Trieste, a small Italian city, has become a beacon for progressive mental health care, contrasting starkly with institutional models still prevalent in many parts of the world, reports The Financial Times. With its focus on community integration and patient rights, the Trieste system offers a humane, cost-effective alternative to psychiatric institutionalization.
At the psychiatric emergency unit in Trieste’s general hospital, coercion and isolation are rejected in favor of open-door policies and supportive environments. Patients are often quickly transitioned to neighborhood community mental health centers, where a network of resources addresses their needs without bureaucratic barriers. The system is rooted in the pioneering vision of Franco Basaglia, who, as the city’s psychiatric hospital director in 1971, championed the idea that people with mental health conditions are citizens with rights, deserving of dignity and respect.
Basaglia’s philosophy, often encapsulated as “putting the illness in parentheses,” continues to guide Trieste’s approach. By closing the city’s 1,200-bed asylum nearly 50 years ago, funds were reallocated to strengthen community services, leading to measurable successes. Suicides in Trieste fell from 25 per 100,000 people in the early 1990s to 13 per 100,000 by 2011, while the city now manages with just 46 general mental health beds for its population.
Trieste’s success has drawn international attention, with visitors from 16 countries in 2023 alone. Cities like Los Angeles and countries including Brazil and Argentina are attempting to adapt its model. Brazil, inspired by a visit from Basaglia in 1979, has shifted over three-quarters of its federal mental health funding to community-based care, a dramatic increase from just a quarter in the early 1990s.
Yet, the system is not without challenges. Funding constraints, staffing shortages, and political shifts threaten its sustainability. The election of a rightwing regional government in 2018 sparked concerns over privatization and the erosion of the model’s founding principles. Nevertheless, local advocates, including researchers and healthcare professionals, remain committed to preserving its legacy.
The Trieste model stands in sharp contrast to systems like Japan’s, where psychiatric institutions remain central. While Japan has reduced its suicide rates—down from 27 per 100,000 in 2003 to 17.6 per 100,000 in 2022—the country’s mental health sector has faced criticism from groups like Human Rights Watch for practices such as arbitrary detention and physical restraints.
Meanwhile, in countries like the U.S. and the UK, deinstitutionalization often led to underfunded community services, resulting in gaps in care. In Los Angeles, for example, over 5,000 inmates in the county jail system suffer from mental illnesses, with limited access to rehabilitation.
Despite its challenges, Trieste’s community-based model remains an international benchmark. Its emphasis on early intervention, minimal bureaucracy, and holistic care demonstrates that mental health systems can respect human dignity while delivering effective outcomes. For former patient Michele Sipala, who now works as a peer supporter, the system’s essence can be summarized in one word: freedom.
