From Vincenzo Passante/Psychiatry at the Margins: “This approach is the basis (at least on paper) of the entire mental health system in Italy. So what is the ‘Trieste model’ exactly?
. . . Anyone who is interested in the Trieste model should [get] to know its history, what the Basaglians always stood against in traditional psychiatry but also how they differed from other movements critical of psychiatry in the way they envisioned change.
While the Basaglian approach had significant influence outside Italy (for example in South America), it has been almost completely ignored in the US, and the UK has arguably been the most resistant country in the world to Basaglian practice since the 80’s, with the beginning of a change of heart becoming evident only in very recent years. As a Basaglian who is originally from Trieste and now lives in the UK, I therefore face an up-hill task in influencing the English-speaking world on this subject.
. . . The system in Trieste is organized around a number of community mental health centers, the number of which varied across the years. Aside from a brief period for one of them currently, they are normally all open 24/7. These settings include beds for people who need them, but are also places where people can meet to pass some time with others, see a psychologist or another professional. They are therefore both crisis and not-crisis services, in line with the idea that ‘freedom is therapeutic,’ which was one of the mottos of the revolution.
There is also a general hospital ward (the last time I visited, in April this year, it had 7 beds and 5 were occupied, but before the local government started cutting services, this place was often almost empty). There are no locked doors and no restraint is used across the whole mental health system. Conflict is resolved by means of negotiation and compromise. Help is not structured around treatment pathways based on a diagnosis (or alternative fixed conceptualizations), but on the person’s whole life and needs across the board. This does not mean that disorders are not believed to exist, nor that technical interventions are not used, but that we ‘put the illness in brackets’ and that we operate way beyond treatment. It means that intra-psychic problems exist within a whole life and societal context and that the context in itself can be part of both the problem and of the solution. The approach is to suspend judgement on the exact nature of a person’s problem at the beginning of the relationship, and gradually help the person make sense of their life within a dialectical context.
These are the basic facts about the system and the vision of care that underpins it. The reaction from UK professionals to this picture is sometimes enthusiasm, sometimes curiosity and sometimes skepticism.
To address questions and concerns, I would like to briefly address a number of common objections I encounter. I hope that the following lines can be food for thought and further conversations.”
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