Learning from Italian mental health law

As I’ve mentioned before (see previous post), Franco Basaglia in Italy was twice found not guilty of criminal liability following patient homicides. There has been considerable damage in this country caused by services being blamed for homicide by psychiatric patients (see eg. another previous post). The original motivation for such concern came from SANE, when its argument that asylums should not be closed because their rundown was causing homelessness amongst psychiatric patients was shown to be false. SANE, therefore, changed its tack to blaming rundown for psychiatric homicides even though these had not in fact increased. This campaign was reinforced by the Zito Trust, formed after Christopher Clunis unfortunately stabbed Jonathan Zito at Finsbury Park tube station. Homicide reports became mandatory even though they are often flawed, following the first by Blom-Cooper et al for Jason Mitchell (later accepted to be flawed by one of its co-authors, Adrian Grounds). Ray Goddard, the consultant for Jason Mitchell, had his picture put on the front page of the Sun (see previous post).

I actually think the reform of the MHA in England and Wales needs to learn from the Italian experience of removing the ‘risk’ criterion from Mental Health law. The reason for involuntary treatment was no longer that the patient is dangerous but that they need help. The psychiatrist is, therefore, not obliged to repress and control social dangerousness. I also think that current reforms can learn from the ban introduced on admitting any further patients to the traditional asylums in Italy, which encouraged them being phased out. Too many people, including people with learning disability, seen as difficult to manage and place are currently ending up in inappropriate secure provision, often in the private sector. Any further such civil admissions should be prohibited  to secure provision (see previous post), reserving secure psychiatric beds for people who need an alternative to prison. The government has said it wants to close such provision, at least for learning disability, following the Panorama exposure of abuse in Winterbourne View and Whorlton Hall, but has floundered in doing so, blaming lack of community resources, which of course is only part of the reason. Such civil detentions should be managed in more open environments, which if admission to secure beds was prohibited, would happen.

It might actually be worth reading what Italian law says (see english translation)  It states very simple principles that involuntary health treatment must be implemented respecting people’s dignity and their civil and political rights. For some reason the government wants to change the current principles in the Code of Practice (maybe to make them simpler?). It wants to put new principles on the face of the Act, which in my view water down the current Code of Practice principles (see previous post). It would do far better to copy the simple statement from Italian law.