Having worked in English psychiatric services for over ten years, after working in Italy for several decades and experiencing the transition from psychiatric hospital to community, reading the Italian National Action Plan on Mental Health 2025–2030 (PANSM)¹ left me somewhat perplexed.

The transition from the psychiatric hospital to the territory in the spirit of Law 180/1978² was a far-reaching event that reflected the process of deinstitutionalisation in several countries and aimed at renewing society as a whole.

New individual and social rights were emerging, inducing significant changes in lifestyles and socio-political organisations. Yet the many experiences developed in Italy according to Law 180 seem to have left little trace on those who drafted the PANSM.

In fact, I had the impression of reading a document more aligned with current English mental health services — which, despite some Anglo-Saxon projects having inspired other countries, today appear in a very critical situation and hardly represent models to imitate.

I will focus on two particularly problematic aspects: the excessive supply of and demand for diagnosis and treatment (which I call hyperclinicalisation) and the long-standing issue of cure-control.

As early as the 1970s, before Law 180, the problem of people being reduced to zombies by excessive psychotropic drugs was already evident. Today, although newer drugs have fewer motor side-effects, they remain highly problematic, and discontinuation — even gradual — is often difficult.

In recent decades, clinical categories in mental health have more than tripled and, although mostly descriptive, they are propagated and treated as true diseases with proven biological aetiology.

Attention has shifted almost exclusively onto the sick individual, while the life context in which the person lives has been increasingly neglected. Once inside the clinical process, exiting is difficult; the environment is deemed irrelevant.

People in difficulty have no other way to be heard than to identify with one or more DSM/ICD diagnoses — categories of questionable scientific basis, strongly promoted by pharmaceutical multinationals.

Many human ailments are not illnesses in the strict sense. Inappropriate clinical interventions risk neglecting interpersonal, cultural and social problems.

There is a vast grey area between ordinary suffering and illness that would benefit from initiatives actively engaging family, social networks and citizen governance — true primary prevention and community development.

Equating mental and physical illness is said to reduce stigma, yet this only reinforces the urgency of early diagnosis and treatment. The PANSM is firmly rooted in the DSM illness model — precisely when, in Italy, strong criticism of that model was emerging alongside innovative psychosocial approaches.

The bio-psycho-social paradigm has become, as some say, a “bio-bio-bio” paradigm. Everything society cannot or will not understand is medicalised.

In England, mental health services are organised in separate Trusts. Small acute wards have replaced the old asylums, but most admissions are involuntary — compulsory measures are eight times more frequent than in Italy³ and disproportionately affect migrant populations⁴.

Patients often leave hospital on depot medication under Community Treatment Orders, with the threat of rapid re-hospitalisation. Many wards resemble prisons more than places of care.

Compulsory interventions continue to rise year after year, sustained by the belief that most mental suffering stems from biological illness requiring prompt diagnosis and treatment — if necessary, imposed by force.

Instead of building ever more complex legal safeguards to justify a system of treatment-and-control, it would be far better to separate treatment from control and invest in genuine community-based psychosocial responses.

Italian experiences in the spirit of Law 180 remain a precious resource for maintaining balance between clinical and psychosocial interventions, and for protecting against the dangers of hyperclinicalisation and the misuse of psychiatry as social control.

1. Piano di Azione Nazionale per la Salute Mentale (PANSM) 2025–2030. Ministero della Salute / European Observatory, 2025.
2. Law 180 (Basaglia Law), 1978.
3. Sheridan Rains et al. Variations in patterns of involuntary hospitalisation. The Lancet Psychiatry, 2019.
4. Barnett et al. Understanding ethnic inequalities in mental healthcare in the UK. BMC Medicine, 2022.

Original source (Italian)

Pini, Pino. “Salute mentale: non limitiamoci solo all’aspetto clinico. Continuiamo ad applicare la legge 180 e a contribuire allo sviluppo delle comunità co-creando progetti psicosociali innovativi.” Toscana Medica, 2025.
Full Italian text (PDF)

About the author

Pino Pini is an Italian psychiatrist who worked for decades in the public mental health services of Florence and Prato, directly experiencing the deinstitutionalisation process in relation to Law 180 (1978).

For over ten years he has been practising in the NHS North London Mental Health Trust, United Kingdom. He is a board member of Mental Health Europe (MHE) and a long-standing advocate of community-based, psychosocial approaches within the critical psychiatry movement.