Forty years after the approval of the Law 180 (the Italian Mental Health Act of 1978) and the initial triumphalism, the outcomes of this law are not fully satisfactory. This judgment stems from the vast disparities - in provision and quality of psychiatric community care - that persist in the country, after more than half a century of ‘anti-mental hospital’ practices. However, no other country in the world has achieved similar results with such limited investments. The Mental Health Act of 1978 revolutionized Italian psychiatric care through the creation of an extended network of community mental health services. To implement this reform Italy devoted only 3.5% of the National Health Fund to mental health, as opposed to 10% and more in France, Germany and the United Kingdom. Furthermore, health cuts, restrictions on staff turnover and the merging of local health units generated problematic working conditions not in line with community mental health principles. Mental health departments thus risk nowadays to offer mainly pharmacological treatment with few psychotherapeutic and social inclusion interventions. The data reported by the author reveal that the Italian Mental Health Act of 1978 generated a revolution in mental health care, nonetheless consistent regional inequalities persist, i.e. in the capacity of services to intercept psychic distress or provide essential levels of care that respect guideline standards. The goal of Italian mental health services, for the next 40 years, is to guarantee, throughout the country, the right to mental health treatment with standardised practices and social inclusion.
Keywords: Law 180, community psychiatry, inequalities, epidemiology