Sunday, 23 March 2014

Therapeutic Communities in Sicily

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 communities.

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 training ( 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 (from Uruguay).
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 Palermo.

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 places.

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! 

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