What can we do when reforms are in short supply? This is a question that many of us ask ourselves when rigidities and bureaucracies show us their sordid face. Without going any further, the integration of services and community work is the only way (I think there are no dissenters in this) to adequately care for complex chronic patients, but when it comes to the truth, it turns out that the levels of care, professionals’ abilities and the fragmentation of medical specialties are a drag on the progress of the necessary reforms.
I’ve pondered on this when I read that The Guardian had just published a book by John Foot, "The man who closed the asylum" that tells the life of Franco Basaglia, a psychiatrist with an exceptional entrepreneurial force. During the war, according to the author, Basaglia was imprisoned as an antifascist and this experience was key to the fact that when he was appointed director of an asylum in the early 1960s, he realized that the psychiatry practiced in that establishment was inspired by and took the shape of prisons.
Franco Basaglia embraced the ideas of anti-psychiatry and by his first day as director of the Gorizia asylum, he already refused to sign repressive orders, beginning to work for the democratization of the internal life of the institution from the outset. His biographer says that the transformative enthusiasm of Basaglia and his collaborators (including his wife) was overwhelming. The reactionary forces stood up to him, but he was determined: the asylums could not be reformed; they had to be abolished. In 1978, shortly before dying at the age of only 56, he managed to convince the Italian parliament to approve the law that takes his name and which meant the dismantling of all Italian mental hospitals and adopt the European model (see post: Mental health, the most forceful transformation).
If you have six minutes do not hesitate to click on this video, narrated by John Foot the author of the book on Basaglia, about the closure of asylums for the insane in Italy.
Going back to where we started, to the need to go beyond the reforms for complex chronic patients, I think it would be good to recover the Basaglia spirit, in the sense that what we ought to abolish what we do know, just as the anti-psychiatry did in their moment, to realize that if we don’t understand how people are and how they live, it will be impossible for us to offer them adequate services. For this reason, it will be necessary to eliminate levels and specialties in order to integrate services from community leadership.