...
which was essential in the birth of the reform law of 1978.
General objectives
The general objectives of Law 180/78 included creating a decentralised community service of treating and rehabilitating mental patients and preventing mental illness and promoting comprehensive treatment, particularly through services outside a hospital network. Law 180/78 introduced significant change in the provision of psychiatric care. The emphasis has shifted from defense of society towards better meeting of patients' wants through community care. New hospitalizations to the “old style” mental hospitals stopped instantly. The law required re-hospitalizations to cease without two years. Nobody was involuntarily discharged into the community.History
The new Italian law was created after conducting the long-term pilot experiments of deinstitutionalization in a number of cities (including GoriziaGorizia
Gorizia is a town and comune in northeastern Italy, in the autonomous region of Friuli Venezia Giulia. It is located at the foot of the Julian Alps, bordering Slovenia. It is the capital of the Province of Gorizia, and it is a local center of tourism, industry, and commerce. Since 1947, a twin...
, Arezzo
Arezzo
Arezzo is a city and comune in Central Italy, capital of the province of the same name, located in Tuscany. Arezzo is about 80 km southeast of Florence, at an elevation of 296 m above sea level. In 2011 the population was about 100,000....
, Trieste
Trieste
Trieste is a city and seaport in northeastern Italy. It is situated towards the end of a narrow strip of land lying between the Adriatic Sea and Italy's border with Slovenia, which lies almost immediately south and east of the city...
, Perugia
Perugia
Perugia is the capital city of the region of Umbria in central Italy, near the River Tiber, and the capital of the province of Perugia. The city is located about north of Rome. It covers a high hilltop and part of the valleys around the area....
, Ferrara
Ferrara
Ferrara is a city and comune in Emilia-Romagna, northern Italy, capital city of the Province of Ferrara. It is situated 50 km north-northeast of Bologna, on the Po di Volano, a branch channel of the main stream of the Po River, located 5 km north...
) between 1961 and 1978. These pilot experiments succeeded in demonstrating that it was possible to replace outdated custodial care in psychiatric hospitals with alternative community care. The demonstration consisted in showing the effectiveness of the new system of care per its ability to make a gradual and ultimate closure of psychiatric hospitals possible, while the new services, which can appropriately be called “alternative” instead of “complementary” to the psychiatric hospitals, were being created. These services include unstaffed apartments, supervised hostels, group homes, day centers, and cooperatives managed by patients.
In the early sixties, a critical factor for development of the new Law was the availability of widespread reform movements across the country led by the trade unions, the working class, university students, and radical and leftist parties. This unique social milieu led to the passing of innovative legislative projects including legislation on rights for workers, abortion, divorce and finally, Law 180.
Main provisions
Law 180 was based on the following main provisions:- Psychiatric assistance was to be shifted away from mental hospitals to Community Mental Health Centres, newly organized in a sectorised or departmental manner to assure integrations and connections with services and community resources.
- Hospitalization of new patients to the existing mental hospitals was not to be allowed. The construction of new mental hospitals was also prohibited.
- Psychiatric wards were to be opened inside General Hospitals with a limited number of beds (no more than 14–16).
- Compulsory treatments were to be exceptional interventions applied only when adequate community facilities could not be accessed and when at the same time the treatment outside of the hospital was not accepted by the patient.
Dichotomy in mental health treatment
Since the passing of Law 180 in 1978, the Italian Mental Health Act has produced serious debate, disputing its sociopolitical implications, appraising its positive points and criticizing its negative ones. However, the international discussion has never questioned what Law 180 has done to improve the destiny of the mental ill who commit crimes. The Italian experience demonstrates how, when there are no convenient solutions, difficult issues may be sidestepped. Italian legislation has created a dichotomy in mental health treatment: to its credit it has given the law-abiding mentally ill the right to refuse treatment and has stopped all further admission of mental patients; at the same time, it allows the law-breaking mentally ill to be confined in special institutions on indeterminate sentences, thereby depriving them of all civil rights.Main consequences
The main long-term consequences of implementation of Law 180 are the following:- Patients who were staying in mental hospitals before 1978 were gradually discharged into the community.
- The availability of psychiatric beds in Italy is lower than in other comparable countries: Italy has 46 psychiatric beds for every 100, 000 population, compared with 58 in the United Kingdom and 77 in the United States of America.
Estimations
American psychiatrist Loren MosherLoren Mosher
Loren Richard Mosher was an American psychiatrist, clinical professor of psychiatry, expert on schizophrenia and the chief of the Center for Studies of Schizophrenia in the National Institute of Mental Health...
called Basaglia Law revolutionary one and believed that valuable lessons might be learned from the gradualism intrinsic to the models used in developing the law and from the national health insurance support which implemented it.
In 1993, Italian psychiatrist Bruno Norcio stated that Law 180 of 1978 was and still is an important law. That was the first to establish that the mentally ill must be cured, not secluded; that psychiatric hospitals must cease to exist as places of seclusion; and that the mentally ill must be granted civil rights and integrated into community life.
In 2001, Stefano Carrara wrote that in Italy, the “enlightened” (as per the definition provided by Nobel laureate Rita Levi-Montalcini
Rita Levi-Montalcini
Rita Levi-Montalcini , Knight Grand Cross is an Italian neurologist who, together with colleague Stanley Cohen, received the 1986 Nobel Prize in Physiology or Medicine for their discovery of nerve growth factor...
) Law 180/78, more known as “Basaglia Law”, gave rise little more than twenty years ago to model of psychiatric care considered so avant-garde in the world that it was put under observation by some countries, such as France
France
The French Republic , The French Republic , The French Republic , (commonly known as France , is a unitary semi-presidential republic in Western Europe with several overseas territories and islands located on other continents and in the Indian, Pacific, and Atlantic oceans. Metropolitan France...
, for its export.
In 2009, P. Fusar-Poli with coauthors stated that thanks to Basaglia law, psychiatry in Italy began to be integrated into the general health services and was no longer sidelined to a peripheral area of medicine.
British clinical psychologist Richard Bentall
Richard Bentall
Richard Bentall is currently appointed as a Chair of Clinical Psychology at the University of Bangor in Wales, UK and is a Chartered Clinical Psychologist. Born in Sheffield, he attended the University College of North Wales, Bangor as an undergraduate before registering for a Ph.D. in...
argues that after Franco Basaglia had persuaded the Italian government to pass Law 180, which made new hospitalizations to large mental hospitals illegal, the results were controversial. In the following decade many Italian doctors complained that the prisons had become depositories for the seriously mentally ill, and that they found themselves “in a state psychiatric-therapeutic impotence when faced with the uncontrollable paranoid schizophrenic, the agitated-meddlesome maniac, or the catatonic”. These complaints were seized upon psychiatrists elsewhere, eager to exhibit the foolishness of abandoning conventional ways. However, an efficient network of smaller community mental health clinics gradually developed to replace the old system.
Giovanna Russo and Francesco Carelli state that back in 1978 the Basaglia reform perhaps could not be fully implemented because society was unprepared for such an avant-garde and innovative concept of mental health. Thirty years later, it has become more obvious that this reform reflects a concept of modern health and social care for mental patients. The Italian example originated samples of effective and innovative service models and paved the way for deinstitutionalisation of mental patients.
According Corrado Barbui and Michele Tansella, after 30 years of implementation, Law 180 remains unique in the international scenario, taking into account that Italy is the only country in the world where traditional psychiatric hospitals are outside the law.