Treating Schizophrenia in Mediterranean Region; do we need Reform? State of Art in Italy after 30 Years of Psychiatric Reform

Abstract

In Italy 30 years ago a very radical psychiatric reform has been carried out. All psychiatric hospitals have been closed by law. This reform received very strong political support but was not scientific or evidence based. After 30 years it is necessary to evaluate the Italian reform scientifically.

Basaglia's law was oriented, first to create a net of community care, and then to close Psychiatric Hospitals. The challenge was to improve the quality of life of patients that had spent their life in an Asylum. The patients admitted to psychiatric hospitals, normally had a diagnosis of Chronic Psychosis, Chronic bipolar disorder, mental retardation, but not other more prevalent psychiatric, sometimes more prevalent, diseases. The hypothesis was that psychiatric illness would improve further if the medical interventions were less specialised, thus the psychiatric intervention have to be very generic and supportive, specialization or pharmacologic treatment was perceived as bad practice. Many psychiatric illnesses did not receive specific treatment (panic attacks, personality disorders e.g)

After 30 years this model shows some evidence of efficacy. We must consider weather we can really can apply this model in community treatment or whether we need a scientific based reform in which we can apply algorithms of treatment, early detection of disease and integrated and specialist treatment for severe psychopathology. Data from national health service will be presented and also some specific proposals in a European perspective.