Dipartimento di Salute Mentale,ASUI Trieste, WHO Collaborating Centre for Research and Training,Trieste, Friuli-Venezia Giulia,Italy.
Epidemiol Psychiatr Sci. 2018 Aug;27(4):336-345. doi: 10.1017/S2045796018000070. Epub 2018 Mar 6.
Italy pioneered deinstitutionalisation over the past 60 years and enforced a famous mental health (MH) reform law in 1978. Deinstitutionalisation has been completed with the very closure of all psychiatric hospitals over two decades.
After 40 years of implementation, this article presents the main achievements and challenges of the Italian MH reform law, including its long-term effect and impact in Italy and abroad.
The Legislation of 1978 was based on the discovery of rights as a key tool in mental healthcare. At the climax of crisis of psychiatric hospitals as total institutions in this country, through the new community-based system of care, it has fostered the lowest rate of involuntary care and gave back the full citizenship to people with MH disorders. This act was also part of a social movement for expanding civil and social rights, and a promise of a true paradigm shift not only in psychiatry, but also in the way of providing an adequate welfare community for all citizens. According to the WHO, the Italian city of Trieste, together with its region, is a practical example of how the Italian movement achieved deinstitutionalisation, intended as a complex process resulting in the gradual relocation of the economic and human resources and subsequent creation of 24 h services together with the development of social inclusion programmes.
Even if the great principles of the Italian reform law were anticipatory (e.g., the UN Convention on Rights of Persons with Disabilities - CRPD), the law application has been poorly provided with resources and did not follow those avant-garde experiences as models. Limitations are evident today especially at the organisational levels, such as services capable to take up the challenge and transforming the field, left free from the imprint of total institutions. These endemic critical aspects concerning to implementation policies, together with the financial crisis of the Italian healthcare system, must be taken into consideration for a re-launch of this historical law. The rights-based approach opened by the Law 180 should now take into consideration the new legal situation caused by the CRPD worldwide in the area of individuals' human rights, especially about the issue of legal capacity and related involuntary care.
意大利在过去 60 年中开创了去机构化的先河，并于 1978 年颁布了一项著名的精神卫生（MH）改革法。通过过去 20 年的努力，所有精神病院都已关闭，从而实现了去机构化。
该法律实施 40 年后，本文介绍了意大利 MH 改革法的主要成就和挑战，包括其在意大利和国外的长期影响。
1978 年的立法基于发现权利是精神卫生保健的关键工具。在该国精神病院作为完全机构的危机达到顶峰时，通过新的基于社区的护理系统，它促成了最低限度的非自愿护理，并使精神障碍患者恢复了完整的公民身份。该法案也是扩大公民权利和社会权利的社会运动的一部分，也是不仅在精神病学领域，而且在为所有公民提供适当的福利社区方面实现真正范式转变的承诺。根据世界卫生组织的说法，意大利的的里雅斯特市及其地区是意大利运动实现去机构化的一个实际例子，这种去机构化被视为一个复杂的过程，导致经济和人力资源的逐步转移，随后创建 24 小时服务，并开展社会包容计划。
即使意大利改革法的伟大原则具有前瞻性（例如，《联合国残疾人权利公约》——CRPD），该法律的适用也严重缺乏资源，并没有将这些前卫经验作为典范。今天，特别是在组织层面上，限制是显而易见的，例如能够应对挑战并改变领域的服务，这些服务不受完全机构的影响。这些与实施政策有关的内在关键方面，以及意大利医疗保健系统的金融危机，都必须考虑在内，以便重新启动这项具有历史意义的法律。第 180 号法律所开启的基于权利的方法现在应该考虑到《残疾人权利公约》在全球范围内对个人人权领域，特别是在法律能力和相关非自愿护理问题上所带来的新法律情况。
