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Michele Sipala is a peer support worker at Recovery House, located in the heart of the city centre in Trieste. Recovery House provides a six-month transitional residential environment for six young people, age 18 – 35, to help give a “kick start” into more independent living. Recovery House was started in 2015 and over the past nine years, it has served 55 young people.

In this conversation, we discuss the unique needs of younger people in the mental health services in Trieste who are transitioning into the adult service sector – with changes to their clinical supports and all the stresses and challenges that can accompany an expectation of moving into adult life. He reiterates the three pillars of their mental health system: the importance of work, home and socialization.

Resources and publications mentioned in this conversation:

The Recovery House in Trieste: Rational, participants, intervention as the “work.” APA Psyc Net 2018

The Recovery House of Trieste. Journal of Recovery in Mental Health. 2018

Full article here.

Book that has had a great impact on Michele:

Tutto chiede salvezza (Italian)

Everything Calls for Salvation (English version)

And it is a Netflix series – with two seasons.

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In this episode we sit down and talk with Caterina Vicentini in my hotel room in Trieste. Caterina is a math and physics teacher at the secondary school level in a town – Monfalcone -- that is about 30 minutes from the city centre of Trieste.

She is a service user and takes advantage of opportunities like this to share her story to help destigmatize mental illness and to offer hope that one can have a full life -- education, career and family –- even while encountering the challenges of a mental illness. Of course, she lives and works in a region that is known for exemplary care.

Her first crisis in her 20’s happened when she was a graduate student. At that time, she had been awarded an Erasmus Fellowship which allowed her to study in Belgium. Then she was offered an opportunity as a PhD student to be a teaching assistant.

She recalls for us her first experience of being taken to the hospital, forcibly injected by someone she did not trust, and then placed in a padded room with four point restraints. The shock of all that is beyond frightening and you will hear about her Houdini-like liberation that took all night long.

In 1991 she and her husband returned to Trieste and she shares the stories over the subsequent decades of a few more incidents that would set her back, and how she emerged stronger each time.

Note: when she talks about going to the “centro di salute mentale” or staying there in one of their beds, this is not a hospital. This is the community mental health center, which is an unlocked place with crisis beds for those who might need to stay for a day, a week or longer.

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In this episode, we speak with Claudia Battison, a Psychiatric Rehabilitation Technician (PRT) in the mental health system in Trieste Italy. I am joined in this interview by Dr. Joy Agner, Assistant Professor at the USC Chan School of Occupational Therapy and Occupational Science at USC.

Heart Forward has become particularly interested in the potential role that occupational therapists -- if empowered to practice their profession to its full potential -- could play in mental health support settings in the U.S. Unfortunately, the way that OT services are primarily funded (through short-term, medically oriented reimbursement systems) constrain their ability to come alongside people in their recovery journey over the long term.

This topic was already approached in a Season Four podcast with Dr. Deborah Pitts from USC’s Chan School.

In this conversation, we learn about the ways in which the PRT engages with the system users. Three stark differences emerge:

• Time. There are no deadlines. They are afforded the time necessary to get to know the user and tease out the life plans/goals (also referred to as a personal rehabilitation project) that are meaningful to the user.
• Friendship. The relationship is described more like a friendship than what might be more typical in an American context. This equates with the ethos of coming alongside people in horizontal relationships that eschew the power dynamics associated with “professional” more verticalized relationships.
• Team. The PRT is part of a broader team – an équipe of other “operators” (their word for staff) – in the Community Mental Health Center. The other team members can help to weigh in on how to support the system user; the PRT is not left to his or her own devices.

And, or course, all of this is grounded in the belief that a mental health system must support a person in all three pillars of one’s life: casa, lavoro e socializazzione, or housing, work/purpose and community. The PRT must pay attention to each of these pillars to provide support for recovery.

As we have researched this further, it appears that this role if fairly unique to Italy and was created to augment the psycho-social support that is an underpinning to the Italian model. As described in one of the articles linked below, “Psychiatric rehabilitation technicians are trained to perform multidisciplinary rehabilitation and education interventions for people and their carers.”

Here are two articles about the role of the Psychiatric Research Technician.

Psychiatric Rehabilitation in Italy: Cinderella No More – The Contributions of Psychiatric Rehabilitation Technicians. Internation Journal of Mental Health. 2016

Who cares for it? How to provide psychosocial interventions in the community. International Journal of Social Psychiatry. 2012