13^th May 2018. 40 years on, Italy, the first nation in the world to permanently close all psychiatric hospitals

May 13th marks the fortieth anniversary of the closure of mental hospitals in Italy. Forty years ago, the Italian law on psychiatric assistance n. 180 of 1978, known as the law “Basaglia” definitively rejected the institutionalization of the mental patient, in favor of a care system based on community (1).

The law marked a fundamental stage in ethics and in the recognition of rights particularly for vulnerable people, which include: the abandonment of the concept of mental illness that is vitiated by fear and by the need for isolation of the psychiatric patient in closed structures; the incorporation of the treatment of mental illness within the National Health Service; the inclusion of psychiatric assistance in a network of services that gives preference to the territorial sector over hospitals; the modification of the guidelines that regulate obligatory admissions.

The shift of interest from the “disease” to the “person” is the key principle of this new ethical paradigm, which has also been accepted by international policies (2).

Recently, the closure of psychiatric judicial hospitals has sealed the abandonment of the policy of the psychiatric institutionalization even against the committers of crime (3).

However, the decline of welfare, the dissolution of traditional references of social protection in which the family played a central role, the disintegration of the social fabric, the affirmation of an exasperated individualism, all constitute dangerous advances which could lead to a re-emergence of the old procedures and new exclusions of the dynamics in which a physical and psychological separate space is defined, far from the responsibility and the involvement of citizens. Increasing sanitization of policies combined with the shift of new social needs into the health system therefore risks a re-proposal of new forms, even if not apparent, of institutionalizing discomfort, in the many forms in which it is expressed in conflict with the demands for freedom pointed out by the reform law.

What did asylums for the insane teach us? Perhaps it was not only a physical space, a problem of walls and enclosures, but rather a place where the mind, in relation to “the other”, is saturated with cynicism, intolerance, prejudice which is then expressed externally. Indifferent towards the “different from us”, their experience and history - even more so if they are vulnerable - is the mental representation of the asylum that reaffirms its constant and pervasive presence.

Teaching of the 180 law is still necessary as it has already shown us that within a culture of rights it is possible to identify new paths that are capable of responding to a change of social conditions and new economic and welfare emergencies (4, 5).