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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

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Elena Cerkvenic recently published a book, Sono Schizofrenica e amo la mia follia, which translated means: I am schizophrenic and I love my madness. This book ia part of a new series being published – La Collana 180: Archivo Critico della Salute Mentale by Meltemi, a publisher in Milan.

Elena meets with us to share her story as a young woman, living in Trieste, excited by her career studying and teaching languages and literature with a bright future ahead of her. While on a study visit in Munich, at the age of 29, she experienced a psychiatric disruption that was sudden, scary and unexplainable.

Her life now is bright and full and she describes herself as happy and empowered. She credits the mental health services in Trieste for supporting her recovery and coming alongside her as a “family,” especially during about 20 years of suffering when she was quite isolated and somewhat abandoned by her family and friends.

Elena was motivated to write this book as a source of hope for others who should not give up on their recovery and their future. She provides a very first-person glimpse into the mental health services in Trieste and feels grateful for the kindness of the people she met along the way and their belief in her potential.

Bio from the official website for the book:

Elena Cerkvenič was born in Trieste into a Slovene minority family. A graduate in Languages, she has taught German in middle and high schools. She is currently involved in initiatives for the dissemination of Slovenian language and culture and is involved in associations of people who live or have lived the same experience as her. Her publications include the poetry collections Amore chissà se (2009) and Sapor di.vini (2012).

Links:

"Sono schizofrenica e amo la mia follia": presentato il libro di Elena Cerkvenič - RTV SLO

She speaks about the influence of philosopher Pier Aldo Rovatti.

If you want to reach out to Elena, please send an email to kerryhmorrison@gmail.com.

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In this episode, we learn about the inner workings of two critical elements of the community-based ecosystem in Trieste: the community mental health center (CMHC) and the psychiatric unit in the city’s general hospital (known as the Psychiatric Diagnostic and Treatment Services or SPDC).

Tommaso Bonavigo, is a psychiatrist at the CMHC Maddalena. He received his education at the Università degli studi di Trieste, graduating first as a doctor (2010) and then as a psychiatrist (2016).

Alessandra Oretti is the interim director of the mental health department for the city of Trieste and also serves as the head of the central hospital’s psychiatric unit. She has worked in the Trieste mental health system dating back to 1994 and received her degree from the Università degli studi di Trieste in 1998.

The Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) is the Health Authority which services the Friuli Venezia Giulia region.

Oretti and Bonavigo are part of the team of ASUGI experts in the following cooperation projects:

1. RING project (INTEGRATED STRENGTHENING OF THE PALESTINIAN HEALTH SYSTEM) led by the Italian Agency for Development Cooperation (AICS) in the West Bank area (mainly in the psychiatric hospital of Bethlehem)
2. DUSM project (Diritti umani e salute mentale dei detenuti ) in Albania, which means Human rights and mental health of the prisoners in Albania, led by a consortium of Italian and Albanian NGOs
3. Collaboration with East London Foundation Trust for developing a pilot CMHC which will remain open 24 hours

In this interview, you will pick up on these themes:

• The importance of the therapeutic relationship which is based upon trust built up over time.
• How services are integrated in Trieste and the ways in which all the various people impacting a service user – the social worker, nurse, psychiatrist, police (if warranted) and others – create a team around a person.
• How accountability is assured through the designation of catchment areas – which denotes a territory for which the staff in a CMHC feel responsible for the people they serve.

Resources:

How a small Italian city became a model for mental health care. Financial Times, Sarah Neville, December 2024.

Guidance from World Health Organization: "Comprehensive mental health service networks. Promoting person-centered and rights-based approaches.” See chapter at page 18.

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Dr. Giovanna Del Guidice has spent her entire career in pursuit of promoting a more humane and relationship-based treatment ethos for people living with mental health conditions. In this interview we hear the story about how she boldly travelled to Colorno Italy as a young psychiatrist in her 20’s to meet Franco Basaglia in person. The fact that she had read his books and wanted to follow his lead, because she was uncomfortable with the teachings of conventional psychiatry, clearly impressed him because you will hear the story about how she was offered a job and became part of the original equipe! On her part, it was a bold move but clearly changed the trajectory of her life.

Giovanna, since 2010, has been involved in the Conferenza Basaglia (CONFERENZA PERMANENTE PER LA SALUTE MENTALE NEL MONDO FRANCO BASAGLIA ). This is an organization that she co-founded with Dr. Franco Rotelli, the psychiatrist who followed Franco Basaglia to lead the mental health department in Trieste in the late 1970’s. She currently serves as president.

From the website, her biography is presented:

“Psychiatrist, one of Franco Basaglia’s collaborators, has worked since 1971 in the deconstruction process of the Trieste psychiatric hospital and for the construction of community mental health services. She was director of the mental health department of the Caserta Health Authority (2002-2006) and of Cagliari (2006-2009). Mental health consultant of the Calabria health councilor.

She is a champion for the abolition of mechanical restraint in mental health services, which is seen as a remnant of the old asylum culture and is detrimental to the dignity and rights of those who suffer it, but also negatively impacts the operators who are required to implement it. She is the author of a book … e tu slegalo subito (“and you untie it immediately”) which was published in 2020. [Note: this Vimeo trailer for the book underscores why this is such an inhumane practice.]

In this episode, we are aided by the translation skills of Erika Rossi, a documentary filmmaker who recently directed a film that features Giovanna Del Guidice among many others. The film, 50 years of CLU, captures the story of the formation of the first social cooperative in Trieste.

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Beatrice Stanig is a young woman who is making her way in Trieste. She is a member of the Women’s Association, Luna e L’Altra and a peer support worker in the mental health system. She has also written a book, Sei Innocente and started the process to work on a second.

In this conversation, we cover several topics that help to provide insight into the way in which community based mental health system comes alongside the users who depend upon it. We touch upon:

• The special place in holds in her heart for the women’s association, Luna e l'Altra which has provided her a place of community and purpose since she first stepped across the threshold when she was 22.
• Her role as a peer support worker and her desire to see this profession recognized by the Italian system in order to create a viable path toward economic independence for those who do this job.
• The recent creation of an association in Italy meant to organize peer support workers. It is called the Associazione Italiana Persone Esperte in Supporto tra Pari (AIPESP). Translated that would be the association for experts in peer support. Here is another article that describes the formation of this association.
• Her thoughts (and personal experience therewith) about the “power gap” that exists between system users and the clinicians and staff professionals in the mental health system and why it is important to have another person in the room when users meet with the professional staff.

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Season Five is a special treat: made in Italy!

This past year, with generous support from the Conrad N. Hilton Foundation, Heart Forward was afforded the opportunity to curate a study group to learn about a system in Trieste, Italy that the World Health Organization (WHO) has declared a global best practice for community-based mental health care.

As the Équipe met regularly via Zoom to prepare for their October 2024 study visit, they fashioned a mission statement define their purpose:

The Équipe is an intentionally curated and diverse learning community that is committed to advancing a more humane and holistic mental healthcare system. Rejecting the institutional status quo, which contributes to suffering, homelessness and incarceration in the US, we look abroad for bright spots that could inform sustainable change.

So about these conversations. During our week in Trieste, I snuck away to do interviews in the city. Who will you meet?

Claudia Battiston. Claudia is a Psychiatric Rehabilitation Technician – which is a role unique to Italy, but seems to complement what we know as occupational therapy.

Dr. Tomasso Bonavigo, interviewed alongside his colleague, Dr. Alessandra Oretti. Bonavigo works in a community mental health center and Dr. Oretti is the director of the psychiatric unit in the central hospital and is as the interim director of the mental health department.

Elena Cerkvenic. She is a service user in Trieste and just published a book this year called Sono Schizofrenica e amo la mia follia.

Dr. Mario Colucci. A psychiatrist and philosopher, who has worked in the community system for most of his career and has written extensively about the Basaglian vision.

Dr. Giovanna Del Guidice. Here’s a female psychiatrist who managed to work alongside Franco Basaglia and now is dedicated to keeping the flame alive as she travels to other countries to provide training.

Stefania Grimaldi. One of the cornerstones of the model in Trieste is the network of social cooperatives. We’ll learn about one such social cooperative, La Collina, and how this system works.

Michele Sipala. Michele, in a peer support role, is involved with a very innovative six-month residential program for young service users in the city’s mental health system, Recovery House.

Beatrice Stanig. She speaks about how the association – L’Una e L’Altra – has provided a place of purpose for her. She is now a peer support specialist and has written a book called, Sei Innocente.

Caterina Vicentini. Caterina is a service user who provides a glimpse into how valuable the services in Trieste have been to her recovery and her ability to continue her career as a teacher.

The episodes will be ready for release mid-January 2025. Subscribe so you will be alerted when the first episode is available.

This is a non-sponsored podcast with no ads and entirely supported through donors. To support this podcast, please consider a donation HERE.

And thank you to my technical producer, Aaron Stern of Verdugo Sound for editing and production support.