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Hospital closure

After the initial success of discharging many institutionalized patients, it was optimistically proposed that large asylums could be closed and replaced by small psychiatric units in general hospitals, with support from community facilities.

In most countries, the program of hospital closure took place gradually. A notable exception was Italy , which at first lagged behind most other countries but later made rapid changes. In 1978, the Italian Parliament passed Law 180, which aimed to abolish the mental hospitals and replace them by a comprehensive system of community care. Admission to psychiatric hospitals was prohibited, and there were requirements that psychiatric units be set up in general hospitals and that community services be developed in defined areas.

The scheme was based on the work of Franco Basaglia in hospitals in northeast Italy , and on the proposals of the professional and political movement he founded. This movement - Psichiatria Democratica - combined an extreme left-wing political view that patients in psychiatric hospitals were the victims of oppression by the capitalist system with the conviction that severe mental illness was induced by social conditions and not by biological causes. Basaglia's forceful personality and qualities of leadership helped him to succeed in finding new ways of caring for patients in the community. Other workers found it difficult to repeat his successes. The consequences of this sudden change were varied. In those parts of Italy where the reforms were financed adequately and were implemented by enthusiastic staff, the new provisions were successful. In areas where the provision of new facilities was inadequate, there were many problems for patients and their families.

In the UK and elsewhere, the pace of change was , slower, but similar problems arose. Some patients could not manage in the community without intensive support, and even then required repeated readmission to hospital so that the arrangements became known as the 'revolving door policy'. The rehabilitation services had been expected to discharge patients in an improved state, but they found it necessary to provide continuing care for so many that it was difficult to take on new patients. Some discharged patients attended day hospitals for years without further improvement. It became clear that earlier views of the benefits of 'de-institutionalization' had been overoptimistic, and that services outside hospital were inadequate to provide the help needed by discharged patients and their families. Attempts were made to develop more adequate community facilities, a policy known as community care.

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