Our solution is based on the community mental health model pioneered in Trieste, in northern Italy. According to the World Health Organisation (WHO), the “Trieste model” of psychiatry is one of the most progressive and successful mental-health treatment systems in the world.
The initial aim of the Joshi Project is to develop a community mental health centre (CMHC) in Glasgow as a pilot project, based on the “whole person / whole community,” that has operated successfully in Trieste for almost 40 years.
The model has also been emulated by mental health services in more than 30 countries, including NHS Trusts in Wales and the North of England.
We keep asking the same question: Why not Scotland?
In the longer term, we hope this innovative and cost-effective community mental health system will be scaled up and made available in communities across Scotland.
The Guiding Principles of our Proposal
- Mental health care in Scotland should be more inclusive and available to all those who need it.
- People with mental health problems should have increased choice in terms of care and treatment options and they should be at the centre of their own mental health care. All efforts should be made to reduce and eliminate coercive treatments.
- Families and caregivers should be included in care and treatment.
- As far as possible, all mental health care must be community-based with quick and easy access, and all care should be individualized and aim to ensure social inclusion.
- Treatments based not only on the management of conditions, but also on the individual’s whole-life, long-term recovery and re-integration into the community.
The Trieste Model: What it is and can it be accomplished?
The Trieste model is a unique system of social psychiatry, interlinked to the community as it relates to the individual.
At its core is the 24-hour community mental health centre (CMHC). This is the hub for admission, individual and group treatments, psychotherapy, acute psychiatry, social connections, prevention, outreach, community networking and family support.
Each CMHC also has a small number of beds (usually 6/8) for short-term crisis care or emergency stays, as well as providing respite for families.
In Trieste, there are currently four CMHCs covering a total population of 235,000 – roughly equivalent to the size of Greater Glasgow.
Uniquely, the CMHC – like the pilot we propose in Glasgow – operates a 24/7, walk-in policy. Those who use the CMHC are referred to as participants or guests, never patients.
The CMHCs are designed to be informal but safe spaces, like a social centre, where participants come and go as they wish, dropping in for lunch to chat with friends or family members, meet with psychiatrists or therapists, or simply hang out. The low eligibility criteria to enter the service for treatment reduces stigma and also permits self-referral, along with referrals from local GPs and social workers.
It is from these centres that treatment/ rehabilitation/ recovery/ re-integration links are developed with other community services and institutions, as well as a broad range of community support networks. These networks include local GPs, schools, colleges, employers, job training, peer support, family groups and social service agencies.
Community assets are used to promote wellness, as well as physical and mental health, through sports clubs, theatre, arts, music and other cultural groups.
Uniquely, every individual’s needs are assessed on the basis of their personal story/history – not the disorder or diagnosis they may have previously been given.
All aspects of the person’s life are explored and assessed – from social and family relations to living conditions and other life problems.
One major, distinguishing feature that sets the Trieste model apart from existing systems of care is that the treatment focus is not merely the management of mental illness, but rather on the individual’s whole-life, long-term recovery and re-integration into the community.
The Trieste approach also allows individuals to be a central part in decision making with complete control over their own recovery.
Participants are encouraged to explore their aspirations as a basis for a personalized program or a “life project.” These are fostered through a number of non-government organizations (NGOs) in order to support individuals in their daily life and to address their immediate needs and personal aims.
Meanwhile, networking with other community services ensures that mental health care is a fundamental component of community care.
It is not possible to evaluate the effectiveness of single interventions (i.e., rehabilitative psychoeducational, psychotherapeutic), because these are interwoven in the ‘‘whole system’’ approach. However, the effectiveness of the community mental health centre services in Trieste and elsewhere, have been demonstrated as positive outcomes in terms of:
- Dramatic suicide rate reductions
- Significant hospitalisation rate reductions
- Significant reductions in compulsory treatment rates
- Significant reductions in forensic patient rates
- Significant reductions in re-admission rates
- Increases in the use of the individual care and recovery projects / participants’ compliance and overall service usage
- Steady increases in effective job placement
Transferability to Glasgow
Based on its successes, we believe the introduction of a Trieste-inspired community mental health care system in Glasgow could have an enormous impact on treatment outcomes for people with mental illness in the city.
Glasgow already has a strong sense of community and culture, a number of significant community organisations and health initiatives and a wide range of social, cultural and recreational services, many of which could be linked through a CMHC.
The idea is not to exactly replicate what is being done in Trieste, but to adapt it to Glasgow/Scottish needs and ultimately accomplish the same kind of successes.