Search

Abstract: Background: In May 1978, was voted Law 180, forbidding any new admission in Italian mental hospitals. Many authors set it as an example to be followed in other countries; others contradict this point of view. The purpose of this paper is to analyse the Italian psychiatric revolution in retrospect thirty years later. Method: Several articles and books written by stakeholders and by social researchers were reviewed. Results: The occurrence of the Italian psychiatric revolution cannot be understood without considering the backward situation of mental care in Italy at the time. Changes began before 1978 but were accelerated and shaped by the law. However, some flaws of the previous system have remained over time, most of all, the North-South gap. Discussion: Three points are specially original in Italy and need to be considered before advocating a similar law in another country: first, phasing out psychiatric hospitals went along with difficult problems, second in Italy, local human action is very important, so that implementation of such a law is a bottom-up process, and third, the history of the Italian mental care system has created in the general population a lower propensity to seek care than in other countries. [Copyright &y& Elsevier]

Abstract: In opposition to a widespread belief in psychiatry, mental disorders per se, without alcohol or drug abuse, represent a risk for violence against others, including homicide, that is significantly higher than that of the general population. The present paper extensively reviews the scientific literature during the past 15 years and present their findings in a summary table. The contradictory results of the notorious McArthur study are also presented and critically discussed. Elevated risks of assaults are more closely associated with a subgroup of patients showing one or more of the following characteristics: a history of previous violence; non compliance with antipsychotic medication and follow-up; alcohol and/or illegal drug abuse; violent fantasies; acute psychotic symptoms; and cerebral damage. Although violence associated with mental disorders is significantly higher than that observed among the general population, the absolute number of assaults committed by patients is still low. Between 85 and 97% of violent offenders are not mentally ill. Certain aspects of the deinstitutionalization, such as lack of outpatient resources and a modification of the law reflecting more concerns for the rights of the patients might provoke health care interruptions. However, a clinical commitment relayed by legal interventions in case of danger generate significant reduction of the risks for violence. [Copyright &y& Elsevier]