Democratic psychiatry and the Trieste model

Domain V · Systemic, relational, group & community · Franco Basaglia · 1961 · Gorizia and Trieste, Italy

What it is

Democratic psychiatry is not a single therapy. It is a movement and a whole service system that grew out of Franco Basaglia's work. Basaglia directed Gorizia asylum from 1961, Colorno until 1971, and Trieste's provincial psychiatric hospital from August 1971. The movement led to Italy's Law 180 of…

Format

• Housing. About 45 places in group homes and supported housing.
• Format: the centre is a walk-in service with no waiting list and no selection by severity. The response comes in "real time", usually within 1–2 hours. All staff take turns on reception.

Who practises it, and how they are trained or regulated

• training in the field;
• Today Trieste runs a network of community mental health centres (CMHCs, Centri di Salute Mentale), each open 24 hours, 7 days a week. Each has a few "hospitality" beds and an open door, and none of the services use mechanical restraint or ECT. Around them sit a small general-hospital unit, supported housing, social cooperatives and personal health budgets. Timeline: the first CMHCs opened in the health districts in…
• No certification or licence is needed to work "in the Trieste model". There is no manual and no fidelity scale. The DSM itself says no universal model can be defined, and lists conditions that carry it instead (see §2).

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• How do you and the practitioner understand what is happening, in spiritual or cultural terms? Is that a source of comfort, worry, or both?
• Does it use a device, heat, cold, water or a physical procedure? Has a medical professional checked that it is safe for you?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• Token involvement.
• Losing people at the prison gate.
• Group homes turning into mini-institutions.
• Clinical-looking spaces that signal custody.
• Families sidelined, or families taking over the plan.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.