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Medicine in Society

Medicine in Society John Wattis Kathleen Jones and Alison Poletti, Understanding the Italian experience. British Journal of Psychiatry, 146 (;o,85), 341-347. Sally Rawlings, Behaviour and skills of severely retarded adults in hospital and small residential homes. British Journal of Psychiatry, 146 (1985), 358-366. These papers appearing in the April edition of the British Journal of Psychiatry at first sight appear to have little in common. However, they both in their own way reflect a dissatisfaction with the dogmatic political approach to health and social service planning. The paper by Jones and Poletti adopted an essentially historical approach in analysing the results of'the Italian experience' whereas the paper by Rawlings used scientific methods of behaviour observation to evaluate the effects of alternative forms of care on mentally retarded people. To take the paper on the 'Italian experience' first, this was based on the available literature, Italian as well as British and on a study tour of Italy during which discussions were held with staff at a randomly chosen wide range of facilities. In 1978 the Italians enacted the famous (or infamous) law 180 which forbade the admission of new patients to mental hospitals, set up a review for existing inpatients with a view to discharge and required the provision of small 'diagnosis and cure' units in general hospitals. Most of the British publicity given to the results of this measure has been favourable and there have been MINDsponsored exhibitions in which supporters of the Italian movement, Psichiatria Democratica described its successes. The general message from this publicity is that we in Britain and the USA have a great deal to learn from what has happened in Italy. Jones and Poletti set out to explore just what we might learn from a full rather than a selected study of the facts. The Italian reforms were largely inspired by one man, Professor Basaglia, and the movement he founded in 1974, Psichiatria Democratica. Basaglia had studied Doctor Maxwell Jones' work at Dingleton and was also acquainted with the Community Mental Health Centre movement in the USA. A blend of Anglo-American ideas and Italian