It's just not right.
Grumpy old psychiatrist wonders why - and tries things to escape oppression, institutionalisaton, industrialisation of mental health and digital tyranny.
Hopefully by only bending the rules, but never breaking them.
Well, we'll see.
While the fortune of British 'Democratic' therapeutic communities
always seems to be teetering on the brink of oblivion, it seems like the
Sicilian version is going from strength to strength, and with government
backing. They are expanding in all directions: adults, personality
disorder, psychotic illness, homelessness, adolescents, refugees, forensic and
group apartments; properties are also being repossessed by the government from
convicted mafiosi and given over to social enterprises to set up as therapeutic
A thriving network of community-based units already runs a
sophisticated quality network (adapted from 'Community of Communities' at the
Royal College of Psychiatrists) which held its first Annual Forum last year
with twelve members, and is planning its second one (with many more members) at
the end of this year.
The psychiatric authorities in Sicily also want to forge links
with the British ‘Living-Learning Experience’ (LLE) therapeutic community
which has been essential TC training in the UK for nearly twenty years now.
This has involved close liaison with the British ‘Living and Learning’ team,
which already includes two Italians and another Italian-speaking therapist
The "regional psychiatric authorities"
Numerous LLEs have been held in Sicily since 1999, twice at Erice,
in Caltanisetta, Partenico, and with two based on a converted fishing boat in
Trapani(for training new British
personality disorder teams, one from Oxford and one from Nottingham). A formal one-day
event, organised by the regional psychiatric authorities, was held in Piazza
Armerina, for about a hundred delegates, in 2008. After much work developing
their clinical model of therapeutic ‘community in the community’ practice, this
was followed by the first LLE for Sicily’s new therapeutic communities at
Caltagirone in 2013, and a second one last weekend at Altavilla Milicia, near
The setting was a 50-bedroom monastery with one monk, looking out
at the sea on one side and the mountains on the other, sat in the middle of a
large garden filled with lemon and orange trees, and olive groves. We had the
venue to ourselves: the guest rooms were converted monastic cells, and the
group rooms were normally for lectures and seminars, from which we carefully
removed various Catholic artifacts and set the chairs in circles.
The monastery with one monk
We started the workshop as always, with the staff (six of us this
time) meeting for a team meal, the night before the participants arrived. This ensures
good ‘team bonding’ and was particularly important for this workshop, as some
of the staff had not worked together before. It also allows us to relax and
unwind after our various journeys.
The 19 delegates started arriving a little before midday on
Thursday, while the staff team was preparing lunch, Sicilian-style. This was
the first of several culinary extravaganzas, subsequently effortlessly prepared
and elegantly presented by various groups of delegates. The show was on the road!
Apart from the usual community meetings and small groups, we were all involved
in numerous games, activities and fun – although my own linguistic deficiency (non parlo l’italiano!) left me almost
entirely in the dark about what we were doing until we actually did it. But
everybody seemed to get a great deal out of the experience – and one of the
Italian staff took a video of everybody’s evaluation and feedback – see
After we had all said our goodbyes, the team went to meet a Professor
of Psychology at Palermo University – who is helping the research and
development project for TCs. We learned of how all Sicilian forensic mental health
facilities are to be closed, and the service users transferred to the
day-to-day care of social cooperatives (while remaining under the supervision
of government-employed psychiatrists). These cooperatives are to be run as TCs –
about four of them residential, with fifty places, and the rest – for people
less likely to be a danger to others – will be non-residential community
We also heard of how the TC standards for Children and Young
People have been translated into Italian, and are being used for quality
assurance and improvement. We left feeling excited about all the action going
on in Sicily – and perhaps a little regretful that therapeutic communities back
home do not enjoy the same level of formal and organisational support.
But it should give a good opportunity for plenty of future
cooperation and collaboration for training, research and service development in
the Sicilian sunshine!