International Mental Health Collaborating Network

SAVE TRIESTE'S MENTAL HEALTH SYSTEM

Trieste is recognized by the World Health Organization as the model of global best practice in mental health care. It has inspired dozens of programs throughout the world to create an integrated network of community services focused upon the whole-person needs of its users; maintaining their dignity as citizens; and minimizing the coercive practices of old fashioned institutional settings.  As we have seen play out in a tragic way in the in the U.S., neglect makes people sicker.  Trieste has shown us how community inclusion improves people’s lives.

 But this great achievement is now threatened by a new right wing regional government that, on poorly informed and ideological grounds, is fast and impulsively dismantling Trieste's wonderful system of community care. We stand in strong solidarity with clinicians, patients, and families throughout the world eager to protect the model of mental health care that has made Trieste a beacon of hope for the world's most vulnerable citizens. 

As a Friend of Trieste and all that it stands for, please sign this petition and distribute widely.

Go here to sign.

For updates on this situation, please consult www.accoglienza.us

Trieste Mental Health Service Model under threat

Due to the Covid 19 pandemic, the already dramatic Italian situation consisting in a lack of resources in mental health services, has worsened further throughout all the country. Inaccessible mental health centres, contraction and even suspension of home visits, reduction of voluntary work and social cooperatives. 

Nevertheless, it was thanks to the easy and quick access to Mental Health Centres, without waiting lists, that not only the services of Trieste, but those of the whole Region of Friuli Venezia Giulia, had consolidated a national and international recognition and reputation.

WHO has indicated again that the Trieste model (which now has become regional) as a global example of an integrated network of community services. This recognition will appear in an important WHO document to be published soon. Responses to people "in real time", with an approach that is not only psychiatric in the strict sense but broadened to respond to the needs of life in its all aspects, respecting and promoting human rights, have been the pillars of Trieste model. 

In many other Italian regions, on the other hand, residential structures are spreading, often looking as traditional closed institutions, often privatised and absorbing most of the resources; people are tied up in squalid hospital wards; no home visits are provided; psychotropic drugs are used almost as the exclusive intervention (and often badly); people's daily needs are burdened on families. This is the situation shown a few years ago by the Parliamentary Commission, which instead rewarded our services. However, despite the multiple awards, the current regional government from the very beginning did not hide the desire to put their hand on the Mental Health Services, and the achievement of the improvement objectives established by the Regional Plan for Mental Health in 2018 became immediately difficult. Listening to the requests of citizens and associations has been also substantially interrupted. There was a reduction in the workforce of all professional figures. The desire to reduce and merge the Community Mental Health Centres became clear, taking a direction which is the opposite to what should be the ultimate goal of a Community Mental Health Service, and so doing blocking the process undertaken during many years, including the functioning of mental health services for 24 hours, with the possibility of welcoming people in crisis in a non-alienating environment. All this has been questioned by re-proposing old hospital wards. This will be achieved with the administrative measures which will break the continuity of the management line.

After the numerous retirements, the management of the facilities, even of the Departments, has been entrusted to staff "acting", or for short periods, with top functions often entrusted "to override" several services. At the same time, the competitions for the directions of the Mental Health Centers were suspended, and they will be reduced. In these days the competitions for leading positions in Trieste and Pordenone have restarted and quite bizarre rankings have come out: all those who were trained by Basaglia’s school have been penalized or excluded, despite years of commitment and excellent curricula, to the benefit of candidates, often unknown, who come from outside the region. We never thought that even in this region the spoils system would reach executive positions, in which skills and public health orientation should be fundamental elements.

We are entrusting our services to psychiatrists completely alien to consolidated - avant-garde experiences, and who, instead, come from backward situations, from psychiatric wards that are often closed and that still use physical restraint. In other words our services will be managed by people offering old-fashioned outpatient or hospitalization models instead of treatment and reintegration programs that respond to the needs of people with mental disorders. These self-defeating choices are harmful not only to the current system, but to citizens in general, and lead the way of the dismantling of the best services created by the psychiatric reform, resulting in the impoverishment and inefficiency of the public service which risks to become progressively privatized throughout Italy.

Citizens must be involved and restart from a strong alliance of users, families, professionals, services, putting together the experiences of yesterday and today before the breakdowns are irreparable and the huge heritage accumulated in 50 years of experience is dispersed. Freedom is therapeutic, it has been said and argued: it is a right, the greatest, for human beings the one which Franco Basaglia has given back to all Italians, closing the asylums and changing the law. For this reason, let's not leave the services alone, and let's prevent the mental health services of the region, from disappearing permanently from the radar, with serious damage for everyone.

Mauro Asquini, Renzo Bonn, Angelo Cassin, Peppe Dell’Acqua, Roberto Mezzina, Franco Perazza, Franco Rotelli                                                                                               (Ex-Directores de los Departamentos de Salud Mental de Trieste, Gorizia, Udine, Alto Friuli e Pordenone) 

Grazia Cogliati, psichiatra 

Giovanna Del Giudice, presidente COPPERSAM “Conferenza Basaglia” 

John Jenkins, International Mental Health Collaborating Network

Mario Novello, psichiatra 

Sashi Sashidharan, psichiatra 

Benedetto Saraceno, past director department of Mental Health and Substance Abuse WHO 

Paul Baker, Secretary,  International Mental Health Collaborating Network

Contact [email protected] if you would like to add your support.

Big issues identified by Covid-19 

Requiring Fundamental Change in Mental Health

A Local and Global Action Plan in Development

Covid - 19 Action Plan Coalition April 2021Download

The Action Plan is the result of the work with a coalition of organisations representing people with lived experience; who use services; family members, mental health professionals, policy makers and researchers and has been adopted by a Coalition of International Organisations:

  • International Mental Health Collaborating Network
  • World Federation for Mental Health
  • World Association for Psychosocial Rehabilitation 
  • Mental Health Europe
  • European Community based Mental Health Service Providers Network (EUCOMS)
  • Global Alliance of Mental Illness Advocacy Networks (GAMIAN)
  • Human Rights Monitoring Institute (HRMI)
  • Italian Society of Psychiatric Epidemiology (SIEP) 
  • Transforming Australia’s Mental Health Service System, Incorporated

The Action Plan addresses the need for fundamental change in mental health that should prioritise improving mental health by focusing on social determinants and achieving equity in mental health care for all people worldwide. 

These targets are for people and organisations to use locally within their communities and mental health services.

We are now actively seeking the support of all organisations and services that want to be part of this campaign for fundamental change.

International and National Responses to the impact of COVID - 19 on mental health needs and services

We welcome other organisations and individuals to join us.

We are collating information about the responses of international organisations and national governments. Here you will find reports written by IMHCN Members; briefing documents and articles:

Meeting the whole life needs of a person through
a community whole systems approach

The IMHCN and its partners have been at the forefront of pioneering community mental health services for the last twenty years.

    • The objective is to build an integrated and comprehensive system with widespread community ownership capable of meeting the identified whole life needs of individuals and local communities.
    • It is widely acknowledged that this will improve peoples quality of life and provide opportunities for recovery from mental health issues. However, closing institutions does not necessarly lead to ending institutional thinking and practice.
    • If these reforms are to be effective we should start by changing the thinking and practices within institutions by creating and applying a whole life recovery approach.
    • This work brings many challenges and opportunities for people with mental health issues, family members, mental health workers, services and communities.
  • We have designed programmes to assist people and organisations to make these changes which are being developed and have been implemented across the world.

You can read more about our work here.

We invite you to join us as members (services, individuals and communities) in promoting and developing our work in your country and internationally. For more information about membership go here.

 

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