La réforme italienne, 18 ans après : historique, implantation et conséquences

En 1978, une réforme psychiatrique radicale qui révolutionna le système de dispensation de soins en santé mentale était adoptée en Italie. La réforme a attiré l'attention internationale pour son engagement ferme à se défaire des hôpitaux psychiatriques traditionnels et à mettre en place à travers le pays un système de soins éliminant ce type d'établissement. Cet article décrit la préparation de la réforme, illustre ses caractéristiques et ses conséquences et fournit des données sur son implantation. Dans les années qui suivirent, des législations pertinentes ont complété la réforme ; elles sont décrites ici. D'autres éléments du processus de mise en oeuvre sont mentionnés et les études empiriques existantes sont aussi passées en revue.In 1978 a radical psychiatric reform was passed in Italy, that revolutionized the mental health delivery system. The reform has attracted international attention for its resolute commitment to getting rid of the traditional state hospital and implementing a nationwide mental health system without this type of hospital. The paper begins by depicting its preparation, then after charting the main features of the reform and its implications, it moves on to providing data on the implementation. In the following years relevant legislation has supplemented the reform and is covered in the paper. Other concurrent elements of the implementation process are mentioned and existing empirical studies reviewed

Rationale, component description and pilot evaluation of a physical health promotion measure for people with mental disorders across Europe

Introduction: The HELPS project aimed at developing a toolkit for the promotion of physical health in people with mental disorders to reduce the substantial excess morbidity and mortality in the target group. Methods: The HELPS toolkit was developed by means of national and international literature reviews, Delphi rounds with mental health experts and focus groups with mental health experts and patients/ residents in 14 European countries. The toolkit was translated into the languages of all participating countries, and usability of toolkit modules was tested. Results: The toolkit consists of several modules addressing diverse somatic health problems, lifestyle, environment issues, patient goals and motivation for health-promotion measures. It aims at empowering people with mental illness and staff to identify physical health risks in their specific contexts and to select the most appropriate modules from a range of health promotion tools. Discussion: The HELPS project used an integrative approach to the development of simple tools for the target population and is available online in 14 European languages. Preliminary evidence suggests that the toolkit can be used in routine care settings and should be put to test in controlled trials to reveal its potential impact

Thirty- five years of psychosocial rehabilitation in Italy

There is no mental health without respect for the dignity of mental patients on an equal basis with all other citizens. Rehabilitation is no exception, and deinstitutionalization is its necessary prerequisite. Italy has embraced these principles its 1978 mental health reform, which did away with the mental hospital. After thirty-plus years of community psychiatry, the nation has now the opportunity of exploring further enlightening developments of rehabilitation in the never-ending process of promoting the role of mental patients in society at large

L'istituzione: un soggetto refrattario?

L'istituzione: un soggetto refrattario

La r\ue9forme italienne, 18 ans apr\ue8s: historique, implantation et cons\ue9quences

La r\ue9forme italienne, 18 ans apr\ue8s: historique, implantation et cons\ue9quence

Mettiamo caso che... (i manicomi fossero rimasti).

La riforma italiana del 1978 ha trasformato radicalmente il sistema assistenziale psichiatrico bloccando i ricoveri nei manicomi e sviluppando servizi alternativi nella comunità e negli ospedali. L’articolo ipotizza alternative possibili nell’andamento e nell’uso del sistema psichiatrico pubblico qualora la riforma non avesse avuto luogo. Vengono inoltre effettuate delle comparazioni con altri paesi europei, per individuare somiglianze e differenze nei profili di cambiamento dei rispettivi sistemi psichiatrici. Infine, si utilizzano i dati correnti sul numero di pazienti al loro primo ricovero nei servizi psichiatrici italiani odierni, per stimare la numerosità della popolazione che avrebbe altrimenti sperimentato l’istituzionalizzazione in manicomio nei trenta e più anni trascorsi dalla riforma.The 1978 Italian psychiatric reform law brought about fundamental changes in the system of care by blocking admissions to mental hospitals and developing alternative community and general-hospital services. The paper discusses the possibly different course and use of the public psychiatric system had the reform not been implemented. Comparisons with other European countries are also presented to identify similarities and differences in the patterns of change of their psychiatric systems. Finally, available data on current first-ever psychiatric admissions in Italy are used to estimate the number of people who would have experienced institutionalization in an asylum in the 30+ years since the reform