Trieste

The story of the Trieste model began in 1971, when psychiatrist Franco Basaglia was appointed director of the San Giovanni psychiatric hospital. Basaglia was a firm critic of traditional psychiatric institutions and practices of the time, which he viewed as oppressive and dehumanising. He questioned their legitimacy, and asked whether there could be a better way.     

The Trieste model of care hinges upon several key principles that starkly contrast with compulsory or forced mental health treatment practices, such as:  

1. A human-centred approach. The Trieste model focuses on supporting the individual needs and rights of people seeking wellness, rather than treating their ‘distress’ or ‘illness’. People receiving support are active, not passive, participants in their process of care, and the social, economic and personal factors that contribute to their distress are recognised and considered in the development of their care plans.  
2. Deinstitutionalisation. Since the closure of the old psychiatric institutions, smaller mental health centres have become the norm. These centres focus on upholding people’s dignity and offering personalised support.   
3. Community integration and wrap-around support. A wide range of support is offered for people in distress, including employment, education, and housing assistance. In Aotearoa New Zealand, a similar shining example is Rapua Te Āhuru Mōwai, a kaupapa Māori service providing wrap-around support and housing to people who would otherwise have nowhere to go after being discharged from an inpatient mental health unit.    
4. Non-forceful practices. Basaglia and his followers advocated for non-restrictive, non-forceful treatments, moving away from practices like involuntary hospitalisation, physical or chemical restraint and excessive medication use. Instead, the Trieste model strives to create therapeutic environments that hero individual freedom and dignity. While staying in community mental health centres, people are encouraged to engage in ongoing activities, host visitors, share meals with others, and are supported to participate in employment, education, and day-to-day life in their community.   

In a publication from 2021, the World Health Organization (WHO) recognised the Trieste model as a best practice example of mental health care. As such, it continues to inspire and guide mental health reform efforts worldwide.   

The Trieste model’s focus on supporting people’s dignity, autonomy and community integration remains a beacon for those advocating for compassionate and effective mental health care, including here in Aotearoa New Zealand.