THE DE-INSTITUTIONALIZATION OF PSYCHIATRIC PATIENTS THROUGH PSYCO- SOCIAL REHABILITATION

Abstract

Abstract Beginning with the careful historical examination of the de-institutionalization of psychiatric hospitals in Europe, this work focuses its attention on the Italian territory and Law 180 of 1978 on psychiatric reform, which has led to the closure of mental institutions and the creation of replacement institutions such as the Mental Health Departments that are present throughout the Italian territory for every certain number of inhabitants. Mental Health Departments have the goal of caring for psychiatric patients within their context of life. Therapy is not organized anymore as a solution-cure, but rather as a complex entity - while also daily and elementary - of indirect and multidisciplinary strategies geared toward socially rehabilitating the patient affected by psychic disturbances. In this regard, out-patient institutional structures, semi-residential structures, and residential structures with the objecttives of being responsible for the patient during his or her psychological and pharmacological therapies, insertion in a protected work field, and in helping the patients' families. In particular, this article will describe the outpatient activities and semi-residential activities put into action by a mental health department in an Italian city with the population of over a million people. In some cases, alternative hypotheses for intervention will be proposed in lieu of those already existent. Key words: De-institutionalization, Department of Mental Health, Rehabilitation Psycho-social (ProQuest: ... denotes formula omitted.) The de-institutionalization in Europe and in the rest of the world Goffman was the first to talk about institutions. According to this author, A total institution may be defined as a place of residence and work where a large number of like-situated individuals cut off from the wider society for an appreciable period of time together lead an enclosed formally administered round of life (1). The Green Book of the European Community states that (2), the process of reforming mental health, several European countries shift away from the traditional model of care in large psychiatric hospitals, (2). Therefore, the slow but progressive discharge of the patients from the large, centralized and isolated psychiatric hospitals is happening in Western European countries, though different measures are being used. In the last 15 to 20 years, such process has also caught the attention of Central and Eastern Europe (3). Within this common tendency, however, exist fundamental differences in the modalities used and when this change occured. (4). For example, in Greece de-institutionalization began in the 1980s. In 1984 began the progressive discharge of patients from the large psychiatric state hospital Leros State Hospital as well as its demolition. In 2000, the program Psychargos began, its goal being the closure of the 9 remaining psychiatric hospitals by the year 2015. In Latvia, on the other hand, the process began in the 1990s, after the restoration of Latvian independence, through the development of out patient services all over the country and within general hospitals. The discharge of the patients from the large psychiatric hospitals was also affected by the scarcity of social services. In Scotland, the process began in the late 1940s. In 1949, the first experiment was performed in an open door policy at the hospital in Dingleton, Melrose. The discharge of the psychiatric patients follows the general trend of the Western European countries and therefore is not a radical process as it occurred in Italy. Rather, it is a slower process that is accompanied by a significant development of community services. All of the 1960s psychiatric reforms in Europe proposed the gradual elimination of institutionalization through the creation of service centers, the transfer of the therapeutic intervention into the social context of persons, prevention and rehabilitation, etc. …