Medical and social consequences of the Italian Psychiatric Care Act of 1978

Summary

Introduction

A wide-ranging debate over psychiatric care in general and the Psychiatric Care Act of 1978 in particular, has been going on at various levels of Italian society. Laymen have been expressing their views in favour of ‘open’ or ‘closed’ mental hospitals; journalists have been surveying public opinion on the question, and presenting the opinions of different sides; and psychiatrists and politicians have been tirelessly bringing forward arguments about the applicability and feasibility of the new law. Before the 1978 Act, psychiatric care in Italy had been marked by a long period of legislative inertia going back to Act 36 of 1904, which largely reflected the psychiatric legislation of other European countries. Considering the year in which it was passed, the 1904 Act was effective and commendable. It permitted the founding of new psychiatric hospitals and laid down regulations for compulsory admission. This law, however, belonged to the pretherapeutic era of psychiatry and the impact of psychopharmacology quickly made it out of date. The major shortcoming of the 1904 Act was that it lasted too long and almost exclusively provided for the admission of patients without considering how their discharge was to be achieved. Only in 1968 was the 1904 Act partly updated by the addition of article 4, which provided for voluntary admission to psychiatric institutions and for the founding of mental health centres for patients discharged from psychiatric hospitals.