Franco Rotelli

Abstract

Radical reforming psychiatrist. He was born in Casalmaggiore, Italy, on July 23, 1942 and died of lung cancer in Trieste, Italy, on March 16, 2023 aged 80 years. “Single purpose asylums are not a good answer”, said Italian psychiatrist Franco Rotelli in a speech he gave many years ago to mental health workers. “They are not useful for the process of empowering people, which is what should be done in mental health.” He was speaking during his directorship of San Giovanni psychiatric hospital in Trieste, Italy, a post he held for over 15 years and during which he transformed the structure and activity of mental health services in his region of Italy. Rotelli believed that people with psychiatric disorders could and should be part of the community, not locked away in an institution. “Psychiatrists and other mental health professionals from all over the world came to see his work in Trieste”, says Dévora Kestel, the Director of Mental Health and Substance Use at WHO in Geneva, Switzerland. He welcomed this interest, she adds. “He wanted to share his vision and make it available to all.” Rotelli trained in medicine in Italy at the University of Parma and, in 1969, joined a hospital in Castiglione delle Stiviere for patients detained under Italian mental health legislation. “He was appalled by the scandal of how patients were being treated”, says a long-time friend Professor Benedetto Saraceno, psychiatrist and Secretary-General of the Lisbon Institute for Global Mental Health in Portugal. Rotelli started a programme of reform, as Saraceno describes it, with “no physical restraint of patients, no isolation room, much more freedom, and more humane treatment from nurses”. He began to transform the hospital into a therapeutic community. 1970 saw the appointment of a new director at a long-stay psychiatric hospital some 60 km away at Colorno, near Parma. The psychiatrist chosen for the post was Professor Franco Basaglia, who had an established reputation for reform in mental health care. Basaglia soon realised that he had a like-minded colleague in the vicinity and encouraged Rotelli to join him in Colorno. In 1971, when Basaglia moved to Trieste to take up the directorship of San Giovanni psychiatric hospital, Rotelli went with him. As Saraceno puts it, “he became the right arm of Franco Basaglia”. At the age of just 30 years Rotelli was appointed the hospital's chief physician. Basaglia and Rotelli's joint project was the deinstitutionalisation of people in long-stay psychiatric hospitals and the creation of community mental health services. “At first they encountered a lot of resistance”, says Kestel. “They were taking power away from those who held it.” But their view prevailed and long-stay psychiatric hospitals in Italy were eventually closed. The transformation was supported by new laws governing the provision of mental health. When Basaglia left Trieste in 1979, Rotelli took on the San Giovanni hospital directorship and held it until 1995. Basaglia died in 1980. “Rotelli then became the undisputed leader of (psychiatric) reform in Italy”, says Saraceno. Rotelli not only continued his predecessor's work but also introduced further innovations. One such was the creation of non-medical social enterprises, which Saraceno describes as “complex systems of people working with patients and ex-patients to create a close interconnection between welfare and health, between private and non-profit enterprises, between volunteers and professionals, between work and housing and mental health”. Later in his career Rotelli spent 6 years as director of all local health services in the Trieste region. Saraceno identifies three factors as contributing to Rotelli's influence. “First, he was extremely kind and generous. Second, he was more in love with questions than with answers…He was always questioning, keeping up a permanent conflict of ideas and perspectives. This fostered creativity because he was forcing you to rethink and never be satisfied that you had a final answer…The third quality was his strong leadership. His charisma could keep a group united.” Rotelli's influence has found a receptive home in many countries, and in WHO. Since it was founded, Kestel points out, WHO has had just half a dozen directors of mental health “yet two of us [herself and her predecessor, Saraceno] were trained in Trieste”. Kestel applauds Rotelli's openness to the views of others: “When I first met him in Trieste, I was just a volunteer. But I could always go to him and express my opinion on any issue. His door was always open.” Rotelli is survived by his wife Giovanna Butti and a son, Francesco, and by his previous wife Giovanna Gallio and sons Federico and Ilja.