The Simon Heng Column

Lately I have read a great deal about the way people with mental
health difficulties should be treated. As usual, politicians are
driven as much by the prejudices of the media as they are by
informed debate. There is a huge amount of fear and
misunderstanding of mental health survivors and this largely stems
from ignorance of what it means to live with a mental illness.

In the mid-1980s, I visited Trieste in Northern Italy, to see for
myself the pioneering work on care in the community going on there.
The system had, until a few years previously, detained mental
health patients, even chaining people to walls to “control” their
behaviour. The psychiatric workers decided to release all but the
most disturbed.

There was uproar among the local population. People were afraid
that civil order would break down with the release of these
“uncontrollable” people. The professionals argued that, not only
could their patients be responsible citizens, but the community
itself had a responsibility towards them. Each locality opened a
community mental health centre: weekly reviews were held, to which
local people were invited, to examine the mental health of the
community in general, and individuals in particular. These were
well attended, and it seemed that everyone felt entitled to
contribute.

Although these effectively open case conferences seemed alarming,
the system appeared to work with the Italian sense of community
spirit and family cohesion. What impressed me was the complete
change in attitudes; people with mental health problems were
expected to take responsibility for their own behaviour, and in
return expected to receive support for their difficulties from the
whole community.

Our mental health system could learn valuable lessons from the
Italian experience, even without their sense of community. Mental
health is everyone’s concern, and everyone’s responsibility. Mental
health survivors need to be treated as integral members of of our
communities, rather than tolerated and secretly feared. Maybe it’s
not too late.