Italian mental health care in the 1978 post reform era : the impact on relatives

A radical movement in psychiatry effectively changed the face of Italian mental health care when in 1978 law 180 was passed. For the first time this introduced systematic deinstitutionalisation of the mentally ill on a scale that generated international interest. Italy however, was ill prepared to receive the mentally ill into the community at the rapidity with which mental hospital numbers were being reduced. Little thought had been given to what this might imply. Some feared the repercussions would be devastating, others were encouraged by the successes of previous community care initiatives and the impetus to spread them nationally. Families of the mentally ill were to form one of the major cornerstones for the new reform to function. The reliance on relatives to provide care was not foreseen by policy makers. The recognition of informal carers in Britain by feminist academics pointed to he heavy burden placed by community care policies on women. Understanding the extent of impact on relatives caring for someone diagnosed mentally ill was a parallel theme for academics in clinical psychology and psychiatry. The present study sought to address some of these issues: community mental health care after the 1978 reform, the impact of care on relatives and what this signified for women. South Verona was the location chosen for the study. The success there in implementing community mental health services was well in tune with what the originators of the reform sought to achieve. Amongst the relatives interviewed remarkably little material or objective impact was found. Favourable economic and cultural factors accounted for the comparatively minimal impact materially. There was however, a notable degree of psychological or subjective impact on relatives. Most relatives were satisfied with community psychiatric services received by patients, but some were unhappy with the way staff perceived them. Some policy implications and service recommendations are considered in the final sections.