Therapeutic community in localcommunity. The limits, resources ofpartnership and democracy

Raffaele Barone, Simone Bruschetta

Basaglia’s idea of TC“The subversive action of the TC which would

unmask the castle of scientific prejudices on whichthe traditional psychiatry is based, loses all itsmeaning in the moment in which it is absorbed asmodel of a new institutional reality, inside the same structure.

The essential is what comes after the recovery: whichis a technically unsolvable problem because it isessentially a political and social question.”

Basaglia’s idea “If you want to act inside these institutions, you

couldn’t consider the double level on which theproblems move.

The care of a mentally ill always presents to faces:

the fight against the disease as a specific fact;

the fight against the disease as a social fact,

The technicians’ task inside this system is using thetechnical proposals as means to stress thecontraddictions in which you live.” (Basaglia 1968).

Political , cultural, economical and social context and influence of the law 180

The TCs problems in Italy have been stroglyinfluenced by the closure of the PsychiatricHospital through the strong influence of thelaw 180. New problems come out with thedefinitive closure of the Judiciary PsychiatricHospitals.

The social and economic crisis

The second consideration concerns the difficultsocial and economic crisis which we are living inItaly.

We are actually living an extraordinary phase ofuncertainty where almost all seems to be calledinto question, which tells about a welfare inprogressive retreat or worse of decay, whichproduces new and growing exclusion from theworkmarket and an increasing discomfort of the“social coexistence”.

New positive perspectives for users

On the other side we assist to the emerging of mentalhealth users’ ripener protagonism who claim the willto count in the defnition of their life project and to bereleased from the traditional control power ofpsychiatry. In this crisis phase, in many realities inwhich we operate, we are starting a series ofinnovations full of new positive perspectives for ourusers: health budget for an independent life, groupapartments, social farms, protagonism of users andfamilies’ associations.

Therapeutic Communities asenabling environment

Let’s define “therapeutic community”, the life andwork context which create “enabling environments,inside and outside TC”, inhabited by persons’ groups(patients, operators, relatives, managers, costumers)which share the ownership and the responsibility ofthe Personalized Therapeutic Planning for each user,starting from his health needs and from the economicbudget that the “local community” addresses to them.

Therapeutic communities There are various TCs: public and private TCs with

intensive (18 months) and extensive (24 months) temporalprograms for heavy mental illness and they acceptmaximum 20 users. These are rehabilitative-therapeuticcommunities for severe mental illnesses.

These communities also accept patiences coming fromjudiciary psychiatric hospitals which are closing or sent bythe judge as controlled freedom patiences. They have nopersonal control but only social and medical care. Thepoint is that they have to be cared and not controlled.

In each community there are about 20-30-40% of theseusers.

Housing Community TCs with low intensity of health treatment and high

social treatment for maximum 10 users. Thesecommunities can also become “Housing Community”for those users who have a long term disease andrequire a high level of social protection. These arefunded by the local government for the socialtreatment and receive health care services by the staffof the public territorial services of mental health.These are managed by social firms. These are civil flatsand are in the centre of the town.

Group Apartments

The “Group Apartments” is another supportedHousing programme. The objective target ofprogramme is the social, work and human inclusion.In this housing programme there are only 4 people.The operators are there two to four hours a day. It’s selfmanaged as a cooperative apartment.

Others Enabling Environments Social farms and green care are beginning to spread in

rural territories. This is a new experience and combines thework inclusion and the development of the agriculturecooperatives. It supports the domestic life through thebuilding of a social net of social relationships. Thisprogramme finishes when the patient decides to live in aflat in total autonomy. These social firms manage thecultivation and the marketing of typical local agriculturalproducts. Some of them manage restaurants.

Health budget for independent life

This programme is developing in some Italian MHS.

They are personalized projects on the base ofindividual health needs to promote and support theindependent life.

They finance users’ projects on their needs in socialactivities, work inclusion and social housing.

Social and work inclusion In this sense are decisive the promotional capacities of

the local social and working inclusion projects, as for example:

IPS-SE (Individual Placement and Support –Supported Employment)

Social farms

Social firms “Type B”

Vocational Training

Job Bursary

Microcredit Programmes

Permeability and Impermeability ofthe social environment

The permeability and the impermeability of the socialenvironment depends on the social context, on itsresources, formal and informal, public and private,and on the promotional capacity of the empowermentof the users and on the fight against the stigma.

The idea of communitas The community is a property of the subjects it links. A

definition which qualifies them as being part of a whole oralso a substance produced by their union. This union isthought as a quality that they add to their nature ofsubjects, making them also subjects of community. A socialrelationship can be defined of community, if and in thelimit in which the disposition to act is based on a commonbelonging.

Communitas is what doesn’t belong to you, that beginswhere yours finishes and so is “public” in opposition to“private” or “general” (collective, communal) in contrast tothe particular.

The idea of communitas and munus

Munus is the gift from which you have to disobligeyourself.

What preveals in munus is the reciprocity or themutuality which gives to each other an engagement.

Communitas is the whole of people united not by aproperty but by a duty.

Immunitas is an aspect of private property and it is theparticular and the privilege.

The relationship between collectivity and individualityis the topic on which the community has to work.

Multi-Familiar Psychoanalysis Groups

A new care context for severe psychiatric patients arethe Multi-Familiar Psychoanalysis Groups. These aregroups in which meet, in a dynamic matrix founded onthe exchange, on the mirroring and on the resonance,couples or families with users and operators (Foulkes,1975; Garcia Badaracco, 2000).

The Multi Familiar Group-Psychoanalysis helps thepatients and the families either in the discharge phasefrom the TC or in the prevention of the use of HousingCommunity.

The multifamiliar psychoanalisis group

It is a “Conversation group”,

They work on these aspects:

“Pathological Symbiosis”, “The group as thirdfunction”, “pathological narcissism” ,“other fromhimself” , “methaphoric mirroring”, “the multipletransferts”, “projective identification”, “los otros innosotros”, “sane virtuality”, “relation messages”,“pathogen interdependence”, “disidentificationprocess”, “the personal responsibility principle”, “themente ampliada”, “the principle that’s not importantto be right but to be listened to”.

“Short checklist ofdemocratic process standards”:

Does the TC support users’ participation and personal responsibility?

Does the TC promote users’ Empowerment and Recovery?

Is the TC open to users’ and their relatives’ evaluation?

Is the TC sharing the development dynamics of the localcommunity?

Is the TC a social-working inclusion tool?

Does the TC promote and bear witness of people’s human rights?

Is the TC also an anthropological and groupanalitical readingsystem of the society?

Does the TC support and promote the empiric free and laicresearch?

Without gift there isn’t community. The latin etimo of community is actually cum-munus

(common gift). But it’s a gift which obliges who receivesit to Exchange, and so to start the social rule of exchange.

The democratic participation supports themultibelonging experience made through a net of socialbonds, in absence of which it would be the sense ofemptiness and of confusion to characterise the life andwork contexts.

Caring the social bonds means to develop that sentimentof belonging and social identity, called indeed«citizenship».