Heart Forward Conversations from the Heart

The U.S. Mental Health System seen through an international lens: A Conversation with Dr. Roberto Mezzina (Trieste) and Dr. S.R. Sashidharan (Glasgow)

December 11, 2020 Season 1 Episode 9
Heart Forward Conversations from the Heart
The U.S. Mental Health System seen through an international lens: A Conversation with Dr. Roberto Mezzina (Trieste) and Dr. S.R. Sashidharan (Glasgow)
Show Notes

 There is much to be gleaned from this very rare opportunity to have two extremely thoughtful and committed psychiatrists in the same Zoom room.    Dr. Roberto Mezzina joins from Trieste Italy where he served for 40 years in the Dipartimento di Salute Mentale, and most recently headed their world-renowned mental health system.  Dr. S.P. Sashidharan calls in from Glasgow  and both were part of a small delegation invited to Los Angeles in September 2018 to tour our systems as part of a collaboration between Trieste and Los Angeles County.

Before they share recollections from that Los Angeles visit, Roberto and Sashi describe their early career and how they discovered Trieste as young psychiatrists in the 70’s.  Roberto had the opportunity to work alongside the visionary Dr. Franco Basaglia as he crusaded to close the asylums in Italy and create the community-based system of care.  

You will hear about how the Trieste system is recognized by the World Health Organization and learn about the commitment to human rights in their approach to care.  In Trieste, there are no locked doors and no reliance upon restraints.   They believe la libertà è terapeutica– freedom is therapeutic.  

Listening to this from an American context will be challenging because their views sound almost radical given the human-centered approach.  Sashi will raise the notion of an “Anglo-American blind spot” insofar as how psychiatry is viewed.  As he says, “we have become inured to our practices which constantly and repeatedly deny people of their liberties.”

Sashi and Roberto will describe their experience seeing restraints used in the psychiatric hospital and the shock of walking through Skid Row (described by Roberto as an “open air asylum”) in one of the richest nations in the world.  But most compelling is their reaction to the plight of mentally ill inmates chained to furniture at L.A. County Twin Towers.  

Yet, they have not given up on us, and continue to offer encouragement.  They saw bright spots during that week which are referenced:  in particular Anthony Ruffin and the L.A County DMH HOME Team, the Downtown Woman’s Center and The Center in Hollywood (recalled as the “Sacramento Center” by Sashi).  They were impressed by the compassion and expertise demonstrated by the Mental Evaluation Units for both the Los Angeles Police Department and Los Angeles Sheriff’s Department.  They call out the leadership of Dr. Jonathan Sherin, embracing the values of change as head of the county’s mental health department.

 Guests:
Dr. Roberto Mezzina, International School Franca and Franco Basaglia and former director of the WHO Collaborating Centre, DSM, Trieste, Italy.

Dr. S.P. Sashidharan, Institute of Health and Well Being, University of Glasgow.

 Resources

The Man Who Closed the Asylums, by John Foot

 Trailer to movie about Dr. Franco Basaglia

C'era una volta la città dei matti  (Once upon a time there was a city of the crazy people)

Note:  there are subtitled versions available

 

Information about September 2018 trip to Los Angeles and evolution of the partnership between LA County and Trieste.