Italian psychiatry is probably more debated than known in the international arena. Law 180 of 1978, which introduced a radical community psychiatry system, has drawn worldwide attention and debate, with comments ranging from the enthusiastic to the frankly disparaging (Mosher, 1982; Jones et al, 1991). More recently, this interest was marked by a well-attended symposium ‘Lessons Learned from Italian Reforms in Psychiatry’ held at the 2003 annual meeting of the Royal College of Psychiatrists in Edinburgh.
Historical analyses of how the reform movement took momentum, produced a law and how it was enacted can be found elsewhere (Perris & Kemali, 1985; Saraceno & Tognoni, 1989; Mangen, 1989; Fioritti et al, 1997). In this article we try to outline the general social context in Italy, its health and psychiatric services, their organisation, functioning and culture.
Italian communities at a glance
Italy is a country of 56 995 744 inhabitants (census of 21 October 2001) and its economy is the world's seventh largest in terms of gross domestic product (GDP) (World Bank, 2003). It has the world's fifth highest life expectancy at birth (76.9 years for men and 83.3 years for women) (World Health Organization, 2003).
Administratively, the country is divided into 20 regions and 109 provinces. Because of its historical fragmentation until reunification in 1870, striking social and economic differences persist across the nation. Per capita income, economic activities, distribution of wealth, rates of unemployment and the development of welfare services are still very different in northerncentral compared with southern regions. In acknowledgement of this, a policy of devolution is now transferring most administrative powers to regional councils; notably, this includes all functions related to planning and management of health services. This explains the remarkable differences in models and implementation of psychiatric services, whose landscape has been described as ‘patchy and confused’ (Freeman et al, 1985).
Although rapid demographic changes are occurring (in particular, massive immigration is compensating for a decrease in the native population, which presently has a low birth rate), Italian society is still based on strong family links and demographic stability. Recent comparative studies (Warner et al, 1998; Fioritti et al, 2002) have shown that over 70% of patients with psychosis live with their family, in accommodation they own and in which they have typically lived for about 20 years.