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INTERNATIONAL SCHOOL - Franca and Franco Basaglia

Second module - October 22-27, 2012
Trieste, via Weiss 5 - Dipartimento di Salute Mentale

Materials of the school (LOGIN)

A rationale for a fully integrated, person-centered mental health system of care.

WHO CC for Research and Training in MH Trieste - Azienda per i Servizi Sanitari n.1 “Triestina”
Funded by Regione Friuli Venezia Giulia, under the Patronage of Province and Municipality of Trieste
In partnership with WHO Geneva and Copenhagen; International Mental Health Collaborating Network - IMHCN

The school is organised in two parts:

The International Course
Comprehensive Community Services. Learning and practising

From 22 th to 25th of October

The International Conference
Why Change? Creativity and Innovation in mental heath development

From 26th to 27th of October

- Rationale

- International Course

- International Conference

- Programme

- Teachers and speakers


The WHO Collaborating Centre for Research and Training in Mental Health – MHD is proposing a second module of the International School which is part of the workplan agreed with the WHO for 2009-2013.
The first module’s topic (19-24 of September 2011) focused specifically on supporting rehabilitation and social inclusion of people with mental health problems still interned or treated basically in psychiatric hospitals.
The Ottawa, Caracas and Helsinki declarations, as well as the EU’s Green Paper and the Pact on Mental Health and Well-being stated that the old psychiatric hospitals should be replaced with more adequate and modern care methods provided by community based services.
The decade-long activity in the field of development cooperation and the widespread renown of the Friuli Venezia Giulia’s mental health system, in particular for what concerns Trieste, the pilot centre of the Italian mental health reform and recovery of social and civil rights for people with mental health problems, have generated a massive demand for training from professionals all over the world. The Mental Health Departement indicated as Lead for service development by WHO Europe in 2004, will host the European WHO Collaborating Centres Meeting on 6-7 November 2012.
This second module will focus on putting learning into practice based on the particular needs of participants in implementing change from institutions and their practices into community mental health services and a whole life recovery approach.

Aim: To learn from the Trieste experience and the international success practices of deinstitutionalisation and service development.
To provide practical on the job service and clinical placements on learning how to achieve deinstitutionalisation and community mental health services and practices.
Method: Lectures, seminars and workgroups, service and clinical practical placements, tutored visits to the services and programmes of the Mental Health Department, videos and written material.


International Course

(on days 1-4)

Participants to outline in advance their particular needs in aspects of community work and development that can be implemented in their practice and services over time.
The Trieste international school program to respond to these needs in devising the practical program for groups of managers, psychiatrists, nurses, social workers, etc.
From this a tailored made programme for each group can be designed to specifically relate to people’s own job and the learning and experience they require from the programme in order to develop their role and further benefit their service developments and their users.

An introduction for all participants on the 1st day will focus on strategic, historical, organisational aspects of the transition from the institution to a community comprehensive service system. This will highlight the need to change the thinking, change the practice and change the system by demonstrating how this was done in Trieste and some other services in the world.
Examples of community mental health services from IMHCN members will also be introduced and presented throughout the module and particularly in the last two days open conference.
Each day there will be lectures, seminars and workgroups.
Also there will be practical service and clinical placements in each part of the service with staff from Trieste. These can take the form of clinical tutorials and observation of day to day practice on different topics. These would be most useful for practitioners. There would also be service placements with course participants and staff in pairs or in small groups, again on different topics.

The participants can choose which topics to follow during the course (on day 4), based on their particular need in developing their role and services.

They will be several topics related to deinstitutionalisation and community mental health development including:

- working with people in crisis,
- planning and management of change in deinstitutionalisation and community mental health systems development,
- devising person centered recovery plans,
- continuity of care,
- building trusting relationships,
- rehabilitation and habilitation of users,
- employment opportunities,
- housing,
- social and cultural programmes,
- suicide prevention,
- working with families, working with people in the criminal justice system,
- partnerships with the community organisations and groups,
- managing difficult clinical situations.

Participants will be offered opportunities through discussions to connect with their own working context (using real-life, operational examples experienced in visits and on the job practical service and clinical placements), the deinstitutionalisation examples in Trieste with their own national and local situations.
Further visits to other demonstration sites can be offered by the IMHCN after this course.

Professional / job Streams

Day 1-3
· 20 field teachers as personal tutors involved – they explain what they do in the real world, leading 2 participants who will be shadowing them in the day-to-day operation in the service.
· At the beginning of each day there will be a discussion / reflection on what they observed.
· Contents are: experience in management, in management of change and service development, operational management of present service, clinical work. People will be organised per profession / language / learning objectives. There will be also group experiences with simulation.

On day 4
How to set up a Community based service:
How to develop:

1) a MDT
2) a 24 hour CMHC
3) a recovery plan
4) crisis approach
5) work with total institutions

1) How to develop a multidisciplinary team (MDT):
  • What’s the mission of the CB Service?
  • What’s the role of different professionals?
  • Individual and /or group intensive management (ACT)
  • Decision-making process
  • Personal and collective responsibilities
  • Positive risk-taking
  • Managing informations and coping with contradictions and conflicts.

2) How to develop a 24 hour community mental health centre in the real world?
  • Defining vision, mission and values
  • Operational criteria
  • Physical environment and social habitat
  • Organising actors, spaces, timetable, basic procedures
  • The process of care between programmes and individual care plans
  • Critical aspects
  • Setting up a development plan

3) How people can be trained to whole life and recovery?
  • Providing an assessment and recovery plan
  • Involving the social network
  • Connecting services around the individual project
  • Meeting the needs of people with complex needs on the long-term
  • How these can be budgeted and implemented?

4) How to meet the needs of people in crisis?
  • The understanding of a crisis,
  • Involving social networks and micro-systems,
  • Developing a crisis plan,
  • The experience of home treatment and service procedures,
  • The alternative to admission,
  • Collaborative models with acute units.

5) How to deal with existing large institutions in order to phase them out?
  • How to avoid seclusion and restraint? The open door issue
  • Working with staff
  • Therapeutic work with inpatients
  • Technical and administrative management of change
  • Changing relationships and the environment
  • Working outside and establishing relationships with the community
  • Strategies for discharge and closing down the institution
  • Re-conversion of human and economic resources in community services

Developing me and my services (see Participants’questionnaire)
Group discussions
  • What have I learned from the course?
  • What is the most important for me and my service?
  • Is it possible to implement back home what I have seen and learnt?
  • What are the obstacles to the implementation of these in my service?
  • How might these obstacles be overcome?
  • What ongoing support might I need and what can be offered from Trieste and the IMHCN?

International Conference

“WHY CHANGE? Creativity and Innovation in mental health development”
(on days 5-6)

The International Conference on the last two days can be seen as complementary to the course.
It will be open to other participants and will provide an updated view on innovative programmes on main
topics of community based services.

Main topics:

Change the thinking: the new challenges. Human rights in mental health, stigma and discrimination, public health approach, deinstitutionalisation and recovery.

What is ‘community’ psychiatry? Paradigm change.

Change the practice: initiatives and programmes. Toward a recovery practice.

The community based service: examples of good practices, programmes and components. Integration of mental health into primary care, family burden, job placement and social coops, community alternatives to acute and crisis services, supported housing, community involvement, social activities, forensic issue, user focus.

Why change the system? Learning from other service change experiences worldwide.

What about the model? Sustainability of mental health care in the community.



1. Comprehensive Community Services. Learning and practising

22 OCTOBER, Monday
8.30 – 9.00 am

9.00 am
Welcome and participants’ introduction
R. Mezzina, I. Karavalaki

10.00 am – 1.00 pm
General Principles and Philosophies
1. Deinstitutionalisation – G. Dell’Acqua
2. The issue of law and rights – B. Norcio
3. Whole life and recovery – J. Jenkins

1.00 pm Lunch

2.00 pm
Rehabilitation, job placement and social inclusion
G. Ridente, I. Karavalaki

3.30 – 4.30 pm
Organisation of clinical placements
I. Karavalaki
Developing me and my service
J.Jenkins, R.Mezzina
23 OCTOBER, Tuesday
9.00 am
Questions and discussions on previous day

9.30 – 11.00 am
Mental health organisations and systems of care -
principles and programmes
G. Dell’Acqua, A. Rosen

11.30 am – 1.00 pm
The 24 hour CMHC
R. Mezzina

1.00 pm Lunch

2.00 – 5.30 pm
Clinical Placements

24 OCTOBER Wednesday
9.00 am
Questions and discussions on previous day

9.30 – 11.00 am
MDT and case management / ACT
M. Flowers, C. Brandolin

11.30 am – 1.00 pm
Crisis approach
A. Signorelli, S. Sashidharan

1.00 pm Lunch

2.30 – 5.30 pm
Clinical Placements

25 OCTOBER Thursday
9.00 am
Developing me and my service
J. Jenkins, R. Mezzina, I. Karavalaki, M. Flowers

10.30 – 12.30 am
How to set up a CB Service?
5 topics / Group work
How to develop:

1. MDTM. Flowers, C. Brandolin
2. 24 hour CMHC R. Mezzina, I. Karavalaki
3. A recovery plan I. Marin, M. Aslan
4. Crisis approach S. Sashidharan, M. Fleming, A. Signorelli
5. Work with total institutions J. Pfeiffer, C. Roll

1.00 pm Lunch

1.30 – 3.30 pm
Repeat groups

3.45 – 5.00 pm
Developing me and my service: Planning exchanges and support
R. Mezzina, J. Jenkins, I. Karavalaki, M. Flowers

2. Why Change? Creativity and Innovation in mental heath development

26 OCTOBER, Friday
9.00 am
Change the thinking: the new challenges
Chair and introduction John Jenkins
· Deinstitutionalisation today - Franco Rotelli
· Lobbying for change: the human rights approach - Jan Pfeiffer
· Recovery as a social concept Mike Smith

11.15 am Coffee break

11.30 am
Key Issue: is there a ‘community’ psychiatry? Paradigm change
Pat Bracken, Roberto Mezzina, Sashi Sashidharan

12.30 am – 1.00 pm

2.00 – 5.00 pm
Change the practice: initiatives and programmes
Chair: Peppe Dell’Acqua
The community based service: examples of good practices, programs and components
· Primary care and early intervention: ‘headspace’ - Alan Rosen
· Working with families - Peppe Dell’Acqua
· Community alternatives to acute and crisis services - Assunta Signorelli, Margaret Fleming
· Personal budgets in complex care programmes - Pina Ridente
· User focus and peer-operated services Marion Aslan
27 OCTOBER, Saturday
9.00 am
Why change the system? Learning from service change experiences
Chair: Mario Novello
· Lille Nicolas Daumerie
· Udine and Trieste Renzo Bonn
· Gaza, Palestine Dyaa Saymah

Coffee break

· Athens, Greece Theothoros Megaloeconomou
· Monaghan, Ireland Margaret Fleming
· New Zealand Rob Warriner

12.00 am
Key Issue: What about the model? Sustainability of MH care in the community
Alan Rosen, Mario Novello

1.00 pm
Final remarks and future appointments – Close
Roberto Mezzina, John Jenkins


Teachers and speakers

· Alan Rosen, former Director of Lower North Shore MH Services, University of Wollongong, Sydney, Australia
· Assunta Signorelli, Director of Acute Unit, MHD, ASS n. 1, Trieste
· Bruno Norcio, former Director of Acute Unit, MHD, ASS n. 1, Trieste
· Carmen Roll, WHO consultant, former director of housing programme, ASS n.1 Trieste
· Cristina Brandolin, Nurse Coordinator, Domio MH Centre, MHD, ASS n.1 Trieste
· Dyaa Saymah, WHO Mental Health Programme in Gaza
· Franco Rotelli, former General Manager ASS n-.1, President of Permanent Conference on Mental Health-Franco Basaglia-ConfBasaglia, Italy
· Giuseppe Dell’Acqua, former Director of MHD, A.S.S. 1 Trieste
· Irini Karavalaki, WHO CC, MHD, ASS n.1, Trieste
· Izabel Marin, social worker, researcher, MHD, ASS n.1, Trieste
· Jan Pfeiffer, Human Right Commission, EU, Czech Republic
· John Jenkins, President, International Mental Health Collaborating Network-IMHCN, UK
· Margaret Fleming, Director of Nursing, University Dept, Monaghan, Irleand
· Mario Novello, Director, MHD, ASS n.4, Udine
· Marion Aslan, Crazydiamond mental health training and consultancy, executive director of Elemental - International centre for Recovery and Thriving
· Martin Flowers, Team Manager, Manchester, UK
· Mike Smith, Crazydiamond mental health training and consultancy
· Nicolas Daumerie, psychologist, WHO CC Lille
· Pat Bracken, Consultant psychiatrist, Cork, Ireland
· Pina Ridente, Head of Rehabilitation Unit, MHD ASS n.1, Trieste
· Renzo Bonn, Head of CMHC Udine Nord, ASS n.4, Udine
· Rob Warriner, Director, Walsh Trust, New Zealand
· Roberto Mezzina, Director, WHO Collaborating Centre for Research and Training, MH Dept, ASS n.1
· Theodoros Megaloeconomou, Head of CHMC, Hospital of Dafni, Athens
· Sashi Sashidharan, fomer Medical Director, Birmingham MH NHS Trust, University of Warwick, UK
· Vivienne Miller, TheMHS Conference Director, Sydney, Australia

DSM - Via Weiss 5 - 34128 Trieste - Italy - Tel. (+39) 040 399 7350 Fax (+39) 040 399 7363 - e-mail: dsm@ass1.sanita.fvg.it