Abstract
In 1978, in Italy, approval of Basaglias reform law marked a shift from an asylum-based to a community-based mental health system. The main aim of the reform was to treat patients in the community and no longer in psychiatric hospitals. Following the Italian model, similar reforms of mental health care have been approved worldwide. The community-based model aims to promote integration and human rights for people with mental disorders on the basis of their freedom to choose treatment options.
 By 2000, all psychiatric hospitals had been closed and all patients discharged. Mental health care is organized through the Department of Mental Health, which is the umbrella organization responsible for specialist mental health care in the community; this includes psychiatric wards located in general hospitals, residential facilities, mental health centres, and day-hospital and day-care units.
 Approval of Law 180 led to a practical and ideological shift in the provision of care to patients with mental disorders. In particular, the reform highlighted the need to treat patients in the same way as any other patient, and mental health care moved from a custodialistic to a therapeutic model.
 Progressive consolidation of the community-based system of mental health care in Italy has been observed in the past 40 years. However, some reasons for concern still exist, including low staffing levels, potential use of community residential facilities as long-stay residential services, and a heterogeneity in the availability of resources for mental health throughout the country.
Highlights
BACKGROUNDIn Italy, the shift from asylum-based to community-based mental health services was marked by approval of Law 180 ( known as the “Basaglia law”) in 1978
In Italy, the shift from asylum-based to community-based mental health services was marked by approval of Law 180 in 1978
Law 180 started the dismantling of psychiatric asylums and development of community-based mental health centres, with a focus on people with severe mental disorders being treated in the community.[2]
Summary
In Italy, the shift from asylum-based to community-based mental health services was marked by approval of Law 180 ( known as the “Basaglia law”) in 1978. The DMH includes the following facilities: community mental health centres (CMHCs), day care facilities (DCF), general hospital psychiatric units (GHPUs) and residential facilities (RFs). Community mental health centres are active every day for 24 or 12 hours, depending on the regional organization They include a multidisciplinary staff comprising psychiatrists, psychologists, social workers, rehabilitation therapists and nurses, who collaborate in order to provide integrated and personalized interventions for patients with severe mental disorders. Community residential facilities Community residential facilities are non-hospital, community-based facilities that provide overnight care for patients with severe mental disorders People living in these residential facilities have relatively stable mental health conditions and require rehabilitation interventions. These residential facilities are classified as high-, medium- or low-intensity of care reflecting the level of patient autonomy. The proportion of compulsory psychiatric admissions progressively declined from 1978 to 2005, and remained stable thereafter, accounting for less than 5% of all psychiatric admissions
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