Bondioli, Cesare (Author)
Based on the latest Mental Health Report issued by the Ministry of Health in “Rapporto sulla salute mentale”, the article analyses changes in the National Health System (Servizio Sanitario Nazionale, SSN), and in particular in mental health related services, over the four decades since the adoption of Act. N.180 on Mental Health and the establishment of the National Health Service (NHS). Re-visiting the building blocks of the psychiatric reform, the article analyses the impact on the approach and the level of service provided to patients, as well as tries to identify areas and modalities for further discussion. The National Health System (NHS) current challenges such as the progressive decrease of public investment, the diminished number of health operators, the externalization and privatization of services, had negative impact on mental health services’ availability, affordability, and coverage comprehensiveness. Results and impact of the psychiatric reform vary however across the country depending on the level of implementation in different territories. The article claims that further deteriorating of services is due to the disengagement toward the comprehensive approach promoted by the Act. N.180 based on the de-institutionalization of asylums replaced by opportunities of diversified support made available in local areas. In addition, the de-institutionalization of asylums, did not spread on private institutions and residences , with an alarming shifting from more integrated, public/community based treatment to a more specialised outpatient psychiatry, far away from local areas, often applying methods of old mental hospitals.
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