Law 180 Research Articles

The Basaglia Law. Returning dignity to psychiatric patients: the historical, political and social factors that led to the closure of psychiatric hospitals in Italy in 1978.

Law no. 180 of 1978, which led to the closure of psychiatric hospitals in Italy, has often been erroneously associated with one man, Franco Basaglia, but the reality is much more complex. Not only were countless people involved in the movement that led to the approval of this law, but we should also take into account the historical, social, and political factors that came into play. The 1970s in Italy were a time of change and political ferment which made this psychiatric revolution possible there and nowhere else in the world.

Public utility or places of experiment? The reality of the asylum

The intention of this paper is to provide the most thorough overview of what concerns the reality of the asylum, through different types of analysis, in order to outline a detailed historical, political, health and cultural picture of the phenomenon. The historical and socio-psychological analysis in the paper traces the stages of the stigma of the "insane" (since antiquity, in fact, insanity and diversity have been two of the most unknown and frequent problems in the history of mankind) from the Middle Ages to the present day, a very long period of time in which there have been more and more interpretations on the subject; suffice it to say that now we speak of "mental illness", while years ago the mentally ill person was referred to by most as "crazy", a victim of insanity, an incurable disease. Following the analysis is carried out from a social and political point of view with a focus on the darkest and hidden aspects of asylums "Goffmanian" defined as "total institutions". In this sense, the work will focus on the various controversies and protests that have taken place over the years, and on the consequent laws taken on the subject, up to the Basaglia Law of 1978. It will also examine the internal organization of asylums, their structure bare and free of disturbing elements for patients, the training practices of staff, without of course neglecting the condition, the day type of patients and especially the "special treatments" reserved for patients. The flagship of this work is an interview with a former nurse from the largest asylum in Italy, the Mombello asylum, which aims to collect a testimony as it can be direct, engaging and above all not devoid of empirical references.

The quantification of the psychiatric revolution: a quasi-natural experiment of the suicide impact of the Basaglia Law.

BackgroundThe Italian 180/1978 reform abolishing asylums is one of the most contested mental health programs ever implemented. It aimed to shift care of mental illness into the community improving outcomes and reducing expenditure. It was a model for successive deinstitutionalization initiatives across Europe and North America. However, there were longstanding concerns that, without expansion of community care, it may have deprived patients with mental illness access to support, placing them at increased risk of suicide.MethodsRegression discontinuity models were used to quantify the association between the number of suicides and the introduction of the Basaglia Law, disaggregated by age-group and gender, covering 20 Italian regions during the period 1975–84. Models were adjusted for potential socio-demographic confounding factors, region-specific fixed effects and pre-existing time-trends.ResultsItalian regions implemented the Basaglia Law to varying degrees over time. We observed that, after adjusting for pre-existing time trends, the implementation was associated with a consistent increase in the number of suicides for all the age-groups [incidence rate ratio, age 15–44: 1.29, 95% confidence interval (CI) 1.18–1.41; age 45–74: 1.45, 95% CI 1.37–1.54] and for both genders (males: 1.47, 95% CI 1.41–1.53; females: 1.36, 95% CI 1.25–1.47). Hospital closure appeared to be an important mediating mechanism.ConclusionsThe Basaglia Law was associated with a significant increase in the number of suicides, with evidence of an association with closures of facilities, leaving those with mental illness with nowhere to go, as the envisioned community care structures failed to be developed as originally planned.

Franco Basaglia: biography of a revolutionary.

1978-2018: 40 years since the passing of the Basaglia law, which decreed the closure of psychiatric hospitals in Italy (where almost hundred thousand were confined), the primary goal of Franco Basaglia in his lifelong struggle against the violence of total institutions and, in particular, mental asylums. This article offers a reflection on the human, intellectual, and professional trajectory of Basaglia, highlighting his criticisms of the backwardness of university clinics, his interest in the therapeutic dimension of care (Binswanger and Minkowski), the influence on his thinking of European philosophy more open to the complexity of the human being (Husserl, Jaspers, Merleau-Ponty, and Sartre), and his encounter with historical (Foucault), sociological (Goffman), and anti-institutional (Fanon) perspectives on mental health.

Deinstitutionalization and People-Centered Labor: Basaglia Law and Cooperative Movements in Italy

Deinstitutionalization and People-Centered Labor: Basaglia Law and Cooperative Movements in Italy

The former San Niccolò psychiatric hospital in Siena: a polymorphic reality between architecture, archive and library

Following the closure of the asylums approved by the Basaglia Law, the care of the sick was entrusted to the extra-hospital services set up in public or private hospitals. The heritage of the asylum institutions, which conists not only of the archive, of real estate, of libraries, of museum collections of medical tools and of asylum furnishings, was entrusted to the competent ASL (Local Health Bodies). The sanitary archive of the San Niccolo psychiatric hospital was kept in the premises of the former Chiarugi department, located within the former mental hospital complex in via Roma. It consists of a total of 1916 pieces, which cover a continuous chronological period from 1819 to 2003. In 2003, however, the ASL of Siena decided to donate the Library of San Niccolo to the Faculty of Medicine of the city to avoid dispersing the huge library heritage. The archive as well as the library of the San Niccolo of Siena psychiatric hospital allow us, through the knowledge of the institution’s history, to recover the real experience of the doctors, nurses and patients whopopulated the asylum.

Rights at 180. Forty years after the Basaglia law.

On May 13, 1978 the Italian Mental health act [Law 180] was approved, better known as the Basaglia law, named after of the psychiatrist who inspired it. It represents the basis of the Italian mental health legislation: the outdated custodial care in psychiatric hospitals was shifted away from mental hospitals to community mental health centres. Alternative community care restored dignity and rights to locked up people. After forty years, it is time to make an assessment. Has the revolution begun by Franco Basaglia really ended? A journey through different Italian health centres has been performed, from Friuli-Venezia Giulia, where the Basaglia's experience started, to Piedmont, where - in the small town of Collegno - the largest psychiatric hospital in Italy was located. This paper collects memories of those who experienced this revolution, testimonies of young patients and former residents, stories of doctors involved in the daily care. A journey made of experiences, passions, hopes, disillusionments, but above all rights.

Drafting a dual diagnosis program: a tailored intervention for patients with complex clinical needs

Clinical practice of mental health services changed in 1978 after the Basaglia Law was passed, and it is now characterized by usually voluntary treatments offered by community-based services. That broadened the interventions’ focus from the single subject to their environment. Dual diagnosis is defined by WHO as «the co-occurrence in the same individual of a psychoactive substance use disorder and another psychiatric disorder». It is considered to be a “border territory” since entails networking between different medical services. A literature search was performed in PubMed, Web of Science, Scopus and Google Scholar. Search terms were: “guidelines”, “treatment”, “comorbidity”, “substance abuse”, “alcohol”, “dual-diagnosis”, “psychiatric illness”, “outpatient”, “inpatient”, “health care service”, “clinical practice”. National and regional regulations about health and addiction were screened too. Out of 598 titles, 31 studies were included in this article for their relevance on treatments and networking between services for dual diagnosis cases. There are not any guidelines for clinical practice in the literature, neither there are any shared treatment strategies on a national level. Considering the autonomy that every regional health service has, several different courses of action are possible. Here there are reported the ones available. After discussing the weak points of the treatment options, we suggest the “Multidisciplinary Healthcare” model to best address the difficulties represented by dual diagnosis cases.

Is freedom (still) therapy? The 40th anniversary of the Italian mental health care reform.

On 13 May 1978, the Italian Parliament approved Law 180, universally known as 'Basaglia Law' after the name of the leader of the anti-institutional movement which promoted this radical community mental health care reform. Forty years later, Italian psychiatry still runs a community care system, albeit with degrees of solidity and quality very varied along the peninsula. Mental health care is still an integral part of the National Health System, with liberal regulations on coercion and a lowest number of general hospital and residential facilities beds. Recently, Italy has also closed the special forensic psychiatric institutions and brought the care of the mentally ill offenders within the responsibilities of local Mental Health Departments. Over time, psychiatric deinstitutionalisation inspired policies in other sectors of Italian society, such as those regarding physical and intellectual disabilities, education of children with special needs, drug addictions and management of deviant minors. Furthermore, debate about Law 180 has reached and maintained an international dimension, becoming a term of reference for international agencies such as the World Health Organization and the European Commission, for good and for evil. The overall balance sheet of the Reform process would seem mostly positive, though the last decade has seen many threats challenging the system. Mental health care services have been asked to do much more, in terms of care to a larger population with very diversified needs, but with much less resources, due to the financial consequences of the economic crisis. Although there is no evidence of a trend towards re-institutionalisation, intensity and quality of care may have fallen below acceptable standards in some parts of Italy.

Proposals for Mental Health in Italy at the End of the Nineteenth Century: between Utopia and Anticipating the “Basaglia Law”

The present work refers to the debate which took place in Italy in the final years of the nineteenth century in relation to mental health and lunatic asylums, from which emerged various innovative proposals for avoiding compulsory confinement in numerous cases. Some of them became part of new legislative regulations regarding asylums, but most were excluded. Today, a new historical interpretation allows us to grasp a connection between Law 180, dated 1978 and known as the “Basaglia Law” from the name of its promoter, and alternative proposals to asylum custody omitted from the 1904 law.

Mad and murderous: two matricides reported by the Italian press before and after the Basaglia law

This study presents the results of a qualitative analysis based on 13 crime news articles from Italian newspapers, to show that the belief that mental disorder predisposes many of those suffering from it to behave violently has endured, though the 180 bill was passed 25 years ago. Although the question has already been addressed by social psychologists and psychiatrists, it has not been discussed in great detail by science communication. However, this considers crime articles in newspapers as very interesting examples of indirect communication on health issues, where common belief prevails. The articles analyzed were about two matricides dating back to 1972 and 2001 respectively. The analysis showed that the belief that people with mental illnesses are recognizable, antisocial, can behave violently and cannot recover, has endured over many years. Nevertheless, statements about people with mental disorders are more accurate and the idea that the risk of violence among released mental patients is predictable, has been set aside.

Quais são as nossas diferenças? Reflexões sobre a convivência com o diverso em escolas italianas

O artigo considera a lei Basaglia, do fechamento dos manicômios, como um divisor de águas na sociedade italiana no tocante ao enfrentamento do tema diversidade. Examina, baseado em uma experiência de três anos em escolas italianas, a operacionalização de outra lei que segue os mesmos princípios e prevê a freqüência de todas as crianças, normo- e infra- dotadas, em escolas regulares e que aboliu as chamadas classes especiais. Problematiza o conceito atual de diversidade tendo em vista a crescente presença de um novo grupo de diversos nas escolas, os estrangeiros, e propõe, a partir da leitura de Foucault sobre o direito à saúde, uma linha móvel para o entendimento da diversidade.