The city that cares

Anything that has been around for 40 years is bound to experience the forces of change.   The Israelites were disciplined by God for 40 years before they were given permission to finally enter the promised land.  Any of us who have crossed the threshold of our 40th birthday begin to sense the forces of gravity and physiology as undeniable.  And in Italy, particularly Trieste, it appears, a soul-searching is underway to find a collective voice to speak truth about the importance of protecting what has taken 40 years to create; perhaps the most remarkable system of mental health care on the planet. 

Law 180, the groundbreaking law that was passed by the Italian parliament in 1978, and mandated the closure of all asylums in Italy, reached this 40-year milestone just last year.

I have only parachuted into this city for a month, but I have been privy to several passionate discussions about the winds of change in the political and governing priorities that are emerging in Italy.  Some of the themes are not that different from what we are experiencing (or dare I say “weathering?”) in the U.S.  Fiscal realities, immigration trends, political leanings that incline toward protecting the state rather than protecting the people – Italy is not immune to what we see at home.

This is not a city, or a country, as far as I can tell, that carries out the public discourse in Twitter-battles.  Gratefully, if there is a war of words, it happens in a room with multiple people, representing a cross-generational stake in this world-class system, and embracing the different roles that are integral to the system of community-based care (nurses, social workers, psychologists, users and psychiatrists).  Surprisingly,  little is written about this current conversation, and social media is rarely relied upon.  (Although, a website has been brought back to life to serve as a forum for discussion on these trends.)

A lively discussion about the future of the mental health system structure in Trieste and the surrounding region on 3.11.19. Dr. Franco Rotelli introduces the themes for the conversation.

But, I’ve been privy to some writings from this year, as various voices seek to articulate their thoughts.   One is a work in progress, and it is titled Perche? (which means “why?”) by Dr. Franco Rotelli.  Dr. Rotelli, the true elder statesman in the room, took over the system here in Trieste when Dr. Franco Basaglia left for Rome in 1979.  He continued in this post in Trieste until 1995, and since that time, has held numerous significant posts, including that of managing the regional health authority, helping to create the relationships that have now become the World Health Organization collaborating center, and consulting to other countries, including Cuba, Argentina and Greece.

The larger group assembled for the conversation with Dr. Franco Rotelli at the DSM headquarters on 3.11.19

In the Perche document, where I felt my heart skip a beat is when Dr. Rotelli reminds his readers to not lose sight of the fact that Trieste is una città che cura, translated as “a city that cares.”   That conjures up a meme that could become the rallying cry for protecting this 40-year tradition.  He defines the “city that cares” as having:

  • A good health policy that truly wants to take care of the health of its citizens and not just provide services
  • A network of forze terze  (third forces) defined as associations, cooperatives, social forces, families, users and peers who help with intervention strategies
  • A commitment to breaking down all walls that truly threaten the goal of de-institutionalization:  corporate, ideological, regulatory, disciplinary, agency, legal
A book that has never been translated into English? Too radical in the 1960’s for the American pyschiatric establishment?

It’s a beautiful Sunday afternoon in Trieste, and I am on the precipice of my final week here.  So now I am going to enjoy the sun and walk the streets in search of a book store to find the seminal book by Dr. Franco Basaglia, L’ istituzione negata (The Negated Institution) which, I’ve been told, is a critical read and it was never translated into English!  This will be my homework.

Today, I am pondering this question:   Which institutions exist in Los Angeles that prevent us from being una città che cura?   In my heart of hearts, I believe our people care, but institutional forces stand as a barrier to letting our hearts lead.  Let’s release our hearts! #heartforwardTrieste #heartforwardLA

2 thoughts on “The city that cares”

  1. Kerry – I’ve been trying to get a foothold in the mental health advocacy world in LA for several years now. It seems that everyone I run into is part of the problem. The very people who are screaming for mental health reform are the very same people who continue to elect the same politicians who want to enforce the status quo by promoting so called patient rights (how can someone in a severe state of psychosis make decisions for themselves), out of whack immigration policies that support giving an illegal alien more supportive services than a severely mentally IllAmerican citizen (so the logic here is that when we import enough illegals with serious mental illness we will finally come to our senses and take care of our own), supporting the myth that the severely, and in many cases the untreated, mentally ill do not commit violent crimes instead placing the blame on lack of gun control. The tired excuse of blaming one political party over the other for our broken system. When in fact Republicans and conservatives seem to have a more common sense approach most notably over the past many years the 21st Century Cures Act initiated by non other than a Republican! But no, in California they are voted out and there is a concerted effort to stifel their free speech. This includes what has become a cliche for everyone in the mental health field that Reagan is responsible for closing down our mental health hospitals when in fact that process began under JFK and continued under every president since and up into the Reagan years but he gets all the blame. Why? Because it’s fashionable to bash and place blame on one political party. In Democratically controlled Sacramento under audit it was discovered that millions of dollars allocated for mental healthcare went unspent. All this wrapped up titlely in political correctness. Until we throw all of these people out of office nothing will change. In California we just went from Jerry Brown to Devin Newsome. Not good.
    I’m probably going to get a lot of blowback 0n this post but I’m entitled to my righteousness indignation.

    1. Frank, don’t lose your passion. Keep up the clarion call for change. We each find our way to make a case for change. I am hoping that a pilot we would like to try in LA County (inspired by Trieste) will be supported by the very folks you reference in Sacramento. Stay tuned for more details.

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