This article is co-authored and Zocalo Public Square.
Mental illness bothers me in two different ways. The first surrounds me living and working in Los Angeles every day. When you see people lying half-naked on the hot sidewalk on your way to a trendy new coffee house.When I met parents looking for a missing adult child and was turned down by an agency can help—but do not— because it would be an “invasion of privacy.” People with untreated mental illness are confined in claustrophobic prison cells, chained to furniture for several hours a day, and allowed to go out so as not to harm themselves or anyone else. When I heard that it was
Another haunting also occurs here in Los Angeles, but this one is the product of a trip to Trieste, Italy, “the city that cares.” In Trieste, these tragedies do not exist. That fact bothers me in a good way. Recognized by the World Health Organization as demonstrating global best practice in community-based mental health care. Accorienza (Italian for hospitality), Trieste is the North Star of the world.
Since I first witnessed the human-centered system in Trieste in 2017, I have visited five times so far, first as a fellowship and then as an observer for a month. , can move towards a truly community-based system of care. If there is political will.
America’s current mental health care system dates back to the 1960s, when a vision was gaining momentum to close America’s mental hospitals and build a community care system. can be seen. After President John F. Kennedy called for a community-based system of care in the United States in his final key policy address in 1963, authority gradually passed from the federal government to the states and now to the 58 counties. It was devolved and eventually, in 2011, the California Department of Mental Health was abolished. This moment served as a culmination to the withdrawal of direct responsibility, or accountability, for mental health care from the state.
This downward trend is not unique to California. Today, America’s mental health system is fragmented, built on clinical interventions, paying for some useful things, but not for the life of those at stake. Tied to a redemption system that ignores all needs.
In Italy, we find this same story played out differently. Like the US, Italy was involved in her mid-20s.th A movement of the century to end the dire situation of asylums and institutions. But unlike the United States, Italy had a visionary psychiatrist who revolutionized mental health care in the country and continues to this day.
As a young psychiatrist, Franco Basaglia opposed institutional life, influenced by his imprisonment in World War II as a member of the anti-fascist resistance. When he was appointed director of a mental hospital in the town of Gorizia (in the same province as Trieste) in 1961, he was horrified by the conditions he witnessed.as described in the excellent book The man who closed the mental hospital, Basaglia has initiated a radical change in the face of conventional ‘treatments’.
Some of the measures he implemented are: It has banned restraints, unlocked wards, set up meetings between patients and staff, and required doctors to avoid white coats.
By the time Basaglia moved to a mental hospital in Trieste in 1971, his “democratic psychiatry” movement was gaining momentum. Basaglia and his allies called for steps to promise recovery for mentally ill people and reintegrate people into communities where they can connect with family and friends and find meaning through work.
But he didn’t stop there. In 1977, Basaglia moved to close asylum in Trieste, and the following year the Italian parliament passed Law 180, known as the Basaglia Act, which officially dissolved the national asylum system.
Italy’s community care system, and the local mental health centers that support it, continue today to focus on treatment, recovery and prevention. But the most striking thing I saw in Trieste was the culture that allows people to be treated with human kindness. I was fascinated by a city that values Trieste’s Community Mental Health Program does not define people by mental illness. They understand that a diagnosis is just an information piece.housing Programs incorporate elements ranging from independent living to supportive family-style arrangements with 24/7 staff support. In crisis response situations, community mental health center staff keep people away from the trauma of hospitalization, or worse, incarceration through short-term housing in home-like settings that are fully managed by peers. They play a vital role throughout the system, providing support and wisdom that can only come from lived experience. Community mental health teams also connect people with clubs, associations and social co-operatives to help them find employment that fits their skills and abilities.
In contrast to the current situation in California.
I have yet to meet a person or family member who can describe a success story from the onset of symptoms of mental illness to treatment, diagnosis, sustained support, and recovery. We are stuck in a structured system (or non-system), bound by a financial model that emphasizes symptom management but ignores the long-term life needs of those in crisis.
Other solutions are also available.of Podcast interview with Guyton ColantuonoManaging Director project return peer support network, We discussed Peerespite Centers, a cost-effective, trauma-based alternative to hospitalization and prison. He explained that it costs $840,000 a year to run the 12-bed facility. In contrast, an overnight stay in a typical hospital emergency room costs $2,200. However, he has only two Peerless Pite Centers in the entire LA County.
The guiding principle so obvious in Trieste does not require a secret handshake to unlock here. There must be an unwavering focus on the needs of the whole person, not just clinical interventions. A commitment to holding systems accountable to people and outcomes, rather than protecting institutions. A cultural shift to practice radical hospitality rather than clinging to positional authority and power dynamics. We believe in the ability of all people to recover and the right to pursue a purposeful life, rather than erasing the hopes and dreams of those with a mental health diagnosis. and a community spirit that promotes social inclusion and avoids alienation and isolation.
This change movement requires engagement at all levels of government: local, state and federal. Some may say that it is impossible to enact the spirit of Trieste’s care here. try.
State of Mind is Slate and
Arizona State University
It gives us a hands-on look at our mental health system and how we can improve it.
