What is Democratic Psychiatry?


Democratic Psychiatry (Italian: Psichiatria Democratica) is Italian real society and movement for liberation of the ill and weak from segregation in mental hospitals by pushing for the Italian psychiatric reform.

The movement was political in nature but not anti-psychiatric in the sense in which this term is used in the Anglo-Saxon world. Democratic Psychiatry called for radical changes in the practice and theory of psychiatry and strongly attacked the way society managed mental illness. The movement was essential in the birth of the reform law of 1978.

Organising Committee

Democratic Psychiatry was created by a group of left-orientated psychiatrists, sociologists and social workers under direction of Franco Basaglia who was its figurehead. An organising committee, which constituted in Bologna the first nucleus group called Democratic Psychiatry, consisted of Franca Basaglia, Franco Basaglia, Domenico Casagrande, Franco di Cecco, Tullio Fragiacomo, Vieri Marzi, Gian Franco Minguzzi, Piera Piatti, Agostino Pirella, Michele Risso, Lucio Schittar, Antonio Slavich.

Brief History

In 1977, Democratic Psychiatry helped the Radical Party, a political organisation principally concerned with the human rights defence, to collect together three-quarter of a million signatories to a petition to improve the mental health law and thus to prohibit hospitalisation to psychiatric hospitals. According to Italian law this petition could have resulted in a national referendum on the issue. To avoid a referendum which could have forced the government to resign, the government passed Law 180 in May 1978 and thus initiated the dismantling of the psychiatric hospitals.

Directive Committee

The 2010 National Congress of Democratic Psychiatry in Rome elected the new directive committee consisted of national secretary Emilio Lupo, national president Luigi Attenasio, honorary president Agostino Pirella, national treasurer Maurizio Caiazzo.


Basaglia and his followers deemed that psychiatry was used as the provider of scientific support for social control to the existing establishment. The ensuing standards of deviance and normality brought about repressive views of discrete social groups. This approach was nonmedical and pointed out the role of mental hospitals in the control and medicalisation of deviant behaviours and social problems. According to A. Giannelli, at least in the beginning Democratic Psychiatry used phenomenological and existential ideas as its ideological and cultural reference point. However, according to P. Fusar-Poli with co-authors, Democratic Psychiatry was culturally grounded on Gramsci’s theory of “revolutionary reform” and Foucault’s critique of the “medical model”.


The objectives of the association were (and still are) to pool professional initiatives and energies in any part of society which are aimed at closing mental hospitals and restoring the rights of psychiatric patients.


The programme of Democratic Psychiatry stated in Bologna on the 08 of October 1973 included the following proposals:

  • To continue to fight against exclusion, by analysing and rejecting its sources in the social structure (the social relations of production) and in the superstructures (norms and values) of our society.
  • To continue the struggle against the “asylum” as the place where exclusion finds its most obvious and violent expression, as well as the practical means of reproducing the mechanisms of social marginalisation.
  • To underline the dangers of reproducing segregating institutional structures, even in the mental health services created outside the hospital.
  • To make explicit, in a practical way, the link between acting in the specific psychiatric field and the more general problem of medical care, by demanding a unified action (beyond the division of labour and skills) which in the specific struggle for the promotion of mental health involves us in the broadest possible struggle for a concrete and necessary health reform based on, and expressing, a new social logic.

What was the Basaglia Law?


Basaglia Law or Law 180 (Italian: Legge Basaglia, Legge 180) is the Italian Mental Health Act of 1978 which signified a large reform of the psychiatric system in Italy, contained directives for the closing down of all psychiatric hospitals and led to their gradual replacement with a whole range of community-based services, including settings for acute in-patient care.

The Basaglia Law is the basis of Italian mental health legislation. The principal proponent of Law 180 and its architect was Italian psychiatrist Franco Basaglia. Therefore, Law 180 is known as the “Basaglia Law” from the name of its promoter. The Parliament of Italy approved the Law 180 on 13 May 1978, and thereby initiated the gradual dismantling of psychiatric hospitals. Implementation of the psychiatric reform law was accomplished in 1998 which marked the very end of the state psychiatric hospital system in Italy. The Law has had worldwide impact as other counties took up widely the Italian model. It was Democratic Psychiatry which was essential in the birth of the reform law of 1978.

The law itself lasted until 23 December 1978. Then, its articles were incorporated, with very little changes, into a broader law (Italian: legge 23 dicembre 1978, n. 833 – Istituzione del Servizio sanitario nazionale) that introduced the National Sanitary System.

General Objectives

The general objectives of Law 180/1978 included creating a decentralised community service of treating and rehabilitating mental patients and preventing mental illness and promoting comprehensive treatment, particularly through services outside a hospital network. Law 180/1978 introduced significant change in the provision of psychiatric care. The emphasis has shifted from defence of society towards better meeting of patients’ wants through community care. New hospitalisations to the “old style” mental hospitals stopped instantly. The law required re-hospitalisations to cease without two years. Nobody was involuntarily discharged into the community.

Brief History

The new Italian law was created after conducting the long-term pilot experiments of deinstitutionalisation in a number of cities (including Gorizia, Arezzo, Trieste, Perugia, Ferrara) between 1961 and 1978. These pilot experiments succeeded in demonstrating that it was possible to replace outdated custodial care in psychiatric hospitals with alternative community care. The demonstration consisted in showing the effectiveness of the new system of care per its ability to make a gradual and ultimate closure of psychiatric hospitals possible, while the new services, which can appropriately be called “alternative” instead of “complementary” to the psychiatric hospitals, were being created. These services include unstaffed apartments, supervised hostels, group homes, day centres, and cooperatives managed by patients.

In the early sixties, a critical factor for development of the new Law was the availability of widespread reform movements across the country led by the trade unions, the working class, university students, and radical and leftist parties. This unique social milieu led to the passing of innovative legislative bills including legislation on rights for workers, abortion, divorce and finally, Law 180.

Main Provisions

Law 180 was based on the following main provisions:

  • Psychiatric assistance was to be shifted away from mental hospitals to Community Mental Health Centres, newly organised in a sectorised or departmental manner to assure integrations and connections with services and community resources.
  • Hospitalisation of new patients to the existing mental hospitals was not to be allowed. The construction of new mental hospitals was also prohibited.
  • Psychiatric wards were to be opened inside General Hospitals with a limited number of beds (no more than 14-16).
  • Compulsory treatments were to be exceptional interventions applied only when adequate community facilities could not be accessed and when at the same time the treatment outside of the hospital was not accepted by the patient.

Effects of Law 180

Dichotomy in Nental Health Treatment

Since the passing of Law 180 in 1978, the Italian Mental Health Act has produced serious debate, disputing its sociopolitical implications, appraising its positive points and criticising its negative ones. However, the international discussion has never questioned what Law 180 has done to improve the destiny of the mental ill who commit crimes. The Italian experience demonstrates how, when there are no convenient solutions, difficult issues may be sidestepped. Italian legislation has created a dichotomy in mental health treatment: to its credit it has given the law-abiding mentally ill the right to refuse treatment and has stopped all further admission of mental patients; at the same time, it allows the law-breaking mentally ill to be confined in special institutions on indeterminate sentences, thereby depriving them of all civil rights. As a consequence, the approval of Law 180 led to the closure of psychiatric hospitals in Mantova, Castiglione delle Stiviere and in Mombello.

Main Consequences

The main long-term consequences of implementation of Law 180 are that:

Patients who were staying in mental hospitals before 1978 were gradually discharged into the community, and;
The availability of psychiatric beds in Italy is lower than in other comparable countries: Italy has 46 psychiatric beds for every 100, 000 population, compared with 58 in the United Kingdom and 77 in the United States of America.


American psychiatrist Loren Mosher called the Basaglia Law a revolutionary one and believed that valuable lessons might be learned from the gradualism intrinsic to the models used in developing the law, and from the national health insurance support which implemented it.

In 1993, Italian psychiatrist Bruno Norcio stated that Law 180 of 1978 was and still is an important law: that it was the first to establish that the mentally ill must be cured, not secluded; that psychiatric hospitals must cease to exist as places of seclusion; and that the mentally ill must be granted civil rights and integrated into community life.

In 2001, Stefano Carrara wrote that in Italy, the “enlightened” (as per the definition provided by Nobel laureate Rita Levi-Montalcini) Law 180/1978, more known as “Basaglia Law”, gave rise little more than twenty years ago to model of psychiatric care considered so avant-garde in the world that it was put under observation by some countries, such as France, for its export.

In 2009, P. Fusar-Poli with coauthors stated that thanks to Basaglia law, psychiatry in Italy began to be integrated into the general health services and was no longer sidelined to a peripheral area of medicine.

British clinical psychologist Richard Bentall argues that after Franco Basaglia had persuaded the Italian government to pass Law 180, which made new hospitalisations to large mental hospitals illegal, the results were controversial. In the following decade many Italian doctors complained that the prisons had become depositories for the seriously mentally ill, and that they found themselves “in a state psychiatric-therapeutic impotence when faced with the uncontrollable paranoid schizophrenic, the agitated-meddlesome maniac, or the catatonic”. These complaints were seized upon psychiatrists elsewhere, eager to exhibit the foolishness of abandoning conventional ways. However, an efficient network of smaller community mental health clinics gradually developed to replace the old system.

Giovanna Russo and Francesco Carelli state that back in 1978 the Basaglia reform perhaps could not be fully implemented because society was unprepared for such an avant-garde and innovative concept of mental health. Thirty years later, it has become more obvious that this reform reflects a concept of modern health and social care for mental patients. The Italian example originated samples of effective and innovative service models and paved the way for deinstitutionalisation of mental patients.

According to Corrado Barbui and Michele Tansella, after 30 years of implementation, Law 180 remains unique in mental health law around the world, as Italy is the only country where traditional psychiatric hospitals are outside the law.